Pharmacology PrepU Chapter 10: Antiviral Agents, Chapter 10: Antiviral Agents, Chapter 10: Antiviral Agents, Pharm 10
A group of nursing students are reviewing information about the different antiretroviral drugs. The students demonstrate understanding when they identify which as an example of an entry inhibitor? Select all that apply.
-maraviroc -enfuvirtide
A client is prescribed amantadine to prevent influenza A. The nurse should monitor the client for which adverse effects? (Select all that apply.)
-peripheral edema (swelling) -dizziness
The nursing instructor is giving memory aids to the students to help them to better remember the different drug classifications. When learning about antivirals the nurse instructs the students to look for which syllables?
-vir
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 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?
Alcohol use
Which statement regarding antiviral medications is true?
Antivirals do not eliminate existing viruses from tissues.
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
Locally active antiviral agents can be used to treat: A) HIV infection B) Warts C) RSV D) CMV systemic infections
B
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
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
There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?
Disclosure of the client's condition
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 (Human respiratory syncytial virus)
A nurse is preparing a presentation for a local community group about medications available to treat influenza. Which drug would the nurse describe as also being used to treat Avian flu? a. Rimantadine b. Oseltamivir c. Zanamivir d. Ribavirin
b. Oseltamivir (Rationale: Oseltamivir is the only drug approved for use to treat Avian flu.)
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 -Advise the patient about the adverse effect of granulocytopenia
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
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
A patient with AIDS develops CMV retinitis and is to receive valganciclovir. The nurse would instruct the patient to take the drug twice a day for how long? a. 7 days b. 14 days c. 21 days d. 28 days
c. 21 days (Rationale: Valganciclovir is administered orally twice a day for a period of 21 days then once daily for maintenance.)
A patient is receiving tenofovir as part of a therapy regimen for HIV infection. The nurse would provide what teaching related to what the patient may experience? a. Severe hypersensitivity reactions b. Steatosis c. Changes in body fat distribution d. Pancreatitis
c. Changes in body fat distribution (Rationale: Tenofovir is associated with changes in body fat distribution with loss of fat from arms, legs, and face and deposition of fat on the trunk, necks, and breasts. Severe hypersensitivity reactions have occurred with abacavir. Pancreatitis is associated with didanosine, which has limited its use to treatment of advanced infections. Emtricitabine has been associated with severe and even fatal hepatomegaly with steatosis.)
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?
herpes simplex virus
A 38-year-old man is being treated for HIV-1 with nevirapine (Viramune). Signs of severe liver dysfunction have been noted by the health care provider and a change in the drug therapy is necessary. The nurse explains to the client that:
the therapy will be discontinued.
What statement made by the patient indicates to the nurse that the patient does not understand the transmission of HIV?
"As long as I am taking the HAART therapy, I cannot transmit the virus to anyone else."
HIV selectively enters which of the following cells? A) B clones B) Helper T cells C) Suppressor T cells D) Cytotoxic T cells
B
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
Locally active antiviral agents can be applied to open lesions.
False
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
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?
The use of multiple drugs allows attack on the virus at different points in its life cycle
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
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 tiny and replicate inside cells
A nurse is preparing to administer famciclovir to a patient with a herpes virus infection. The nurse would expect to administer this drug by which route? a. Oral b. Intravenous c. Subcutaneous d. Intramuscular
a. Oral (Rationale: Famciclovir is only administered orally.)
A patient is receiving ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. The nurse administers the drug intravenously over what time span? a. 90 minutes b. 120 minutes c. 30 minutes d. 60 minutes
d. 60 minutes (Rationale: Ganciclovir is administered intravenously every 12 hours over a period of one hour.)
True or False: Children younger than the age of 12 years should not receive indinavir.
True (Rationale: Indinavir is not indicated for use in children younger than 12 years of age. Lopinavir can be used in children as young as 6 months and both nelfinavir and ritonavir can be used in children older than 2 years of age who require treatment for HIV and AIDS.)
True or False: A patient may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbivudine therapy is stopped.
True (Rationale: It is extremely important to teach the patient to never stop taking or run out of their prescription because an acute exacerbation of hepatitis B may result. Withdrawal of the drug must be gradual and carefully monitored.)
An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a health care provider to see if residents may be candidates for treatment with what drug?
oseltamivir phosphate
In which of the following patients is the use of cidofovir contraindicated?
patients with renal impairment
All infections regardless of type can be treated with antibiotics. Is this statement true or false?
false
An adult client is being treated for genital herpes with acyclovir. Which client statement indicates a need for further health education?
"It's a relief to know that this drug will stop me from spreading the infection."
For which viral infection is drug therapy available? (Select all that apply.)
-Hepatitis B and C -HIV infection -Influenza -Cytomegalovirus
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 client is diagnosed with cytomegalovirus infection and is to receive foscarnet. The nurse would expect to administer this drug by which route?
Intravenous (IV)
The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug should the nurse expect the pediatrician to order?
Ribavirin -Ribavirin is indicated for the treatment of influenza A infections and RSV infection in children.
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 a client with AIDS. What is the best response for addressing the family member's fears?
"AIDS is commonly transmitted by contact with blood and body fluids."
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 should expect some nausea and vomiting."
A nurse is teaching a client with herpes zoster to apply acyclovir ointment. What guidance should the nurse include in the instructions?
"Wear gloves when applying the ointment."
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 slows the progression of the disease but does not cure it."
A pt has been diagnosed with herpes and has been prescribed Acyclovir 8 mg/kg IV q8h. The pt weighs 143 lb. What will the pt's daily dose of Acyclovir be?
1,560 mg
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
Place the following steps in the stages of the replication cycle of a virus in the correct order. -Viral nucleic acids replicate -Virus sheds its coat -Virus enters host cell by pinocytosis -Host cell dies releasing virus to move to other cells -Virus adheres to host cell surface -Synthesis of viral protein capsid -Assembly of new virions
1. Virus adheres to host cell surface 2. Virus enters host cell by pinocytosis 3. Virus sheds its coat 4. Viral nucleic acids replicate 5. Synthesis of viral protein capsid 6. Assembly of new virions 7. Host cell dies releasing virus to move to other cells (Rationale: 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.)
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:
2 days
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:
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?
300 mg
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
A pregnant pt's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this pt? A) Zidovudine B) Tenofovir C) Lamivudine D) Stavudine
A
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 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
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
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
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
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
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?
Alcohol Use
Antiviral therapy for influenza is being administered within your long-term care facility; it commenced about 3 weeks ago. The nurse would monitor for which adverse effects? (Select all that apply.)
Anorexia Nausea
What can the nurse do to maximize a patient's adherence to the medication regimen?
As an advocate of the patient, discuss benefits and risks of antiretroviral therapy as well as administration.
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
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 -High-fat meals decrease the blood concentration of this drug by 21%. P
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
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
To prevent viral infections, what precaution should the general public take?
Become vaccinated against prevalent virus infections
To prevent viral infections, what precaution should the general public take?
Become vaccinated against prevalent virus infections.
A pt with HIV is frustrated by the size and complexity of the current medication regiment. What should the nurse teach the pt about combination therapy for the treatment of HIV? A) The pt's immune response is enhanced with multiple drugs B) Use of multiple drugs ensures sensitivity to various viral forms C) Use of combination therapy attacks the virus at different stages of the life cycle D) One drug combats the virus while the others are prescribed to diminish the adverse effects
C
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
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
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
A client with a diagnosis of AIDS has been prescribed valganciclovir. The nurse should expect that this client has developed what AIDS-related complication?
CMV retinitis
Which nursing intervention is necessary when caring for a client diagnosed with hepatitis A? Select all that apply.
Chlorine wipes are effective for disinfection purposes. Effective handwashing is vial in the prevention of cross infection. Educate personal contacts that the client is infectious for up to 10 days after symptoms appear.
A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient?
Combination antiretroviral therapy
Which microorganism is known to cause retinitis in people with HIV/AIDS?
Cytomegalovirus
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
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
A client for whom antiretroviral therapy has been prescribed informs the nurse that the client is taking oral contraceptives. What should the nurse inform the client is one of the effects of combining birth control pills with antiretroviral therapy?
Decreases effectiveness of birth control pills
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.
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 (indigestion)
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.
Antiretroviral drugs have different mechanisms of action. Which action below is NOT a common antiretrovirial mechanism?
Exit facilitators which remove the HIV from the cells
True or False: Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication.
False
True or False: Locally active antiviral agents can be applied to open lesions to control severe symptoms.
False
True or False: Locally active antiviral agents can be applied to open lesions.
False (Rationale: Locally active antiviral agents should not be applied to open wounds.)
True or False: Rimantadine is a teratogenic drug, classified as a pregnancy category X drug.
False (Rationale: Ribavirin is teratogenic and classified as a pregnancy category X drug.)
True or False: Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication.
False (Rationale: The exact mechanism of action of drugs to treat influenza and respiratory viruses is not known.)
The nurse is caring for a client who has been on ritonavir. The nurse identifies an adverse reaction in relation to body fat. What does the nurse see when assessing this client?
Fat has moved to the center of the body and the client appears to have thinners arms and legs
Which drug would a nurse least likely expect to be prescribed for a client with chronic hepatitis B?
Fosamprenavir -Fosamprenavir is a protease inhibitor that may be indicated as part of combination therapy for symptomatic HIV infection
The nurse is caring for a client with AIDS who has developed cytomegalovirus (CMV). The nurse anticipates the health care provider will order which drug to treat this client?
Ganciclovir
A client with active AIDS is infected with a retrovirus. This virus is better known as which?
HIV
For which viral infection is drug therapy available? (Select all that apply.)
Hepatitis B and C HIV infection Influenza Cytomegalovirus
Antivirals are used to treat infections caused by viruses. In particular, acyclovir is useful to treat which infection?
Herpes zoster
A nurse is caring for a client who is taking acyclovir. What is likely to be a priority nursing diagnoses for this client?
Imbalanced Nutrition: less than body requirements related to drug adverse effects
A 58-year-old with HIV is starting treatment with Combivir. He currently has a CD4+ cell count of less than 200 cells/mL and a viral load greater than 45,000 copies/mL. The nurse treating the client knows that what is a sign of effective drug therapy?
Increased CD4+ cell counts
A patient with chronic hepatitis B (HBV) infection is scheduled to begin a new treatment regimen that will include adefovir dipivoxil (Hepsera). What assessments should be prioritized before the initiation of this drug treatment?
Liver function testing and HIV testing
A 3-month-old infant has been diagnosed with respiratory syncytial virus (RSV) and will begin treatment with inhaled ribavirin. Which of the following measures should be taken in the care of this patient and administration of ribavirin?
Nurses who are pregnant or who may be pregnant should not administer the drug.
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?
Oral
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 reference what drug?
Oseltamivir
In which of the following patients is the use of cidofovir contraindicated?
Patients with renal impairment
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
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?
Provide for frequent rest periods
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?
Provide for frequent rest periods.
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?
Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir
When administering the fusion protein inhibitor enfuvirtide, the nurse should include which technique to assure the medication's continued effectiveness?
Regularly rotate the subcutaneous injection sites that are used
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?
Renal function
The client with HIV is experiencing nausea and vomiting related to antiviral medications. The client has lost 20 pounds in the last 2 months since initiating the drug therapy regimen. What is the highest priority nursing diagnosis for this client?
Risk for imbalanced nutrition
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?
Shingles
A male patient has been prescribed efavirenz as monotherapy for HIV. On follow-up visits to the clinic, it will be most important for the nurse to assess for which of the following?
Signs of microbial resistance
An immigrant and his wife are both HIV positive. The physician prescribes antiretroviral medications. However, the client, tell the nurse he is concerned about his ability to afford the treatment. What advice can the nurse provide to the client to help begin the treatment?
The client can approach social agencies and pharmaceutical companies that provide antiretroviral drugs on compassionate grounds
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 hepatitis C and a history of heavy alcohol use.
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 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.
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 nurse is providing health education to a client who has recently been diagnosed with HIV and will soon begin antiretroviral therapy. What teaching point should the nurse prioritize?
The need to adhere to the prescribed drug regimen
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 not take this medication with grapefruit or pomegranate juice
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 not take this medication with grapefruit or pomegranate juice.
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?
The use of multiple drugs allows attack on the virus at different points in its life cycle.
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?
They have synergistic antiviral effects.
Children younger than the age of 12 years should not receive indinavir.
True
True or False: A pt may experience an acute exacerbation of hepatitis B if Entecavir, Adefovir, or Telbivudine therapy is stopped.
True
True or False: Children younger than the age of 12 years should not receive Indinavir.
True
True or False: Ribavirin is teratogenic and is classified as a pregnancy category X drug.
True
The nursing instructor is discussing HIV/AIDS with the junior nursing class. The instructor tells the students that it is important to understand how HIV-1 integrates itself into a person's immune system and how immunity plays a role in the course of HIV disease. What else is this knowledge essential for?
Understanding medication therapy
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.
A patient is being tested for HIV using the EIA (enzyme immunoassay). The EIA shows antibodies. The nurse expects the physician to order what test to confirm the EIA test results?
Western blot test
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?
Yellow sclera (whites of eyes) and hepatomegaly (liver enlargement)
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?
Yellow sclera and hepatomegaly
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. Foscarnet b. Famciclovir c. Ganciclovir d. Acyclovir
a. Foscarnet (Rationale: 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.)
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 group of students asks the instructor the reason why combination therapy is commonly prescribed for patients with HIV infection. What is the instructor's best response? a. Use of combination therapy attacks the virus at different stages of the life cycle. b. One drug combats the virus while the other diminishes the adverse effects. c. The patient's immune response is enhanced with multiple drugs. d. Use of multiple drugs ensures sensitivity to various viral forms.
a. Use of combination therapy attacks the virus at different stages of the life cycle. (Rationale: 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 patient's risk for adverse effects.)
Nursing students are studying antiviral drug therapy in a pharmacology class. A student asks the instructor to explain why multi-drug regimens are used to treat HIV infections. The instructor responds that drug combinations are often prescribed because they:
are more effective than single-drug therapy
It will be most important for the nurse to monitor nevirapine therapy for a male patient during the first few months of therapy in order to:
assess for potentially life-threatening hepatotoxicity or skin reactions
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 is receiving a nonnucleoside reverse transcriptase inhibitor. Why does the nurse caution the patient 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. Antiviral effects may be reduced. d. The risk for renal toxicity is increased.
c. Antiviral effects may be reduced. (Rationale: St. John's wort should not be used because a decrease in antiviral effects may occur. Life-threatening effects can occur when nonnucleoside reverse transcriptase inhibitors are taken with antiarrhythmics, clarithromycin, calcium channel blockers, antituberculosis drugs, warfarin, quinidine, indinavir, saquinavir, or dapsone. The risk for renal toxicity may be increased if the agent is combined with another drug that affects the kidneys. Nonnucleoside reverse transcriptase inhibitors are not associated with atropine-like effects.)
The patient is prescribed docosanol (Abreva) to treat a cold sore on the lip. The patient asks the nurse, "I've heard that this drug can cause fatal adverse effects. Is it safe to use?" What is the nurse's best response? a. "Topical medications do not cause any adverse effects because the medication is just applied to the skin." b. "It is important to follow directions and do not stop use of this medication to avoid adverse effects." c. "Avoid using this drug if you are taking St. John's wort because that increases the risk of adverse effects." d. "This is a topical medication that is not absorbed into the body so adverse effects are local burning, stinging, or discomfort."
d. "This is a topical medication that is not absorbed into the body so adverse effects are local burning, stinging, or discomfort." (Rationale: These drugs are not absorbed systemically so systemic or serious adverse effects that would result in fatality have not been reported. The adverse effects most commonly reported are localized at the site of application such as local burning, stinging, and discomfort. These effects usually occur at the time of administration and pass with time. St. John's wort reduces the effectiveness of protease inhibitors. Anti-hepatitis B agents are the drugs that should not be stopped because of risk of exacerbating hepatitis B.)
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.)
When describing the action of an integrase inhibitor, the nurse understands that this class of drug acts by what mechanism? a. Preventing the growth of viral DNA chain and its insertion into the host DNA b. Blocking the receptor site that HIV needs to interact with to enter the cell c. Blocking the activity of an enzyme in HIV leading to an immature HIV particle d. Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication
d. Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication (Rationale: Integrase inhibitors inhibit the activity of a virus-specific enzyme, integrase, an encoded enzyme needed for viral replication. Nucleoside reverse transcriptase inhibitors prevent the growth of the viral DNA chain and prevent it from inserting itself into the host DNA. Protease inhibitors block the activity of the enzyme protease, which is essential for the maturation of the infectious virus. CCR5 co-receptor antagonists block the receptor site HIV needs to interact with in order to enter the cell.)
The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug would the nurse expect the pediatrician to order? a. Rimantadine b. Zanamivir c. Oseltamivir d. Ribavirin
d. Ribavirin (Rationale: 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 patients who are symptomatic for less than 2 days.)
The physician prescribes zanamivir to a patient. When developing the teaching plan, the nurse includes what important instructions? a. Use a nebulizer to administer the drug via aerosol. b. Take the drug with 8 ounces of water on an empty stomach. c. Apply the drug liberally to the cold sores. d. Use the special inhaler included with the drug to administer it.
d. Use the special inhaler included with the drug to administer it. (Rationale: Zanamivir 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.)
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?
encouraging the client to verbalize feelings about body changes
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?
human immunodeficiency virus (HIV)
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?
if the client has a CD4 T-cell count less than 350 cells/mm3
A neonatal intensive care unit nurse is caring for an infant diagnosed with respiratory syncytial virus (RSV). What route of delivery will the nurse use when ribavirin is administered to this infant?
inhaled
A client has sought care from her primary 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 fever headache
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?
oral
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?
protease inhibitors
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
stay well hydrated by drinking at least eight 8-oz glasses of water daily.
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:
stay well hydrated by drinking at least eight 8-oz glasses of water daily.
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 appraising the success of this addition to the treatment, the nurse should prioritize which laboratory value?
the client's CD4 count
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:
the client's weight.
A client 45-years-old just received a heart transplant. One of the clients medications is ganciclovir. The nurse knows this medication was prescribed why?
to prevent CMV infection.
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.)
A nurse is preparing an in-service program for a group of staff nurses about antiretroviral agents. The nurse would include which drug as being safe to administer during pregnancy? a. Tenofovir b. Stavudine c. Zidovudine d. Lamivudine
c. Zidovudine (Rationale: Only zidovudine has been proven to be safe to administer during pregnancy.)
In which clients are the use of cidofovir contraindicated?
clients with renal impairment
The nurse is caring for a patient with a new diagnosis of HIV. The patient 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 would the nurse include in the teaching plan for this patient? (Select all that apply.) a. Schedule medications to allow for 8 hours of uninterrupted sleep. b. Report nausea, vomiting, and diarrhea immediately. c. Schedule for when to take medications. d. Avoid operating heavy machinery initially. e. See your health care provider regularly.
c. Schedule for when to take medications. d. Avoid operating heavy machinery initially. e. See your health care provider regularly. (Rationale: Having just learned of an HIV diagnosis, this patient is likely to be very anxious, so it is important to draw up a written schedule of when each medication will be taken. Stress the importance of regular visits to the doctor in order for medication effectiveness to be monitored through lab studies and adverse effects to be managed. A patient who is asymptomatic may be noncompliant with medications if adverse effects of the drugs are bothersome, so helping to reduce the negative effects can increase compliance. Instruct the patient to avoid driving or operating heavy equipment until evaluation the effects the medication has on him or her because each patient will respond differently. If no CNS effects occur, the patient can return to normal driving habits. Nausea, vomiting, and diarrhea are likely to occur, so the patient should be instructed on strategies to manage these symptoms and should call the doctor only if they cannot be managed or become acute. Medications should be taken around the clock if necessary to maintain therapeutic effects.)
A group of nursing students are reviewing information about viral infections. They demonstrate understanding of the information when they identify which as being caused by a virus? Select all that apply.
common cold wart influenza hepatitis C
