*look OVER*CH94: Antiviral Agents II Drugs for HIV infection & Related Opportunistic Infections

A patient receiving HAART develops a sore throat and cough. The nurse should consult the prescriber immediately if the therapy includes which drug? a. Abacavir (Ziagen) b. Didanosine (Videx) c. Stavudine (Zerit) d. Zidovudine (Retrovir)

a. Abacavir (Ziagen)

---------Maraviroc

a. Binds with CCR5, thereby blocking viral entry into CD4 cells.

What are known adverse effects of raltegravir (Isentress)? (Select all that apply.) a. Facial edema and angioedema b. Flulike symptoms c. Loss of bone density d. Painful rash that blisters followed by shedding of the epidermis e. Teratogenesis

a. Facial edema and angioedema b. Flulike symptoms d. Painful rash that blisters followed by shedding of the epidermis

What is the most important role of the nurse when treatment failure occurs? a. Identifying factors that may have contributed to treatment failure b. Identifying the patient's immune status c. Supporting the patient emotionally d. Teaching the new drug regimen

a. Identifying factors that may have contributed to treatment failure

Patients who are prescribed protease inhibitors (PI) should be instructed to not self-prescribe the herbal product St. John's wort. What is the possible effect of this combination? a. Increase in metabolism & excretion of the PI b. Increase in likelihood of suicidal ideation c. Increase in likelihood of toxicity from the PI d. MAO inhibitor effects of the St. John's wort

a. Increase in metabolism & excretion of the PI

Which action, when administering enfuvirtide (Fuzeon), would increase the risk of a severe injection-site reaction? a. Injecting the drug deep into muscle b. Not adequately cleaning the injection site. c. Reconstituting the drug in sterile water. d. Refrigerating the solution for 2 hours after reconstituting.

a. Injecting the drug deep into muscle

The prescriber has informed a patient who has been prescribed a nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) of the risk of hepatic steatosis. The patient asks the nurse "What is hepatic steatosis. The nurse should explain that this is a possible severe adverse effect involving a. fatty degeneration of the liver. b. increased secretions of glands. c. infection of the liver. d. stools that are foamy and float

a. fatty degeneration of the liver.

Principles of treating HIV-seropositive pregnant women include (Select all that apply.) a. prophylaxis is recommended for the infant/neonate b. benefits of treatment normally outweigh risks. c. HAART should not be used during pregnancy. d. the drugs are not teratogenic. e. the drug regimen should only include one drug at a time.

a. prophylaxis is recommended for the infant/neonate b. benefits of treatment normally outweigh risks.

A patient has received instructions regarding administration of didanosine (Videx EC). Which statement made by the patient would indicate the patient understood the directions? a. "I can sprinkle the powder on applesauce." b. "I need to notify the prescriber if I cannot swallow this capsule whole." c. "I should keep the medicine in my bathroom medicine cabinet so I remember to take it every morning." d. "I should take this drug with meals."

b. "I need to notify the prescriber if I cannot swallow this capsule whole."

*A patient who is prescribed highly active antiretroviral therapy (HARRT) including rilpivirine reports loss of interest in usual activities. Which nursing action is of greatest priority? a. Asking about difficulties complying with therapy b. Assessing for thoughts of harming self. c. Identifying reasons for loss of interest d. Providing a safe environment

b. Assessing for thoughts of harming self. (Rilpivirine can cause depression. Instruct patients to contact the provider immediately if they start feeling sad, hopeless, or suicidal.)

*An HIV-positive patient is prescribed trimethoprim-sulfamethoxazole for a urinary tract infection (UTI). A priority nursing action is to monitor which laboratory test(s)? (Select all that apply.) a. AST & ALT b. BUN & creatinine c. CBC and differential d. Electrolytes e. Lipids f. PT & INR

b. BUN & creatinine c. CBC & Differential (Trimethoprim- sulfamethoxazole has been associated with thrombocytopenia, leukopenia, and neutropenia; it has also been associated with kidney failure, and elevated BUN/creatinine.)

---------Enfuvirtide

b. Prevents the HIV envelope from fusing with the cell membrane of CD4 cells, thereby blocking viral entry and replication.

The nurse is teaching a patient about the need for if made by the patient, would indicate a need for further teaching? a. "If I don't take all of the drugs as prescribed, the virus is more likely to become resistant to drugs." b. "The higher the number of viruses in my body, the greater the chance one will become resistant." c. "The virus recognizes the antibiotic and is able to change to prevent being destroyed." d. "When the HIV is changing RNA into DNA within the host cell, genetic changes can occur spontaneously."

c. "The virus recognizes the antibiotic and is able to change to prevent being destroyed."

Current recommendations state that antiretroviral therapy for patients with chronic asymptomatic HIV disease should start when the CD4 count drops below what level? a. 200 cells/mm3 b. 350 cells/mm3 c. 500 cells/mm3 d. 850 cells/mm3

c. 500 cells/mm3

What is not a known reaction if a patient who is taking the oral solution of lopinavir/ritonavir is also prescribed metronidazole (Flagyl)? a. Difficulty breathing b. Headache c. Hypertension d. Nausea and vomiting

c. Hypertension

Which assessment finding would best indicate that HAART is currently effective? a. CD4 T count 400 cells/mm3 b. Neutrophils 2750/mm3 c. Plasma HIV RNA below 20-75 copies/ml d. WBC 5000/mm3

c. Plasma HIV RNA below 20-75 copies/ml

When planning nursing interventions and teaching for the most common adverse effects of efavirenz (Sustiva), which nursing problem should be the focus for the nurse? a. Circulation b. Nutrition c. Safety d. Skin integrity

c. Safety

---------Zidovudine

c. Suppresses synthesis of viral DNA, thereby blocking growth of the viral DNA strand.

An HIV-positive patient who has recently been prescribed HAART, including NNRTI efavirenz, calls the prescriber's office and reports experiencing drowsiness and dizziness. An appropriate recommendation by the telephone triage nurse is for the patient to do what? a. Discontinue all drugs and make an appointment to be seen as soon as possible. b. Discontinue taking efavirenz, but continue the other drugs in the regimen. c. Use safety precautions and take efavirenz at bedtime d. Use safety precautions and take efavirenz with food.

c. Use safety precautions and take efavirenz at bedtime

---------Efavirenz

d. Binds directly to HIV reverse transcriptase disrupting the active center of the enzyme, thereby suppressing enzyme activity.

The nurse would be most concerned that a patient may not adhere to HAART therapy with which class of antiviral drugs if the patient verbalized that body image is an important priority? a. fusion inhibitor. b. Nucleoside/nucleotide reverse transcriptase (NRTI) c. Nonnucleoside reverse transcriptase inhibitor (NNRTI) d. Protease inhibitor (PI)

d. Protease inhibitor (PI) (Use of PIs has been associated with redistribution of body fat, sometimes referred to as lipodystrophy syndrome or pseudo-Cushing's syndrome. Fat accumulates in the abdomen ["protease paunch"] in the breasts of men and women, and between the shoulder blades ["buffalo hump"]. Fat is lost from the face, arms, buttocks, and legs. Leg and arm veins become prominent.)

Which drug must be taken 12 hours apart from rilpivirine? a. Buffered aspirin (Bufferin) b. Calcium carbonate (TUMS) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

d. Ranitidine (Zantac)

When emptying a urinal from an HIV-seropositive patient, the nurse splashes urine on intact skin. What should the nurse do? a. Go to the emergency department (ED) at the end of the shift for bloodwork. b. Immediately go to the ED for initiation of post-exposure prophylaxis (PEP). c. Make an appointment with a primary care provider to discuss if postexposure prophylaxis (PEP) is appropriate d. Report the incident immediately to a supervisor.

d. Report the incident immediately to a supervisor.

The nurse is aware that the HIV-seropositive community often share the belief that garlic supplementation decreases HIV reproduction & boosts the immune system. This belief can be particularly dangerous if the patient is prescribed which drug? a. Indinavir b. Lopinavir c. Nelfinavir d. Saquinavir

d. Saquinavir

A hospitalized HIV-positive patient who is prescribed indinavir (Crixivan) complains of sharp, colicky flank pain. In addition to notifying the prescriber, which nursing intervention would be most appropriate? a. Assess bowel sounds. b. Elevate the head of the bed. c. Increase VS to every 4 hours. d. Strain urine.

d. Strain urine.

Which nursing assessment finding would be most significant if a patient was receiving didanosine? a. Flatulence b. Headache c. Itching d. Vomiting

d. Vomiting

An HIV-positive patient who is receiving HAART including maraviroc (Selzentry), reports to the nurse that he has vomited and is experiencing severe abdominal pain. Assessment reveals a generalized pruritic rash. Which action is appropriate? a. Obtain an order for diphenhydramine (Benadryl) for the itching. b. Withhold all prescribed drugs and contact the prescriber. c. Withhold all food and fluids until the source of the abdominal pain is identified. d. Withhold the maraviroc (Selzentry) and contact the prescriber.

d. Withhold the maraviroc (Selzentry) and contact the prescriber.

*It would be of greatest priority to consult the prescriber of enfuvirtide (Fuzeon) if the patient experienced a. headache. b. pain and tenderness at injection site. c. positive pregnancy test. d. muscle weakness in legs and arms.

d. muscle weakness in legs and arms. (Enfuvirtide has also been associated with Guillain-Barré syndrome.)

Weight-bearing exercise and adequate calcium intake are most important if HAART includes a a. fusion inhibitor. b. nucleoside/nucleotide reverse transcriptase (NRTI) c. nonnucleoside reverse transcriptase inhibitor (NNRTI) d. protease inhibitor (PI)

d. protease inhibitor (PI)

When a patient who is receiving nevirapine (Viramune) or delavirdine (Rescriptor) complains of conjunctivitis or muscle and joint pain, it would be a priority to assess for a. dizziness. b. nausea. c. paresthesias. d. rash.

d. rash. (The most common adverse effect is rash; for most patients, the rash is benign. However, if the patient experiences severe rash or rash associated with fever, blistering, oral lesions, conjunctivitis, muscle pain, or joint pain, nevirapine should be withdrawn, because these symptoms may indicate development of erythema multiforme or Stevens-Johnson syndrome.)

---------Raltegravir

e. Prevents insertion of HIV DNA genetic material into the DNA of CD4 cells, thereby stopping HIV replication

---------Ritonavir

f. Inhibits CYP3A4 metabolism, thereby raising lopinavir levels and enhancing antiviral actions.