Pharm Chapter 10 - Antiviral Agents

SATA. The nurse is caring for a pt with a new diagnosis of HIV. The pt underwent testing as a screening process and is currently asymptomatic. The provider orders a combination of antiviral medications to prevent progression of the disease to AIDS. What teaching points should the nurse include in the teaching plan for the pt? A) The schedule for when to take medications B) Avoiding driving or operating heavy machinery initially C) Scheduling medications to allow for 8 hours of uninterrupted sleep D) Reporting nausea, vomiting, and diarrhea immediately E) The importance of seeing the health provider regularly

A B E

A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of longterm antiretroviral therapy? (Select all that apply.) a. Lipodystrophy b. Liver damage c. Kaposi's sarcoma d. Osteoporosis e. Type 2 diabetes

ANS: A, B, D, E Anti-HIV drugs produce strain on the liver and may result in liver disease. A major adverse effect of protease inhibitors is lipid abnormalities, including lipodystrophy, or redistribution of fat stores under the skin. In addition, dyslipidemias such as hypertriglyceridemia can occur, and insulin resistance and type 2 diabetes symptoms can result. The increase in long-term antiretroviral drug therapy due to prolonged disease survival has led to the emergence of another long-term adverse effect associated with these medications—bone demineralization and possible osteoporosis. Kaposi's sarcoma is an opportunistic disease associated with HIV, not a result of long-term drug therapy.

When describing the action of an integrate inhibitor, the nurse understands that this class of drug by what mechanism? A) Blocking the activity of an enzyme in HIV leading to an immature HIV particle B) Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication C) Blocking the receptor site that HIV needs to interact with to enter the cell D) Preventing the growth of viral DNA chain and its insertion into the host DNA

B

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? A.Viruses are large, and it is hard to keep them contained. B. Viruses are tiny and replicate inside cells. C. Viruses are large and normally reproduce outside of the cell. D. Viruses are tiny and it is hard to keep them contained.

B. 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.

In assessing a pt a viral case might be suspected if the pt was diagnosed with: A) Tuberculosis B) Leprosy C) The common cold D) Gonorrhea

C

Naturally occurring substances that are released in the body in response to viral invasion are called: A) Antibodies B) Immunoglobulins C) Interferons D) Interleukins

C

Which of the following would be an important teaching point for the patient receiving an agent to treat herpes virus or CMV? A) Stop taking the drug as soon as the lesions have disappeared B) Sexual intercourse is fine as long as you are taking the drug, you are not contagious C) Drink plenty of fluids to decrease the drug's toxic effects on the kidneys D) There are few if any associated GI adverse effects

C

The physician prescribes Zanamivir to a pt. When developing the teaching plan, the nurse should include what important instruction? A) Take the drug with 8 ounces of water on an empty stomach B) Apply the drug liberally to the cold sores C) Use the special inhaler included with the drug to administer it D) Use a nebulizer to administer the drug via aerosol

C Zanamivir (to treat flu) must be delivered by a Diskhaler device that is supplied with every prescription. Because the drug is inhaled, it would not be impacted by an empty stomach or intake of water. This is not a topical drug but an inhaled medication. Only the special Diskhaler device that is supplied with every prescription can be used to administer the drug, not a nebulizer

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

C. 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.

Which statement regarding antiviral medications is true? A. Antivirals present relatively low risk for toxicity. B. Once antivirals are used, protection lasts for 3 weeks after the last dose. C. Most antivirals temporarily increase viral replication. D. Antivirals do not eliminate existing viruses from tissues.

D. Explanation: Most of these antiviral drugs inhibit viral reproduction but do not eliminate viruses from tissues. In general, available drugs are expensive, relatively toxic, and effective in a limited number of infections. Protection conferred by chemoprophylaxis is immediate but lasts only while the drug is being taken. Antivirals do not increase replication.

Herpes viruses cause a broad range of conditions but have not been identified as the causative agent in: A) Cold sores B) Shingles C) Genital infections D) Leprosy

D

A pt is receiving Tenofovir as part of a therapy regimen for HIV infection. The nurse should provide what teaching related to what the pt may experience? A) It's possible you might have changes in body fat distribution B) Avoid high carbohydrate foods, since your body might have difficulty digesting them C) Occasional pockets of mucus in your stool are expected at the beginning of treatment D) There's a high likelihood of severe hypersensitivity reactions, so take your temperature regularly

A

A nurse is assessing a 66-year-old man who is HIV-positive. The patient has been prescribed didanosine (Videx). It would be most important to question the patient about which of the following? High-calorie diet Alcohol use Activity level Fluid intake

Alcohol use Explanation: Even though it is important for the nurse to assess the patient's diet, activity level, and fluid intake, it is most important to assess the patient's use of alcohol. Two potentially severe adverse effects associated with didanosine are pancreatitis and peripheral neuropathy. Patients who consume alcohol regularly have a higher risk for developing pancreatitis.

A pt with a diagnosis of AIDS had been prescribed Valganciclovir. The nurse should expect that this pt has developed what AIDS-related complication A) Pneumocystis pneumonia B) Kaposi's sarcoma C) CMV retinitis D) Diarrhea

C

A group of nursing students are researching information about antiretroviral agents. They find information about a category of drugs that prevent enzymes from integrating HIV genetic material into the host cell's DNA. The students are reviewing information related to which agents? A. reverse transcriptase inhibitors B. entry inhibitors C. integrase inhibitors D. protease inhibitors

C. Integrase inhibitors prevent enzymes from integrating HIV genetic material into the host cell's DNA. Entry inhibitors prevent the attachment or fusion of HIV to a host cell for initial entry. Reverse transcriptase inhibitors block the reverse transcriptase enzyme so the HIV material cannot change into DNA in the new cell, preventing new HIV copies from being created. Protease inhibitors block the protease enzyme so the new viral particles cannot mature.

After reviewing information about the drugs used to treat herpes virus and CMV infections, a group of students demonstrate understanding about these drugs when they identify what drugs as being available for only intravenous administration? A) Ganciclovir B) Acyclovir C) Famciclovir D) Foscarnet

D Foscarnet is available for intravenous use only. Acyclovir can be given orally or parenterally. Famciclovir is given orally. Ganciclovir is available in oral and IV forms.

True or False: Locally active antiviral agents can be applied to open lesions to control severe symptoms.

False

Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication. True False

False The exact mechanism of action of drugs to treat influenza and respiratory viruses is not known.

A school nurse is talking with a health class of freshman high school students about human immunodeficiency virus (HIV). What patient would the nurse tell the students is at the greatest risk of contracting HIV? Injecting drug user Female homosexual Blood transfusion recipient in 1995 Health care provider

Injecting drug user Risk factors for HIV and acquired immunodeficiency syndrome (AIDS) include being an injecting drug user, male homosexual, heterosexual with an infected partner, and recipient of blood products contaminated with HIV, especially prior to 1985.

Children younger than the age of 12 years should not receive indinavir. True False

True

A pregnant client's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this client? Zidovudine Lamivudine Zalcitabine Tenafovir

Zidovudine Explanation: Only zidovudine has been proven to be safe to administer during pregnancy.

A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." These drugs need to be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are incorrect.

A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment? a. Probenecid has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective. b. The probenecid also prevents replication of the virus. c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir. d. The probenecid reduces the adverse gastrointestinal effects of the cidofovir.

c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are incorrect.

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine (Retrovir). However, the prescriber has decided to stop the zidovudine because of its doselimiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatotoxicity d. Bone marrow suppression

d. Bone marrow suppression Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity. The other options are incorrect.

An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Amantadine (Symmetrel) d. Ribavirin (Virazole)

d. Ribavirin (Virazole) The inhalational form of ribavirin (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed are not used for the treatment of RSV.

The nurse is to administer enfuvirtide (Fuzeon) to a 27-year-old man. After the medication has been reconstituted with sterile water, the nurse will: allow the solution to sit until it dissolves. discard any remaining solution. refrigerate the remaining dose in a syringe. administer the drug at 8-hour intervals.

(For HIV) allow the solution to sit until it dissolves. After reconstituting enfuvirtide with sterile water, the solution should be allowed to sit until the powder dissolves completely, which may be as much as 45 minutes. The remaining dose should be refrigerated in a vial and not in a syringe. Subcutaneous enfuvirtide should be administered at 12-hour intervals.

Place the following stages of the replication cycle of a virus in the correct order. A) Virus sheds its coat B) Assembly of new virions C) Virus enters host cell by pinocytosis D) Host cell dies releasing virus to move to other cells E) Virus adheres to host cell surface F) Synthesis of viral protein capsid G) Viral nucleic acids replicate

1. E 2. C 3. A 4. G 5. F 6. B 7. D

A pt with a diagnosis of HIV has impaired renal function due to a concurrent diagnosis of diabetic nephropathy. What medication is most appropriate to treat this pt's HIV? A) Nelfinavir B) Lopinavir C) Fosamprenavir D) Indinavir

A

Nursing interventions for the patient receiving antiviral drugs for the treatment of HIV probably would include: A) Monitoring renal and hepatic function periodically during therapy B) Administering the drugs just once a day to increase drug effectiveness C) Encouraging the pt to avoid eating if GI upset is severe D) Stopping the drugs and notifying the prescriber if severe rash occurs

A

The pt is prescribed Docosanol to treat a cold sore on the lip. The pt tells the nurse, "I've read some bad things online about the side effects. It is safe to use?" What is the nurse's best response? A) This is a topical medication that is not absorbed into the body, so adverse effects are limited to burning, stinging, or discomfort at the site B) Make sure to avoid using this drug if you are taking St. John's wort because that increases the risk of adverse effects C) Topical medications do not cause any adverse effects because the medication is just applied to the skin and doesn't enter circulation D) It is important to follow directions and do not stop use of this medication to avoid adverse effects

A

A nurse is preparing a presentation for a local community group after media reports about cases of avian influenza in the surrounding region. When explaining the treatment options for avian flu, the nurse should refer what drug? A) Oseltamivir B) Ribavirin C) Rimantadine D) Zanamivir

A Oseltamivir is the only drug approved for use to treat Avian flu

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

A 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.

Which of the following represents the categories of drugs used to treat viral infection? (Select all that apply.) A. Antiretroviral B. Antiviral C. Antiattachment D. Antireplication D. Antitranscription

A & B The drugs used to treat viral infection can be split into two categories: antiviral and antiretroviral agents.

SATA. When explaining to a pt the reasoning behind using combination therapy in the treatment of HIV the nurse would include which of the following points? A) The virus can remain dormant within the T cell for a very long time; It can mutate while in the T cells B) Adverse effects of many of the drugs used to treat this virus include immunosuppression, so the disease could become worse C) The drugs are cheaper if used in combination D) The virus slowly mutates with each generation E) Attacking the virus at many points in its life cycle has been shown to be most effective F) Research has shown that using only one type of drug that targeted only one point in the virus life cycle led to more mutations and more difficulty in controlling the disease

A D E F

SATA. Appropriate nursing diagnoses related to the drug therapy for a pt receiving combination antiviral therapy for the treatment of HIV infection would include the following: A) Disturbed sensory perception related to the CNS effects of the drugs B) Imbalanced nutrition: More than body requirements related to appetite stimulation C) Heart failure related to cardiac effects of the drugs D) Adrenal insufficiency related to endocrine effects of the drugs E) Acute pain related to GI, CNS, or dermatological effects of the drugs F) Deficient knowledge regarding drug therapy

A E F

What should the nurse's assessment of the client prior to administration of antiviral drugs include? (Select all that apply.) A. client's general state of health B. blood glucose C. resistance to infection D. electrocardiogram E. vital signs

A, C, E Explanation: The nurse's pre-administration assessment of the client prior to administration of antiviral drugs should include determination of client's general state of health; resistance to infection; record of client's symptoms; and record of vital signs.

The nurse is reviewing the medication instruction for the client taking acyclovir. Which statement by the client would indicate the need for additional teaching? A. "This medication will maintain the symptoms and cure my disease." B. "I need to complete the full course of therapy as prescribed." C. "I need to contact my health care provider if the lesion turns red." D. "I need to report any rash or itching while taking the medication."

A. Acyclovir does not cure the viral infection; it only decreases the symptoms and severity of the disease. It is important to complete the entire course of therapy. The development of a rash and/or itching can indicate that an allergic reaction is occurring as a result of the medication. The lesion's turning red can indicate a secondary bacterial infection.

What statement made by the patient indicates to the nurse that the patient does not understand the transmission of HIV? A. "As long as I am taking the HAART therapy, I cannot transmit the virus to anyone else." B. "I may transmit the virus to someone if I have unprotected sex." C. "If I have unprotected sex with someone with HIV, I may be re-infected with another strain." D. "I should not breast feed because I can transmit the virus to the baby this way."

A. Explanation: It is important to assess the patient's understanding of HIV transmission and to explain that despite drug therapy, the patient can still transmit HIV to others. In addition, assess the adherence issue. Even when zidovudine is taken exactly as directed, resistance may develop, especially when blood levels are suboptimal.

A client is administered a nucleotide reverse transcriptase inhibitor in combination with a nonnucleotide reverse transcriptase inhibitor. What is the rationale when administering these medications together? A. They have synergistic antiviral effects. B. They facilitate increased adherence to treatment. C. They prevent the development of any opportunistic infections. D. They decrease the length of illness.

A. Because the two types of drugs inhibit reverse transcriptase by different mechanisms, they may have synergistic antiviral effects. A synergistic effect occurs when the effect between two or more substances produce an effect greater than the sum of their individual effects. The use of two medications may decrease compliance because of the burden of taking two medications. Using two medications will not decrease the length of the illness nor will it decrease all opportunistic infections.

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? A. Peripheral neuropathy B. Headache C. Excoriation D. Taste alteration

A. 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.

Antivirals are used to treat infections caused by viruses. In particular, acyclovir is useful to treat which infection? A. Herpes zoster B. Influenza C. Hepatitis A D. RSV

A. Its antiviral spectrum is limited to the herpes viruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV.

A nurse is administering a drug that blocks the protease enzyme so new viral particles cannot mature. Which category of drugs is the nurse most likely administering? A. protease inhibitors B. integrase inhibitors C. entry inhibitors D. reverse transcriptase inhibitors

A. Protease inhibitors block the protease enzyme so new viral particles cannot mature. Reverse transcriptase inhibitors block the reverse transcriptase enzyme so the HIV material cannot change into DNA in the new cell, preventing new HIV copies from being created. Entry inhibitors prevent the attachment or fusion of HIV to a host cell for initial entry. Integrase inhibitors prevent enzymes from inserting HIV genetic material into the cell's DNA.

An elderly female client is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The health care provider prescribes the drug acyclovir (Zovirax). What disease is this client demonstrating? A. Shingles B. Influenza C. Herpes simplex D. CMV

A. The client has herpes zoster virus (shingles). CMV is a virus with symptoms that include malaise, fever, pneumonia, and superinfection. Herpes simplex causes oral, ocular, or facial infections. The influenza virus is commonly called the "flu" and is an acute respiratory illness.

A client who is hospitalized and receiving antiretroviral therapy has a nursing diagnosis of Risk for Injury related to weakness and dizziness. Which would be most appropriate for the nurse to do? A. Provide for frequent rest periods. B. Encourage independent ambulation at least every 2 hours. C. Have the client quickly change positions. D. Place the client's call light behind the client's bed on a table.

A. The nurse should plan activities to provide for adequate rest periods. Having the client change positions quickly would potentiate the dizziness. Independent ambulation should not be encouraged, but ambulation as tolerated with assistance would be the better choice. Placing the call light behind the client increases the risk for falls when the client cannot readily reach the light for assistance.

A patient with AIDS is being prepared for discharge. The nurse caring for the patient with AIDS knows the patient receives Agenerase. What dietary counseling will the nurse provide based upon the patient's medication regimen? Avoid high-fat meals while taking this medication Limit fluid intake to 2 liters a day Limit sodium intake to 2 grams per day. Avoid meals high in protein while taking this medication

Avoid high-fat meals while taking this medication Explanation: Patients taking the protease inhibitor Amprenavir (APV) or Agenerase should be advised to avoid high-fat meals. High-fat meals decrease the blood concentration of this drug by 21%. Patients taking either of these drugs can take the drug with or without regard to meals, but the meals should not be high in fat. Fluid, sodium, and protein restrictions play no role in relation to either of these drugs.

A community health nurse is coordinating care for several pts during a local outbreak of influenza A. For which pt with influenza would treatment with Ribavirin most likely be contraindicated? A) A pt who received the pneumococcal vaccine 14 days ago B) A pregnant pt whose flu symptoms are becoming increasingly severe C) An 11 yr old pt with severe vomiting and diarrhea D) A 90 yr old pt who lives in a long-term care facility and who has multiple comorbidities

B

A nurse is preparing to administer Famciclovir to a pt with a herpes virus infection. The nurse should expect to administer this drug by which route? A) Subcutaneous B) Oral C) Intramuscular D) Intravenous

B

HIV selectively enters which of the following cells? A) B clones B) Helper T cells C) Suppressor T cells D) Cytotoxic T cells

B

Locally active antiviral agents can be used to treat: A) HIV infection B) Warts C) RSV D) CMV systemic infections

B

The antiviral regimen of a pt with HIV includes Abacavir. What health education should the nurse provide to the pt? A) Most pts see their HIV resolve within 8 to 12 months of starting Abacavir B) Make sure you call right away if you have any signs of hypersensitivity that we discussed C) It's very important that you avoid taking any vitamin B supplements while you're on Abacavir D) Plan your day that Abacavir is the first drug you take in the morning and the last one you take at night

B

The nurse is caring for a pt receiving antiviral medications to treat HIV. What laboratory study should the nurse monitor most closely to determine the effectiveness of the medications? A) Liver function studies B) CD4 count C) CBC with differential D) P24 antigen test

B

The nurse is providing health education to a pt who has recently been diagnosed with HIV and will soon begin antiretroviral therapy. What teaching point should the nurse prioritize? A) The pathophysiology of the human immunodeficiency virus and its link to the drug treatment B) The need to adhere rigidly to the prescribed drug schedule C) The incidence and prevalence of hypersensitivity reactions D) The need to report diarrhea or nausea to the provider immediately

B

Virus infections have proved difficult to treat because they: A) Have a protein coat B) Inject themselves into human cells to survive and to reproduce C) Are bits of RNA or DNA D) Easily resist drug therapy

B

In which clients are the use of cidofovir contraindicated? A. clients with history of epilepsy B. clients with renal impairment C. clients with cardiac disease D. clients with low blood cell counts

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

The nurse is caring for a 3-year-old with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on: A. the severity of the client's condition. B. the client's weight. C. the client's body surface area. D. dosage recommendations for adults.

B. In the pediatric client population, dosage is typically based on the client's weight. Pediatric dosage recommendations have not been established for several common antivirals used in HIV therapy.

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

B. 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 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following? A.Neurologic function B. Renal function C. Cardiac function D. Respiratory function

B. The risk for nephrotoxicity is higher in older patients because with advancing age, renal function diminishes and drug excretion becomes less effective. Serious adverse effects or cumulative toxicity can result. It is important for the nurse to be aware of and assess the older patient's neurologic, cardiac, and respiratory functions. However, they would not be as important as the renal function because of the medication being taken.

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? A. "Zidovudine inactivates the virus and prevents recurrence of the disease." B. "Zidovudine slows the progression of the disease but does not cure it." C. "Zidovudine therapy may result in the development of resistant strains." D. "Zidovudine prevents the occurrence of opportunistic infections."

B. 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 pt with a history of intravenous drug use has been diagnosed with hepatitis C and the provider has just prescribed Boceprevir 800 mg PO t.i.d q8h. What is the nurse's best action? A) Contact the prescriber to confirm the dose B) Contact the prescriber to confirm the route C) Ensure that the pt will also receive Peginterferon and Ribavirin D) Administer antiemetics as prescribed 30 min before the drug

C

An HIV-positive patient comes to the clinic and asks the nurse if the patient should receive a flu vaccine. The patient states, "I never get the flu, so why should I take it?" What is the best response by the nurse? A. "If you don't get the flu vaccine, you could die if you get the flu." B. "If you have never had the flu, there is no reason for you to get the vaccine now." C. "All HIV-positive patients should receive the flu vaccine as prophylaxis." D. "You could skip it this year, but I would suggest you taking it next year."

C. Every HIV-positive patient should receive annual influenza virus prophylaxis. The preferred drug is inactivated trivalent influenza virus vaccine, one dose annually.

A nurse is caring for a client diagnosed with HIV. The client wants to know when they will be started on medication for their disease. What would be the nurse's best response? A. when the client is coinfected with hepatitis C B. after the client has been cured of Kaposi's sarcoma C. if the client has a CD4 T-cell count less than 350 cells/mm3 D. if the client is diagnosed with HIV-associated liver disease

C. The current guideline is to initiate treatment if the client develops an AIDS-defining illness or has a CD4 T-cell count less than 350 cells/mm3. Antiretroviral drug therapy is also warranted in infected pregnant women, in clients with HIV-associated renal disease, and in clients coinfected with hepatitis B.

A nurse is providing care to a client who is receiving a protease inhibitor with a nursing diagnosis of Disturbed Body Image related to a redistribution of fat to the abdomen. Which intervention would the nurse include in the client's plan of care? A. informing the client that the change is related to the disease and not the drug B. telling the client that this change indicates the drug is effective C. encouraging the client to verbalize feelings about body changes D. having the client wear protective clothing to prevent further issues

C. The nurse should plan to spend time with the client, encouraging the client to verbalize feelings regarding this change in appearance. It is also important to acknowledge these feelings as being both valid and important to the client. The change is directly related to the drug therapy, not the disease. Wearing protective clothing would be appropriate to prevent photosensitivity and would have no effect on the client's disturbed body image. The change in body image is a direct result of the drug therapy. It is not an indication that the drug is effective.

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? BUN CD4 AST RBCs

CD4 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 nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason? More than one drug is needed to ensure sensitivity to the different forms of the virus. The use of multiple drugs allows attack on the virus at different points in its life cycle. One drug helps to control the virus, while the other drugs help to alleviate the adverse effects. Using several drugs at once helps to improve the client's immune response.

The use of multiple drugs allows attack on the virus at different points in its life cycle. HIV mutates over time, presenting a slightly different configuration with each new generation. Thus, multiple drugs are used to attack the virus at various points in the life cycle to achieve the maximum effectiveness with the least amount of toxicity. Sensitivity is not an issue. The virus needs to enter the cell to cause infection. Adverse effects are numerous with anti-HIV drugs and the use of combination therapy can increase the client's risk for these adverse effects, including further depression of the immune response.

A client is being treated with saquinavir for AIDS. The client history includes a BMI of 37.98%, hyperlipidemia, and sleep apnea. Based on the client history, why would caution be used when the client is started on saquinavir? The drug is largely metabolized by the liver. It may cause an exacerbation requiring a dosage change. There are potential adverse effects associated with hyperlipidemia. Saquinavir has a possible association with cardiovascular events.

There are potential adverse effects associated with hyperlipidemia. Explanation: Saquinavir drug therapy should be used cautiously in clients with elevated triglyceride or cholesterol levels because fat redistribution and hyperlipidemia are among the adverse effects associated with the use of PIs. Because the drug is largely metabolized by the liver, saquinavir should be used with caution in clients with preexisting hepatic dysfunction, not with elevated cholesterol levels. Dosage change may be required in patients with diabetes. Association with cardiovascular events is not the reason for the caution.

True or False: Ribavirin is teratogenic and is classified as a pregnancy category X drug.

True

A patient may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbifudine therapy is stopped. True False

True Explanation: potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach patients the importance of not running out of their drugs and use extreme caution when discontinuing these drugs.

A client may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbifudine therapy is stopped. False True

True A potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach clients the importance of not running out of their drugs and use extreme caution when discontinuing these drugs.

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? Use of combination therapy attacks the virus at different stages of the life cycle. Use of multiple drugs ensures sensitivity to various viral forms. One drug combats the virus while the others are prescribed to diminish the adverse effects. The client's immune response is enhanced with multiple drugs.

Use of combination therapy attacks the virus at different stages of the life cycle. 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.

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

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.

Which protease inhibitor would the nurse expect to administer to a patient who has renal impairment? a. Nelfinavir b. Indinavir c. Fosamprenavir d. Lopinavir

a. Nelfinavir (Rationale: Nelfinavir is primarily excreted in the feces with little renal excretion. Thus it would be an appropriate choice for a patient with renal impairment. Indinavir can cause serious, life-threatening side effects. Patients with hepatic or renal impairment are at risk for increased toxic effects; it would not be a good choice for patients with renal impairment. Fosamprenavir is excreted in the urine, so it would not be a drug of choice for a patient with renal impairment. Lopinavir is excreted in the urine and feces, so it would not be a drug of choice for a patient with renal impairment.)

What would the nurse expect the physician to prescribe as treatment for a patient who has a herpes simplex infection in the eye? a. Trifluridine b. Penciclovir c. Docosanol d. Imiquimod

a. Trifluridine (Rationale: Trifluridine is an ophthalmic ointment used to treat herpes simplex eye infections. Docosanol is used to treat oral and facial herpes simplex cold sores and fever blisters. Imiquimod is used to treat genital warts and perianal warts. Penciclovir is used to treat cold sores [herpes labialis] on the face and lips.)

A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Ribavirin (Virazole) d. Amantadine (Symmetrel)

b. Ganciclovir (Cytovene) Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza type A; and zanamivir is used for influenza types A and B

The nurse is attending a seminar on the use of antiviral medications and learns that what tissue hormone is released in response to viral invasion and acts to block viral replication. a. RNA b. Interferon c. Progesterone d. DNA

b. Interferon(Rationale: Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. 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.)

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providing instructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a. Insomnia and nervousness b. Temporary swelling and rash c. Burning when applied d. This medication has no adverse effects.

c. Burning when applied Transient burning may occur with topical application of acyclovir. The other options are incorrect.

The nurse is caring for a patient receiving antiviral medications to control HIV. What laboratory study would the nurse monitor to determine the effectiveness of the medications? a. P24 Antigen test b. CBC with differential c. T cell count d. Liver function studies

c. T cell count (Rationale: HIV attacks the helper T cells (CD4 cells) within the immune system. Monitoring T cell count would indicate how effective the drug is at controlling the virus. CBC with differential does not include a T cell count. P24 antigen tests confirm the presence of the virus but do not indicate severity of the disease; it is either positive or negative. Liver function studies are not indicated unless liver function is damaged by the disease.)

After teaching a group of students about the drugs used to treat HIV and AIDS, the instructor determines that the teaching was successful when the students identify which group as being one of the newest classes of drugs? a. Fusion inhibitors b. Protease inhibitors c. Nucleoside reverse transcriptase inhibitors d. CCR5 co-receptor antagonist

d. CCR5 co-receptor antagonist (Rationale: CCR5 co-receptor antagonist was introduced in 2007 and is the newest class of drugs developed to treat HIV infection. Nucleoside reverse transcriptase inhibitors was the first class developed to treat HIV infection. Protease inhibitors are not the newest class of drugs developed to treat HIV infection. Fusion inhibitors were first introduced in 2003, but these are not the newest class of drugs developed to treat HIV infection.)

A nurse provides medication teaching related to the importance of adhering to the saquinavir drug regimen. In order to best minimize the risk of increased fatty-like tissue, the nurse will instruct the patient to:` take the drug within 2 hours after a high-fat meal. engage in regular exercise. take the drug within 2 hours after a low-fat meal. follow a low-fat diet.

engage in regular exercise. Explanation: Saquinavir is known to produce adverse reactions in the form of deposition of fatty-like tissues in the body. Regular exercise can offset the effect of fat redistribution in the body. It is advisable to take saquinavir within 2 hours after a high-calorie, high-fat meal, and to follow a low-fat diet. However, regular exercise will be more beneficial in offsetting fat redistribution.

A nurse, reviewing a newly admitted client's previous health records, notes that the client is currently prescribed acyclovir. The nurse should assess the client for signs and symptoms associated with what medical diagnosis? human immunodeficiency virus (HIV) hepatitis A hepatitis B herpes simplex virus

herpes simplex virus Acyclovir is the prototype antiviral agent used to combat the herpesviruses and is an oral, parenteral, and topical antiviral drug. It is not indicated for the treatment of any of the other proposed diagnoses.

A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to take the tablets on an empty stomach. decrease the drug dosage if initial symptoms of nephrotoxicity appear. stay well hydrated by drinking at least eight 8-oz glasses of water daily. eat light meals every day.

stay well hydrated by drinking at least eight 8-oz glasses of water daily. To minimize the risk of developing nephrotoxicity, the patient should stay well hydrated by drinking at least eight 8-oz glasses of water daily. Eating light meals or taking the drug on an empty stomach would not decrease the risk of developing nephrotoxicity. A nurse should never alter the drug dosage without consulting the prescriber.

A 38-year-old man is being treated for HIV-1 with nevirapine (Viramune). Signs of severe liver dysfunction have been noted by the physician and a change in the drug therapy is necessary. The nurse explains to the patient that: the therapy will be discontinued. the drug will be administered three times daily in divided doses. the therapy should be reinitiated at half the previous dosage. the dose should be escalated over a 2-week period.

the therapy will be discontinued. Explanation: Nevirapine drug treatment may precipitate severe hepatic reactions, a development that would necessitate discontinuing the use of the drug

Which microorganism is known to cause retinitis in people with HIV/AIDS? Cytomegalovirus Cryptococcus neoformans Mycobacterium avium Pneumocystic carinii

Cytomegalovirus Explanation: Cytomegalovirus is a species-specific herpes virus. Cryptococcus neoformans is a fungus that causes an opportunistic infection in those with HIV/AIDS. Mycobacterium avium is an acid-fast bacillus that commonly causes a respiratory illness. Pneumocystic carinii is an organism that is thought to be protozoan but believed to be a fungus based on its structure.

A pt believed he had "pinkeye" and waited several days before seeking care. The health care provider's assessment reveals that the pt has a herpes simplex infection in the eye. The nurse should teach the pt about what medication? A) Docosanol B) Imiquimod C) Penciclovir D) Trifluridine

D

A pt is receiving Ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. What should the nurse do when administering this drug? Give it: A) Intramuscularly, preferably in the deltoid site B) Orally with food C) Orally at least 30 minutes before food or 2 hours after food D) IV over 60 minutes

D

A pt is receiving a nonnucleoside reverse transcriptase inhibitor. Why should the nurse caution the pt to avoid the concurrent use of St. John's wort? A) The risk for atropine-like effects is increased B) Life-threatening interactions are possible C) The risk for renal toxicity is increased D) Antiviral effects may be reduced

D

A pt with HIV has had a CCR5 coreceptor antagonist added to the antiretroviral regimen. What assessment should the nurse prioritize? A) Cardiac monitoring B) Respiratory function C) Kidney function D) Liver function

D

A pt's current drug regimen includes Docosanol. What nursing diagnosis most likely applies to this pt? A) Ineffective airway clearance B) Urinary retention C) Risk for constipation D) Impaired skin integrity

D

A nursing student is reading a journal article about highly active antiretroviral therapy (HAART). The nurse would expect to find which condition as being treated with this therapy? A. herpes simplex virus (HSV) B. cytomegalovirus (CMV) C. rotavirus D. human immunodeficiency virus (HIV)

D. HAART is a multidrug therapy that is used to treat HIV. Antiviral drugs have limited use because they are effective against only a small number of specific viral infections. Antiviral drugs are used in the treatment or prevention of infections caused by cytomegalovirus, herpes simplex virus, and rotavirus.

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

D. 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

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? Discontinue the therapy and then reintroduce it. Discontinue the therapy. Reduce the dose. Administer the drug at bedtime.

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.

A client is receiving nevirapine as part of a treatment for HIV infection. The nurse would instruct the client about which adverse effects as most commonly experienced? Dry mouth and dyspepsia Light-headedness and dizziness Buffalo hump and thin extremities Paresthesias and fever

Dry mouth and dyspepsia Explanation: Nevirapine is associated with gastrointestinal related effects, most commonly dry mouth, dyspepsia, constipation or diarrhea, nausea, and abdominal pain. Rimantadine is more commonly associated with light-headedness and dizziness. Tenofovir and fosamprenavir are associated with changes in body fat distribution, leading to buffalo hump and thin arms and legs. Maraviroc is associated with paresthesias and fever.

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. It gives the provider many choices as to which medication can be prescribed. 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.

Each medication is only effective against a small number of specific viral infections. 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.

All infections regardless of type can be treated with antibiotics. Is this statement true or false? False True

False Antibiotics are not effective against viral infections, but if a person has a bacterial infection in addition to a viral infection, an antibiotic is often necessary.

A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus (CMV). The nurse explains to the woman that this infection is caused by a common organism that normally does not cause infection in someone who is not what? Infected with HIV Immunocompromised Autoimmune deficient Infected with hepatitis B

Immunocompromised These antiviral agents are indicated for treatment of the DNA viruses herpes simplex, herpes zoster, and CMV. Research has shown that they are very effective in immunocompromised individuals, such as patients with AIDS, those taking immunosuppressants, and those with multiple infections. These infections do not attack just people with HIV or hepatitis B.

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? Liver function testing and HIV testing Complete blood count and prothrombin time (PT) Pulmonary function testing and echocardiogram Cardiac stress test and blood cultures

Liver function testing and HIV testing 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.

Many of the residents of a long-term care facility have become sick with influenza this winter despite the fact that all residents were immunized earlier in the fall. A nurse who provides care in the facility should recognize the need to have which of the following drugs readily available at the facility? Docosanol Oseltamivir phosphate Ganciclovir Acyclovir

Oseltamivir phosphate Explanation: Oseltamivir phosphate (Tamiflu) is a neuraminidase inhibitor used to manage infection with influenza A or B virus; it is also used as prophylaxis against influenza A and B. Docosanol is indicated in the treatment of oral-facial herpes and ganciclovir (Cytovene) is an antiviral agent used to treat CMV infections. Acyclovir is not used to treat or prevent influenza.

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

The nurse knows that pregnant caregivers should not inhale which medication while administering the medication to clients? Albuterol Amantadine Ribavirin Valganciclovir

Ribavirin Explanation: Ribavirin is a category X drug for women of childbearing age due to the possible toxic effects to the fetus. Albuterol is not toxic to pregnant women or their fetuses. Amantadine is given PO. Valganciclovir is given PO.

When focusing on the lifestyle of the patient with HIV, what are important teaching considerations? (Select all that apply.) Take drug therapy as prescribed. Transmission can occur while on medication. No blood test will need to be done while on therapy. Advise the patient about the adverse effect of granulocytopenia.

Take drug therapy as prescribed. Transmission can occur while on medication. Advise the patient about the adverse effect of granulocytopenia. Explanation: It is important to assess the patient's understanding of HIV transmission and to explain that despite drug therapy, the patient can still transmit HIV to others. In addition, assess the adherence issue. Explain the importance of periodic blood monitoring to ensure the efficacy of therapy. Hematologic toxicities, including granulocytopenia and severe anemia, can occur. Signs of granulocytopenia can develop in 6 to 8 weeks, and signs of anemia can develop in 2 to 4 weeks.

What would the nurse identify as the primary purpose of performing a CD4 count for a patient infected with HIV? The CD4 count is an indication of the patient's current immunological status. The CD4 count indicates the risk for disease progression and is the most important indicator of treatment response. The CD4 count is considered a direct way of measuring drug resistance. The CD4 count evaluates the genetic makeup of a patient's virus and detects the presence of drug-resistant mutations in relevant genes.

The CD4 count is an indication of the patient's current immunological status. CD4 cell counts are an indication of the patient's current immunologic status.

A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug? The client has a diagnosis of type 2 diabetes and did not consistently monitor blood glucose levels prior to diagnosis with HIV. The client experienced an adverse reaction to an influenza immunization several years ago. The client's body mass index at the time of diagnosis was 27 (overweight). The client has hepatitis C and a history of heavy alcohol use.

The client has hepatitis C and a history of heavy alcohol use. Efavirenz is used cautiously in clients with concomitant use of alcohol or psychoactive drugs because they increase the risk of CNS adverse effects. The drug should be used with caution in clients with a history of hepatitis B or C; they have an increased risk of hepatotoxicity. Obesity, diabetes, and adverse reactions to vaccination do not contraindicate the use of efavirenz.

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 experience fewer recurrences. The client will be cured of the viral infection. The client will experience recurrences but milder symptoms. The client will no longer be able to transmit the infection to others.

The client will experience fewer recurrences. 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.

An asymptomatic patient infected with HIV asks the nurse, "When will I have to start taking antiviral therapy?" What is the recommendation for initiating treatment in this patient? Select all that apply. The patient has a CD4 count of 250 cell/mm. The patient has HIV nephropathy. The patient has a CD4 count of 500 cell/mm. The patient has active hepatitis B virus(HBV) with the intent to treat the HBV. The patient has a positive HIV test.

The patient has a CD4 count of 250 cell/mm. The patient has HIV nephropathy. The patient has active hepatitis B virus(HBV) with the intent to treat the HBV. The recommendation for initiating treatment in asymptomatic patients is a CD4 cell count between 200-350 cell/mm, or those with HIV nephropathy, or patients with active HBV with the intent to treat the HBV.

The nurse is caring for a patient who has HIV and is taking saquinavir therapy. What should the nurse include in the dietary education for this patient? The patient should limit carbohydrates when taking this medication. The patient should limit proteins while taking this medication. The patient should not take this medication with grapefruit or pomegranate juice. The patient is not restricted to a specific diet while taking this medication.

The patient should not take this medication with grapefruit or pomegranate juice. Assess the dietary habits of the patient taking saquinavir. Because of the potential for hyperlipidemia, limit high-fat and high-cholesterol foods. Assess alcohol consumption because of the increased risk of hepatic injury. Advise the patient to refrain from taking saquinavir with grapefruit or pomegranate juice.