Pharmacology Chapter 93
Which approach should a nurse take to administer intravenous (IV) acyclovir (Zovirax) to an immunocompromised patient? A) Infuse IV fluids during administration of the dose and for 2 hours afterward. B) Administer IV acyclovir diluted in 20 mL normal saline (NS) over 10 minutes. C) Only infuse the drug if the white blood cell (WBC) count is above 2500/mm3. D) Ask the provider to change the route to subcutaneous (subQ) injection.
A Acyclovir can cause renal damage, and hydration of the patient during the infusion and for 2 hours afterward minimizes this risk. Acyclovir is not given by IV bolus or by intramuscular (IM) or subQ injection. It is used to treat infections in immunocompromised patients, but the dose is not changed or affected by the WBC count.
A nurse is preparing to administer ganciclovir (Cytovene) to a patient for treatment of Cytomegalovirus (CMV) pneumonitis. Which laboratory result should the nurse recognize as a contraindication to use of this drug? A) Neutrophil count below 500/mm3 B) Platelet count of 350,000/mm3 C) Serum calcium level of 9.5 mg/dL D) Reduced forced vital capacity (FVC)
A Ganciclovir is used to treat and prevent CMV infection in immunocompromised patients. Bone marrow suppression is a dose-limiting toxicity of ganciclovir; therefore, the drug is contraindicated in patients with neutrophil counts below 500/mm3 or platelet counts below 25,000/mm3. It does not affect the serum calcium level or FVC, a measure of lung function in patients who have airflow-restrictive disorders.
A nurse administering flu vaccines at an annual clinic should recognize that which individuals should be vaccinated, as recommended by the Advisory Committee on Immunization Practices (ACIP)? (Select all that apply.) A) Women who will be pregnant during flu season B) All children 6 months and older and older adults C) Those who report severe allergy to chicken eggs D) Those who have a history of Guillain-Barré syndrome E) Those 6 months to 18 years old receiving aspirin therapy
A,B,E The ACIP recommends flu vaccination for all children 6 months and older and for older adults. Individuals at high risk of complications from the flu who also should be vaccinated include women who will be pregnant during flu season and children receiving long-term therapy with aspirin (to prevent Reye's syndrome). Influenza vaccines are produced from viruses grown in eggs and should be avoided in persons with allergies to chicken eggs. Influenza vaccine may carry a small risk of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, and should be avoided in those who have experienced it.
When teaching a patient about therapy with Famciclovir, which statement(s) does the nurse include? (Select all that apply.) A) Famciclovir is generally well tolerated. B) Famciclovir is safe to use during pregnancy. C) Famciclovir is administered intravenously. D) Famiciclovir is used in the treatment of acute herpes zoster. E) Famiciclovir is contraindicated in the treatment of herpes simplex genitalis.
A,D Famiciclovir is generally well tolerated and is used in the treatment of acute herpes zoster as well as herpes simplex genitalis. The safety of Famiciclovir during pregnancy and breat-feeding and in children younger than 18 years has not been established. Famiciclovir is supplied in tablets for oral dosing.
A nurse develops a plan of care for a patient who has an outbreak of recurrent genital herpes and is taking oral acyclovir (Zovirax). Which outcome should be included? A) Minimal scarring from lesions B) Less frequent eruption of lesions C) Prevention of transmission to contacts D) Complete eradication of the virus
B Acyclovir is used to treat herpes simplex infections caused by type 2 herpes simplex virus (HSV-2). For patients with recurrent herpes genitalis, oral therapy reduces the frequency with which lesions appear. It does not eradicate the virus or produce cure. Acyclovir does not prevent transmission of the virus to sexual contacts. It does not affect scarring from lesions.
The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus? A) Ganiciclovir B) Amantadine C) Acyclovir D) Oseltamivir
C Acyclovir is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus. Ganiciclovir is the drug of choice for prophylaxis and treatment of CMV infection in immunocompromised patients, including those with AIDS. Amantadine and Oseltamivir are drugs of choice for the treatment and prophylaxis of influenza.
What is the priority instruction a nurse gives to a male patient who is scheduled to receive ribavirin (Rebetol) combined with peg-interferon-alfa-2a for treatment of hepatitis C? A) "Combining these two medications will greatly increase response rates." B) "An antidepressant can be prescribed to alleviate symptoms of depression." C) "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." D) "It is very important that you have blood counts checked every 2 weeks."
C Because ribavirin is embryolethal when taken by female patients and causes sperm abnormalities when taken by males, it is a priority that pregnancy be avoided during its use. Pregnancy must be avoided both by female patients and by female partners of men taking ribavirin. Couples should use two reliable forms of birth control during treatment and for 6 months afterward. It is less important that the patient know that ribavirin is not effective against hepatitis C unless it is combined with interferon alfa. Less important information to provide than avoiding pregnancy includes: hemolytic anemia is an adverse effect; frequent blood checks are advised; and depression is an adverse effect of peg-interferon-alfa-2a for which antidepressants can be prescribed.
A nurse should recognize that for maximum therapeutic effects against the influenza virus, oseltamivir (Tamiflu) should be taken when? A) Two days or more after symptom onset B) When lung crackles are present C) Within 12 hours of symptom onset D) Only when fever is above 102°F
C Oseltamivir is a neuraminidase inhibitor that is effective against the influenza A and influenza B viruses. Its benefits decline greatly when treatment is delayed. Dosing must begin early—no later than 2 days after symptom onset. If treatment is started within 12 hours of symptom onset, symptom duration is reduced by more than 3 days. Specific symptoms, such as lung crackles and fever above 102°F, are not criteria for receiving oseltamivir.
A nurse is providing teaching to a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? A) In the United States, flu season usually peaks in October or November. B) To insure full protection, the best time to vaccinate is September. C) For people who missed the best time, vaccinating as late as April may be of help. D) The influenza vaccine may not be administered at the same time as the pneumococcal vaccine.
C Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate is October or November. For people who missed the best time, vaccinating as late as April may be helpful. Influenza vaccine may be given at the same time as other vaccines, including pneumococcal vaccine.
A patient has been diagnosed with respiratory syncytial virus. The nurse anticipatates administration of which drug(s)? (Select all that apply._ A) Ganciclovir B) Oseltamivir C) Ribavirin (inhaled) D) Palivizumab E) Entecavir
C,D Ribavirin (inhaled) and Palivizumab are used for the treatment of RSV. Ganiciclovir is useful in the treatment of cytomegalovirus. Oseltamivir is used for the treatment of Influenza A and B. Entacavir is a nucleoside analog used in the treatment of HBV.
A patient is receiving weekly subcutaneous injections of peg-interferon-alfa-2a (Pegasys) for chronic hepatitis C. A nurse teaches the patient that which adverse effect will diminish with continued therapy? A) Black, sticky, tarry stools B) Lower leg muscle weakness C) Dyspnea and wheezing D) Flulike symptoms
D The most common adverse side effect of peg-interferon-alfa-2a, a long-acting interferon used to treat chronic hepatitis C, is flulike symptoms characterized by fever, fatigue, myalgia, headache, and chills. Symptoms are likely to diminish with continued therapy over time. Black, tarry stools; lower leg muscle weakness; dyspnea; and wheezing are not adverse effects of peg-interferon-alfa-2a.
