Ch 10: AntiViral Agents PrepU (Pharm Exam 2)

A client with viral pneumonia asks when antibiotic medications will be prescribed. Which response will the nurse make to the client? "The provider is determining which would be the best for you." "Antibiotics are not used to treat viral infections." "The medication has to be obtained from another pharmacy." "The exact antibiotic has not yet been determined from your sputum sample."

"Antibiotics are not used to treat viral infections." Explanation: Viruses can cause a variety of illnesses, including pneumonia. Because a virus needs a host cell to replicate, a virus enters the body cell and then alters the function and activity of the infected cell. The cell infected with the virus eventually dies but more of the virus is released to invade and infect other cells. Because viruses are within human cells in the body, it is difficulty to develop drugs to destroy the virus without harming the body. This is the reason there are few drugs to treat viral infections and antibiotics are not used to treat viral infections. The medication to treat the client's condition does not need to be obtained from another pharmacy. The provider is not determining the best medication for the client. Antibiotics are not going to be determined from the client's sputum sample because the diagnosis of viral pneumonia has already been made.

The nursing instructor has been teaching about antivirals, actions and effects. The instructor realizes that a student needs further instruction when the student makes which statement? "Antiviral drugs will not prevent the spread of the disease to others." "Topical antivirals should not be applied more frequently than prescribed." "When applying a topical antiviral, the nurse should use a finger cot or gloves." "Antivirals are the cure for viral infections."

"Antivirals are the cure for viral infections." Explanation: Antiviral drugs are not a cure for viral infections, but they will shorten the course of disease outbreaks and promote healing of the lesions. All of the other statements are true.

A nurse is caring for a client hospitalized with AIDS. The family comes to visit and a family member asks the nurse about safety when visiting the client. What is the best response from the nurse? "HIV is commonly transmitted by contact with blood and body fluids." "The client should be isolated and have limited visitation." "Why do you think you are at risk?" "Don't worry, you will not contract the disease from the client."

"HIV is commonly transmitted by contact with blood and body fluids." Explanation: HIV infection is commonly transmitted by contact with blood and body fluids. A client who is infected with HIV should refrain from unprotected oral sex, use a condom with a water-soluble lubricant, and be aware of the potential risk of infection to an unborn child. Sharing a cigarette is not a risk factor for contracting HIV. As the disease progresses, the client may develop AIDS.

The nurse is teaching a male client with HIV about his new antiviral drug regimen. Which client statement would suggest that the teaching plan was effective? "I will have to remain on this drug regimen until I have been cured." "I should expect some nausea and vomiting." "I should start taking herbal supplements to meet my nutritional needs." "If I miss a dose, I should double the next dose to make up for it."

"I should expect some nausea and vomiting." Explanation: Nausea, vomiting, diarrhea, and anorexia are common adverse effects of antiviral drugs. Effective therapy relies on adherence to the prescribed dosing schedule; although clients should avoid missing doses, they should not take additional doses to make up for those they missed. Clients should not take other medications or supplements without first speaking with the health care provider. Antiviral drugs may relieve the symptoms of HIV, but they will not cure the disease.

An adult client is being treated for genital herpes with acyclovir. Which client statement indicates a need for further health education? "I'm glad that there something I can take that will help to heal my lesions." "It's a relief to know that this drug will stop me from spreading the infection." "I know that this medication doesn't guarantee the infection won't return." "I was happy to learn that there aren't that many side effects of this drug."

"It's a relief to know that this drug will stop me from spreading the infection." Explanation: Acyclovir decreases viral shedding as well as the duration of skin lesions and pain. Acyclovir does not eliminate inactive virus in the body and thus does not prevent recurrence of the disease unless oral drug therapy is continued. It does not prevent the spread of the disease. There are comparatively few adverse effects of acyclovir.

A 23-year-old client is prescribed zidovudine for treatment of human immunodeficiency virus (HIV). Which statement indicates that the client has understood the client teaching regarding the action of this medication? "Zidovudine therapy may result in the development of resistant strains." "Zidovudine inactivates the virus and prevents recurrence of the disease." "Zidovudine prevents the occurrence of opportunistic infections." "Zidovudine slows the progression of the disease but does not cure it."

"Zidovudine slows the progression of the disease but does not cure it." Explanation: Zidovudine slows the progression of the disease but does not cure the disease. Zidovudine does not inactivate the virus, result in resistant strains, or prevent the occurrence of opportunistic infections.

A client comes to the health care facility reporting flulike symptoms. After a thorough assessment, the client is diagnosed with influenza and is to receive oseltamivir. The nurse understands that this drug has been prescribed because the client been symptomatic for less than: 4 days. 6 days. 8 days. 2 days.

2 days. Explanation: Oseltamivir is used as treatment for influenza if the client has been symptomatic for fewer than 2 days.

A nurse is preparing to administer IV acyclovir to a client diagnosed with a herpes simplex viral infection. The health care provider has ordered 5 mg/kg every 8h. The client weighs 60 kg. How much medication will the nurse administer per dose? 900 mg 300 mg 1200 mg 600 mg

300 mg Explanation: Each dose will contain 300 mg of acyclovir. (60 kg × 5 mg/kg = 300 mg.)

For which clients would treatment with acyclovir be most clearly indicated? A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection A 44-year-old intravenous drug user who has been diagnosed with hepatitis C virus (HCV) A man who contracted hepatitis A virus (HAV) while on a tropical vacation A 2-month-old infant brought to the emergency department with signs of respiratory syncytial virus (RSV)

A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection Explanation: Acyclovir is indicated for the treatment of herpes viruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV; it is not effective against hepatitis or RSV.

To prevent viral infections, what precaution should the general public take? Become vaccinated against prevalent virus infections. Use intermittent hand hygiene. Wear personal protective equipment. Wear masks.

Become vaccinated against prevalent virus infections. Explanation: Vaccinations, avoiding contact with people who have viral infections, and thorough hand hygiene are effective ways to prevent viral infections.

The nurse is caring for a client who is HIV positive. What laboratory test is used to determine this client's ability to fight against viral infections? AST CD4 RBCs BUN

CD4 Explanation: The CD4 count is the laboratory test used to determine a client's ability to fight against infections in a client with HIV. A BUN measures kidney function, an AST monitors liver function, and RBCs monitor the number of red blood cells that a client has. None of these measures will give information about the client's ability to fight infection.

A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient? Didanosine therapy once daily Combination antiretroviral therapy Zidovudine therapy once daily Monotherapy protease inhibitor therapy

Combination antiretroviral therapy Explanation: People with acute primary HIV infection should be treated with combination antiretroviral therapy to suppress virus replication to levels below the limit of detection of sensitive plasma HIV RNA assays.

A client has been treated with abacavir for the past 6 weeks. The client contacts the physician's office with reports of diarrhea, abdominal pain, sore throat, cough, and shortness of breath. Which is the appropriate action to take for this situation? Administer the drug at bedtime. Discontinue the therapy and then reintroduce it. Discontinue the therapy. Reduce the dose.

Discontinue the therapy. Explanation: Hypersensitivity is a common adverse effect of abacavir that usually appears within 6 weeks of beginning therapy. Abacavir treatment should be discontinued if any signs of hypersensitivity occur. Reintroducing the drug after a hypersensitivity reaction may result in fatal hypotension and is therefore not advised. Reducing the dose and administration of the drug at bedtime will not minimize this adverse effect.

There are many antiviral medications on the market. What is the clinical reason for this? Each medication is only effective against a small number of specific viral infections. The client can help in the decision of which medication based on his or her insurance plan's coverage. Each medication is effective against a large number of viral infections. It gives the provider many choices as to which medication can be prescribed.

Each medication is only effective against a small number of specific viral infections. Explanation: Antiviral drugs have limited use because each one is effective against a small number of specific viral infections, so different drugs are needed for different types of viral infections.

A client with active AIDS is infected with a retrovirus. This virus is better known as which? HIV DSV HSV CMV

HIV Explanation: HIV, the virus that causes acquired immunodeficiency syndrome (AIDS), is a retrovirus. CMV stands for cytomegalovirus. HSV refers to herpes simplex virus. DSV is a distractor for this question.

An elderly client is admitted to the medical floor with a fever, body aches and cough. What virus should the nurse suspect this client to have? Herpes simplex Herpes zoster Influenza CMV

Influenza Explanation: Influenza is commonly called the "flu" and is an acute respiratory illness. Symptoms include fever, runny nose, cough, body aches, sore throat, and stuffy nose. CMV frequently has no symptoms but can include malaise, fever, pneumonia, and superinfection. Herpes simplex is a virus causing oral, ocular, or facial infections. Herpes zoster is the same as shingles and is characterized by pustules along a sensory nerve route.

A patient with chronic hepatitis B (HBV) infection is scheduled to begin a new treatment regimen that will include adefovir dipivoxil. What assessments should be prioritized before the initiation of this drug treatment? Cardiac stress test and blood cultures Pulmonary function testing and echocardiogram Liver function testing and HIV testing Complete blood count and prothrombin time (PT)

Liver function testing and HIV testing Explanation: HIV testing should be offered to all patients prior to initiation of adefovir therapy and analysis of hepatic function should be performed, both in light of potential adverse drug effects and the etiology or HBV itself. Cardiac and pulmonary testing are not indicated and assessment of coagulation is not a priority. A CBC would be performed, but liver function would be a priority assessment.

A client has sought care from the primary health care provider after "feeling under the weather" for several days. What signs and symptoms would support the presence of a viral infection? Select all that apply. Malaise Headache Fever Idiopathic bleeding Increased white cell count

Malaise Fever Headache Explanation: Symptoms usually associated with acute viral infections include fever, headache, cough, malaise, muscle pain, nausea and vomiting, diarrhea, insomnia, and photophobia. White blood cell counts usually remain normal since these cells are active in bacterial infections, and bleeding is uncharacteristic.

How is the risk of renal impairment best minimized when foscarnet is administered? Stopping the drug if creatinine clearance drops to less than 0.2 mL/min/kg Monitoring renal function at least every 2 to 3 months during maintenance therapy Placing the client on fluid restriction Monitoring renal function two or three times weekly during induction

Monitoring renal function two or three times weekly during induction Explanation: When foscarnet is administered, renal impairment may be minimized by monitoring renal function (e.g., at baseline; two or three times weekly during induction; at least every 1 or 2 weeks during maintenance therapy) and reducing dosage accordingly. The drug should be stopped if creatinine clearance drops to less than 0.4 mL/ min/kg. Adequate hydration should also be maintained throughout the course of drug therapy.

A nurse is preparing to administer famciclovir to a client with a herpes virus infection. The nurse should expect to administer this drug by which route? Subcutaneous Oral Intravenous Intramuscular

Oral Explanation: Famciclovir is administered orally.

In which of the following patients is the use of cidofovir contraindicated? Patients with renal impairment Patients with low blood cell counts Patients with cardiac disease Patients with history of epilepsy

Patients with renal impairment Explanation: Patients with renal impairment should not be given cidofovir. Ribavirin is contraindicated in patients with cardiac disease. Antivirals should be used cautiously in patients with low blood cell counts. The nurse should also be very careful while administering rimantadine to patients who have a history of epilepsy.

A HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. Which of the following symptoms should the nurse monitor for and immediately report to the care provider? Peripheral neuropathy Headache Taste alteration Excoriation

Peripheral neuropathy Explanation: The nurse should immediately report symptoms of peripheral neuropathy to the care provider. Headache and taste alteration are some of the mild adverse effects of the drug and are not cause for immediate concern. Excoriation is an adverse effect of imiquimod and does not occur in patients being administered didanosine.

When providing care to a client with a viral infection, the nurse knows that ribavirin (Virazole) for inhalation is used to treat which virus? RSV HIV RVS AIDS

RSV Explanation: Ribavirin is an antiviral used to treat RSV. AIDS is not a virus; it is the condition caused by HIV.

A patient being treated for HIV with saquinavir informs the nurse they he has been "suffering from depression" and taking St. John's wort to help. What is important for the nurse to discuss with this patient? Informing the health care provider if any bleeding or bruising is observed when taking the St. John's wort Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir Taking St. John's wort only as directed by the manufacturer to decrease the toxic effects Reporting to the health care provider if any yellowing of the eyes or skin develops

Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir Explanation: St. John's wort induces metabolism of saquinavir, resulting in decreased efficacy. The nurse should monitor for opportunistic infections and advise the patient to refrain from the use of St. John's wort

The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug should the nurse expect the pediatrician to order? Zanamivir Oseltamivir Ribavirin Rimantadine

Ribavirin Explanation: Ribavirin is indicated for the treatment of influenza A infections and RSV infection in children. Rimantadine is used to treat and prevent influenza A infections. Zanamivir is approved for treatment and prevention of uncomplicated influenza infections in adults and children over age 7 years who have been symptomatic for less than 2 days. Oseltamivir is used for the treatment and prevention of uncomplicated influenza for clients who are symptomatic for less than 2 days.

A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient? Serum alanine aminotransferase and bilirubin Arterial blood gases and O2 saturation Urine specific gravity and urine pH A fasting blood sugar and 2 hour post prandial blood sugar

Serum alanine aminotransferase and bilirubin Explanation: Serum alanine aminotransferase and bilirubin are monitored when a protease inhibitor is used and indicates if hepatic function is being affected. Protease inhibitors are metabolized in the liver and partially by the cytochrome P450 oxidase system. Although there have been some cases of kidney stones related to protease inhibitors use, the greatest risk is to the liver and therefore urine specific gravity and urine pH, which indicate renal function would be less critical to access. Lab tests for blood sugar and arterial blood gases would not be directly affected by hepatic function.

A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client? The client will be cured of the viral infection. The client will no longer be able to transmit the infection to others. The client will experience recurrences but milder symptoms. The client will experience fewer recurrences.

The client will experience fewer recurrences. Explanation: Acyclovir and other antiviral medications can be prescribed to reduce the lesions, pain, and itching associated with herpes simplex infections. When administered as prophylaxis, treatment results in fewer recurrences. However, the drugs do not cure infection or prevent its transmission.

A 42-year-old client, diagnosed with human immunodeficiency virus (HIV), has been receiving antiretroviral therapy for several years. Recently, raltegravir was added to the drug regimen. When assessing the success of this addition to the treatment, the nurse should prioritize which laboratory value? The client's CD4 count The client's viral load The client's erythrocyte sedimentation rate (ESR) The client's C-reactive protein levels

The client's CD4 count Explanation: The nurse assesses for an increase in T-helper CD4 cells. The CD4 count measures the ability to fight against infections. CD4 count is more important than viral load in this regard. CRP levels and ESR do not reflect the client's immune function.

A client with HIV is frustrated by the size and complexity of the current medication regimen. What should the nurse teach the client about combination therapy for the treatment of HIV? The client's immune response is enhanced with multiple drugs. One drug combats the virus while the others are prescribed to diminish the adverse effects. Use of multiple drugs ensures sensitivity to various viral forms. Use of combination therapy attacks the virus at different stages of the life cycle.

Use of combination therapy attacks the virus at different stages of the life cycle. Explanation: Because HIV mutates over time, combination therapy is effective in attacking the virus at various points in the life cycle to achieve maximum therapeutic effect with the least amount of toxicity. Sensitivity is not a reason for using combination therapy. The use of combination therapy can increase the client's risk for adverse effects. The use of combination therapy can increase the client's risk for adverse effects.

Place the stages of the replication cycle of a virus in the correct order: Virus sheds its coat Assembly of new virions and Host cell dies releasing virus to move to other cells Viral nucleic acids replicate Virus adheres to host cell surface Synthesis of viral protein capsid Virus enters host cell by pinocytosis

Virus adheres to host cell surface Virus enters host cell by pinocytosis Virus sheds its coat Viral nucleic acids replicate Synthesis of viral protein capsid Assembly of new virions and Host cell dies releasing virus to move to other cells Explanation: A single virus particle is composed of a piece of DNA or RNA inside a protein coat. To carry on any metabolic processes, including replication, a virus must enter a cell. Once a virus has fused with a cell wall and injected its DNA or RNA into the host cell, that cell is altered—that is, it is "programmed" to control the metabolic processes that the virus needs to survive. The virus, including the protein coat, replicates in the host cell. When the host cell can no longer carry out its own metabolic functions because of the viral invader, the host cell dies and releases the new viruses into the body to invade other cells.

The nursing student asks the instructor why it is more difficult to develop antiviral drugs than anti-infectives. The nursing instructor's best reply would be which? Viruses are large, and it is hard to keep them contained. Viruses are tiny and replicate inside cells. Viruses are large and normally reproduce outside of the cell. Viruses are tiny and it is hard to keep them contained.

Viruses are tiny and replicate inside cells. Explanation: Antiviral medications are limited in their ability to treat viral infections because viruses are tiny and replicate inside cells, changing how cells work, depending on the type of cell invaded. In comparison, a bacterial organism is relatively large and commonly reproduces outside of cells. This makes antiviral drugs more difficult to develop.

A female HIV-positive patient with a high CD4 count has been taking nevirapine (Viramune) for 9 weeks. What clinical manifestations indicate to the nurse that the patient is having complications from this medication? Decreased urine output and thirst Constipation and nausea Nausea and headache Yellow sclera and hepatomegaly

Yellow sclera and hepatomegaly Explanation: Severe, life-threatening and in some cases fatal hepatotoxicity, particularly in the first 18 weeks, has been reported in patients treated with nevirapine. In some cases, patients presented with nonspecific prodromal signs or symptoms of hepatitis and progressed to hepatitis. Female gender and patients with higher CD4 counts at initiation of therapy are increased risk factors for this complication.

A client who is positive for human immunodeficiency virus (HIV) is prescribed the protease inhibitor atazanavir. Which laboratory test will the nurse anticipate being prescribed before the client receives a dose of the medication? blood urea nitrogen (BUN) creatinine hemoglobin and hematocrit liver function tests

liver function tests Explanation: Protease inhibitors block protease activity within the HIV virus. Protease is needed for the maturation of an infectious virus. Without it, an HIV particle is unable to mature and infect other cells. Because atazanavir is metabolized in the liver, it is not recommended for clients with impaired hepatic function. Liver function tests would most likely be done before the client receives a dose of the medication. Creatinine and BUN are tests to assess for kidney function. There is no reason for hemoglobin and hematocrit to be evaluated before providing the client with a dose of atazanavir.