11 Antiviral Drugs

A patient is being treated with saquinavir. The nurse would assess the patient for which of the following? A) Increase in patient's weight B) Evidence of liver dysfunction C) Photosensitivity D) Allergic skin reaction

Ans: A Feedback: Patients taking saquinavir experience redistribution of body fat, with the movement to the center of the body. The nurse should spend time with these patients, encouraging them to verbalize their feelings regarding this change in appearance. Taking saquinavir does not cause liver dysfunction, photosensitivity, or any allergic skin reactions.

A nursing instructor is describing the different categories of antiretroviral agents used in treatment for HIV infection. The instructor determines that the teaching was successful when the students identify which category as affecting an enzyme so that new viral particles cannot mature? A) Protease inhibitors B) Reverse transcriptase inhibitors C) Nonnucleoside reverse transcriptase inhibitors D) Integrase inhibitors

Ans: A Feedback: Protease inhibitors block the protease enzyme so the 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. Nonnucleoside reverse transcriptase inhibitors latch on to the reverse transcriptase molecule to block the ability to make viral DNA. Integrase inhibitors prevent enzymes from inserting HIV genetic material into the cell's DNA.

A patient who is receiving antiretroviral therapy is about to be discharged. Which of the following precautions should the nurse instruct the patient to follow to reduce the effects of photosensitivity? A) Wear protective clothing when outside. B) Increase fluid intake. C) Avoid lights while indoors. D) Use tanning beds for tan.

Ans: A Feedback: The nurse should encourage the patient to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid indoor lights as the skin becomes sensitive to sunlight but not indoor lights. The use of tanning beds should be avoided.

An HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. When assessing the patient, the nurse would immediately report which of the following to the primary health care provider? A) Peripheral neuropathy B) Headache C) Excoriation D) Taste alteration

Ans: A Feedback: The nurse should immediately report symptoms of peripheral neuropathy to the primary health 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.

A patient with skin lesions due to a viral infection has been prescribed a topical antiviral agent. When teaching the patient about this therapy, which of the following would the nurse emphasize? A) The drug will not prevent the spread of the disease to others. B) Topical drugs should be applied using the hand, not a finger cot or gloves. C) All lesions should be left open and not covered in any way. D) Sexual contact when lesions are present is permissible if barrier methods are used.

Ans: A Feedback: The nurse should inform the patient that application of the drug does not prevent the spread of the disease to others. Topical drugs should be applied with a finger cot or gloves but not with bare hands. The nurse should instruct the patient to cover all lesions and not leave them open. The nurse should also stress the importance of avoiding sexual contact when lesions are present irrespective of contraceptive measures.

A group of nursing students are reviewing information about antiretroviral therapy. The students demonstrate understanding of the information when they identify which conditions as requiring cautious use of this class of drugs? Select all that apply. A) Diabetes B) Hemophilia C) Impaired hepatic function D) Impaired renal function E) Hypertension

Ans: A, B, C Feedback: Antiretroviral drugs should be used cautiously in clients with diabetes, impaired hepatic function, pregnancy, or hemophilia.

Antiviral drugs have limited use because they are effective against only a small number of specific viral infections. The nurse would expect antiviral drugs to be used for which infection? Select all that apply. A) Human immunodeficiency virus (HIV) B) Herpes simplex virus (HSV) C) Cytomegalovirus (CMV) D) Rotavirus E) Rhinovirus

Ans: A, B, C Feedback: Antiviral drugs are used in the treatment or prevention of infections caused by cytomegalovirus (CMV), herpes simplex virus (HSV) 1 and 2, herpes zoster, human immunodeficiency virus (HIV), influenza A and B, respiratory syncytial virus (RSV), and hepatitis B and C. They are not used for rotavirus or rhinovirus infections.

A nurse is reviewing information about cidofovir in preparation for administration. The nurse understands that which of the following are true? Select all that apply. A) It should not be given to clients who have renal impairment. B) The drug should not be given to clients receiving aminoglycosides. C) Cidofovir is used in the treatment of cytomegalovirus retinitis. D) It is administered by placing one drop in both eyes twice daily. E) The drug should not be given with HMG-CoA reductase inhibitors.

Ans: A, B, C Feedback: Cidofovir should not be given to clients who have renal impairment or who are receiving other nephrotoxic drugs, such as aminoglycosides. The drug is used to treat cytomegalovirus retinitis and is administered IV.

A nurse is providing care to a client receiving highly active antiretroviral therapy (HAART). The nurse would expect the client to receive which of the following antiretroviral agents? Select all that apply. A) Protease inhibitors B) Reverse transcriptase inhibitors C) Nonnucleoside reverse transcriptase inhibitors D) Entry inhibitors E) Integrase inhibitors

Ans: A, B, C Feedback: HAART includes three categories of antiretroviral drugs: protease inhibitors, reverse transcriptase inhibitors, and nonnucleoside reverse transcriptase inhibitors.

Clients receiving antiretroviral drugs for HIV infection may continue to contract opportunistic infections. The nurse would be alert for which of the following when assessing the client during therapy? Select all that apply. A) Fever B) Malaise C) Sore throat D) Lethargy E) Hypotension

Ans: A, B, C, D Feedback: The nurse's ongoing assessment of HIV-positive clients should include close monitoring for signs of infection such as fever, malaise, sore throat, or lethargy.

Which of the following would the nurse identify as a goal for a client who is receiving an antiviral drug? Select all that apply. A) Adverse reactions are identified and treated. B) Adequate nutritional status is maintained. C) Perceptions of body changes are managed successfully. D) Skin integrity is successfully maintained. E) Therapeutic response is achieved.

Ans: A, B, C, D, E Feedback: The goals for a client taking antiviral drugs can include the following: adverse reactions are identified and treated, adequate nutritional status is maintained, perceptions of body changes are managed successfully, skin integrity is successfully maintained, and therapeutic response is achieved.

A client is receiving antiretroviral therapy. Which adverse reactions would the nurse include in the teaching plan for this client? Select all that apply. A) Altered taste B) Peripheral numbness C) Oral candidiasis D) Rash E) Fever

Ans: A, B, D, E Feedback: Adverse reactions associated with antiretroviral drugs are nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, and numbness and tingling in the circumoral area or peripherally or both. Oral candidiasis is not associated with antiretroviral therapy.

The nurse is preparing a plan of care for a client who is to receive antiviral therapy. Which nursing diagnoses would the nurse most likely include related to drug therapy? Select all that apply. A) Acute Pain B) Risk for Impaired Skin Integrity C) Risk for Injury D) Risk for Imbalanced Nutrition E) Body Image Disturbances

Ans: A, C, D, E Feedback: Drug-specific diagnoses for antiviral drugs include Risk for Imbalanced Nutrition, Risk for Impaired Skin Integrity, Risk for Injury, Body Image Disturbance, and Acute Pain.

The nurse is preparing to administer an antiviral drug to a client. Which of the following would the nurse include in the preadministration assessment? Select all that apply. A) Client's general state of health B) Blood glucose levels C) Resistance to infection D) Electrocardiogram findings E) Vital signs

Ans: A, C, E Feedback: The nurse's preadministration assessment of the client prior to administration of antiviral drugs should include determination of the client's general state of health and resistance to infection, record of client's symptoms and complaints, and record of vital signs. Blood glucose levels and electrocardiogram findings are not needed.

1. When teaching a client about antiviral therapy, the nurse would include information about the possibility of which adverse reactions? Select all that apply. A) Rash B) Sedation C) Chills D) Diarrhea E) Headache

Ans: A, D, E Feedback: Adverse reactions associated with antiviral drugs include nausea, vomiting, diarrhea, headache, rash, fever, and insomnia.

A client is ordered to receive an antiretroviral agent that is categorized as a nonnucleoside reverse transcriptase inhibitor. Which of the following would the nurse expect to administer? A) Indinavir B) Nevirapine C) Saquinavir D) Ritonavir

Ans: B Feedback: Nevirapine is classified as a nonnucleoside reverse transcriptase inhibitor. Indinavir, saquinavir, and ritonavir are classified as protease inhibitors.

A patient who is being discharged needs to continue taking the zanamivir using a Diskhaler and a bronchodilator. Both the inhaler and the Diskhaler are prescribed at the same time. Which instruction would the nurse include in the teaching plan for the patient? A) Zanamivir should be taken every 6 hours. B) Use the bronchodilator before taking zanamivir. C) Zanamivir used with a bronchodilator causes orthostatic hypotension. D) Risk of disease transmission is minimal during therapy.

Ans: B Feedback: The bronchodilator should be used before the zanamivir. The drug should be taken every 12 hours, not every 6 hours. The nurse should also inform the patient that treatment with this drug does not decrease the risk of transmission of the flu to others. Zanamivir when used with a bronchodilator does not specifically cause orthostatic hypotension, though antivirals are known to affect the mental status of patients.

A client diagnosed with HIV infection is receiving HAART. The client, who is alert and oriented, complains of anorexia, nausea, and vomiting. He has lost 10 pounds in the last 6 weeks. Additional assessment reveals pale, pink skin without any irritation or breakdown. He denies any complaints of pain. Which nursing diagnosis would the nurse identify as the priority for this client? A) Risk for Injury B) Risk for Imbalanced Nutrition: Less Than Body Requirements C) Risk for Impaired Skin Integrity D) Acute Pain

Ans: B Feedback: The client's complaints along with his weight loss strongly suggest a nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements as a priority. The client is alert and oriented, so his risk for injury is significantly low. There is no evidence of impaired skin integrity at present. However, this may become a concern if the client begins to experience skin breakdown secondary to his poor nutritional status. The client denies any pain, so Acute Pain would be inappropriate.

After teaching a group of nursing students about antiretroviral drugs, the instructor determines that the teaching was successful when the students identify that these drugs are used to treat which infections? Select all that apply. A) Hepatitis C virus (HCV) B) Human immunodeficiency virus (HIV) C) Acquired immunodeficiency syndrome (AIDS) D) Herpes simplex virus (HSV) 1 E) Herpes simplex virus (HSV) 2

Ans: B, C Feedback: Antiretroviral drugs are used to treat HIV and AIDS.

A nurse is preparing to administer ribavirin via inhalation to a client. Which of the following would the nurse need to keep in mind? Select all that apply. A) Administration is via a nebulizer. B) Solution should be discarded and replaced every 24 hours. C) Respiratory status can be worsened by the drug. D) Extrapyramidal effects can occur upon administration of the drug. E) Women of childbearing age should not inhale the drug.

Ans: B, C, E Feedback: Ribavirin is administered by inhalation using a small-particle aerosol generator. The solution should be discarded and replaced every 24 hours. This drug can worsen respiratory status, this drug is pregnancy category X, and women of childbearing age should take care not to inhale the drug.

The nurse is reviewing the medical record of a client who is to receive ritonavir. Which medication if found in the medication history would lead the nurse to contact the primary health care provider because the prescribed drug would be contraindicated? Select all that apply. A) Triazolam (Halcion) B) Bupropion (Wellbutrin) C) Zolpidem (Ambien) D) Lisinopril (Prinivil) E) Procainamide (Procanbid)

Ans: B, C, E Feedback: Ritonavir (Norvir) is contraindicated if the client is taking bupropion (Wellbutrin), zolpidem (Ambien), or an antiarrhythmic drug.

A nurse is preparing a teaching plan for a client who is receiving antiviral therapy. Which of the following would the nurse include? Select all that apply. A) Only notify your physician if an allergic reaction to the antiviral drug occurs. B) These drugs are not a cure for the viral infection, but they will shorten the course of disease. C) Mark a calendar to designate the days the drug is to be taken so that you can keep to the ordered alternate-dosage schedule. D) These drugs will help in preventing the spread of the infection to those around you. E) Take precautions when you're outside because you might experience a sunburn reaction.

Ans: B, C, E Feedback: The nurse's teaching plan for antiviral drugs should include educating the client and family that antiviral drugs are not a cure for viral infection but will shorten the course of disease; that antiviral drugs will not prevent the spread of disease to others; that some antiviral drugs cause photosensitivity, so precaution should be taken when going outdoors; that a calendar should be marked to designate the days the drug is to be taken for clients on an alternate-dosage schedule; and that the physician should be notified if burning, stinging, itching, or rash worsens or becomes pronounced.

A nurse is preparing to administer antiviral therapy. The nurse integrates knowledge of this therapy, administering the drugs cautiously to clients with which of the following? Select all that apply. A) Hepatic impairment B) Renal impairment C) Diabetes D) Low blood cell count E) Hypertension

Ans: B, D Feedback: Antivirals should be used cautiously in clients with renal impairment, low blood cell counts, history of epilepsy (rimantadine), and history of respiratory disease (zanamivir).

The nurse is preparing a plan of care for a client being treated with an antiviral drug. Which outcome would the nurse most likely identify? Select all that apply. A) Client remains free of other medical conditions. B) Client demonstrates an optimal response to therapy. C) Client exhibits continual changes in vital signs. D) Client demonstrates ability to manage adverse reactions. E) Client verbalizes understanding of the therapeutic regimen.

Ans: B, D, E Feedback: Optimal response to therapy and meeting of client needs related to the management of adverse reactions and an understanding of the therapeutic regimen are outcomes that should be addressed by the nurse in the planning step of the nursing process. Continually changing vital signs would be inappropriate. Remaining free of other medical conditions would be unrealistic.

A group of nursing students are reviewing information about antiviral agents. The students demonstrate understanding of the information when they identify which of the following as a drug category used for treating viral infections? Select all that apply. A) Antiattachment B) Antiretroviral C) Antitranscription D) Antireplication E) Antiviral

Ans: B, E Feedback: The drugs used to treat viral infections can be split into two categories: antiviral and antiretroviral agents.

A patient for whom antiretroviral therapy has been prescribed informs the nurse that she is taking oral contraceptives. The nurse responds that the combination of oral contraceptives and antiretroviral therapy can lead to which of the following? A) Decreased effectiveness of antiviral therapy B) Increased risk of vaginal bleeding C) Decreased effectiveness of birth control pills D) Increased serum level of the antiretroviral

Ans: C Feedback: Antiretrovirals decrease the effectiveness of oral birth control agents. Combining antiretrovirals with birth control pills does not, however, increase the risk of vaginal bleeding, increase serum levels of the antiretroviral, or decrease the effectiveness of antiviral therapy.

A client is prescribed entecavir, which is supplied as a buffered powder. The nurse instructs the client to mix the powder with which of the following? A) Fruit juice B) Applesauce C) Water D) Gelatin

Ans: C Feedback: The client should be instructed to mix the buffered powder with 4 ounces of water (not juice), stir until it is dissolved, and then drink it immediately. Using any other substance such as fruit juice, applesauce, or gelatin would be inappropriate.

An HIV-positive patient on antiretroviral therapy informs the nurse that he is considering taking sildenafil. The nurse informs the patient that he may experience which of the following when taking sildenafil with antiretroviral therapy? A) Feeling of dizziness B) Itching of skin C) Risk of hypotension D) Depression

Ans: C Feedback: The nurse should educate the patient regarding the associated risks, such as hypotension, visual disturbances, and prolonged penile erection. Feeling of dizziness, itching of skin, and depression are not conditions that are specifically associated with sildenafil and antiretroviral drugs.

A patient presents to her primary health care provider for treatment of herpes simplex. While obtaining the medical history of the patient, the nurse discovers that the patient has respiratory problems and uses theophylline. The primary health care provider considers prescribing acyclovir as the drug for treatment until she reads the nursing history. The nurse understands that the primary health care provider decided against the use of acyclovir for which reason? A) Increases the risk for acyclovir toxicity B) Increases the risk of seizures in patients with respiratory problems C) Increases serum level of theophylline in patients taking theophylline D) Increased serum levels of antiviral valacyclovir

Ans: C Feedback: When patients receiving theophylline treatment are administered acyclovir, there is an increase in the serum level of theophylline, thus placing the client at risk for theophylline toxicity. The serum levels of acyclovir do not increase. Increased levels of valacyclovir occur if the patient is taking valacyclovir, not theophylline. Taking acyclovir with theophylline does not increase the risk of seizures.

A nurse is providing care to a client with a sulfonamide allergy. The nurse would expect to administer which of the following cautiously if prescribed? Select all that apply. A) Maraviroc (Selzentry) B) Lamivudine (Epivir) C) Fosamprenavir (Lexiva) D) Ritonavir (Norvir) E) Amprenavir (Agenerase)

Ans: C, E Feedback: If a client has a sulfonamide allergy, the antiretroviral drugs fosamprenavir and amprenavir should be used cautiously.

A nurse is caring for a patient who is prescribed amantadine. The nurse would assess the patient for which of the following? A) Asthenia and abdominal pain B) Fever and dizziness C) Anorexia and dyspnea D) Hypotension and insomnia

Ans: D Feedback: A nurse should monitor the patient for hypotension and insomnia, since these are adverse reactions of amantadine. Asthenia and abdominal pain are adverse reactions of adefovir. Fever and dizziness are adverse reactions of acyclovir. Anorexia and dyspnea are adverse reactions of cidofovir. Therefore, a nurse need not monitor the patient for fever, dizziness, asthenia, abdominal pain, anorexia, and dyspnea, as these are not adverse reactions of amantadine.

A patient is being discharged from a health care facility but is required to continue antiviral therapy at home. Which of the following points should the nurse include in the teaching plan to educate the patient? A) A slight elevation in temperature is normal and needn't be reported. B) Double the dosage of the drug if you miss a dose. C) Stop taking the drug as soon as the symptoms of the infection disappear. D) Make sure to notify your primary health care provider if you develop any adverse reactions.

Ans: D Feedback: The nurse should instruct the patient to report adverse reactions to the primary health care provider. The nurse should also tell the patient to report any increase in temperature, even if it is a slight increase. If the patient misses a dose, the next dose should be taken as soon as remembered, but it should not be doubled. The nurse should also instruct the patient to take the drug exactly as directed for the full course of therapy, even if the symptoms of the infection disappear.