Ch 23 Drug Therapy for Viral Infections

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

A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection 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.

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

A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection Acyclovir is indicated for the treatment of herpesviruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV; it is not effective against hepatitis or RSV.

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. if the client has a CD4 T-cell count less than 350 cells/mm3 B. when the client is coinfected with hepatitis C C. if the client is diagnosed with HIV-associated liver disease D. after the client has been cured of Kaposi's sarcoma

A. if the client has a CD4 T-cell count less than 350 cells/mm3 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.

After lunch, the patient asks the nurse how she could have contracted the MRSA infection. What is the nurse's best response? A. "MRSA is spread by direct contact in hospitals and communities." B. "People who travel to third-world countries always return with MRSA." C. "In the community, MRSA is transmitted by the airborne route carried by droplets." D. "The most common way for MRSA to spread is through coughing illnesses such as flu."

ANS: A MRSA is spread by direct contact, such as with indwelling catheters, vascular access devices, and endotracheal tubes, in the hospital and community settings.

Amantadine has been administered within a long-term care facility for the past 3 weeks following outbreak of influenza. The nurse would monitor for which adverse effects among clients receiving the drug? Select all that apply. Nausea Dizziness Anorexia Constipation Extrapyramidal symptoms

Anorexia Nausea Constipation Dizziness

The nursing instructor realizes that a student needs further explanation when the student makes which of the following statements? a) "Antivirals are the cure for viral infections." b) "When applying a topical antiviral, the nurse should use a finger cot or gloves." c) "Antiviral drugs will not prevent the spread of the disease to others." d) "Topical antivirals should not be applied more frequently than prescribed."

Answer: "Antivirals are the cure for viral infections." Antiviral drugs are not a cure for viral infections, but they will shorten the course of disease outbreaks and promote healing of the lesions. All of the other statements are true.

In providing care to a client with HIV, the nurse knows that reverse transcriptase, an enzyme found in retroviruses, affects RNA and DNA in which of the following ways? a) It turns RNA into DNA, which helps reproduce more of the virus. b) It turns DNA into RNA to stop the spread of the virus so that the host is not killed. c) It turns RNA into DNA to stop the spread of the virus so that the host is not killed. d) It turns DNA into RNA, which helps reproduce more of the virus.

Answer: It turns RNA into DNA, which helps reproduce more of the virus. Reverse transcriptase turns RNA into DNA, which helps reproduce more of the virus.

A patient with skin lesions due to a viral infection has been prescribed topical application of an antiviral. Which of the following points should the nurse inform the patient regarding the therapy and the infection? a) Topical drugs should be applied by hand and not finger cot or gloves. b) The drug will not prevent the spread of the disease to others. c) All lesions should be left open and not covered in any way. d) Sexual contact during lesions is permissible if barrier methods are used.

Answer: The drug will not prevent the spread of the disease to others.

Specific antiretrovirals work in different ways. Which of the following describes one mechanism of action of antiretrovirals? a) They are entry inhibitors, which prevent the attachment of the RNA and DNA to the cell wall. b) They are protease inhibitors, which block the protease enzyme so the new viral particles cannot mature. c) They are entry inhibitors, which prevent the virus from breaking down DNA. d) They are protease inhibitors, which block the entry into the cell.

Answer: They are protease inhibitors, which block the protease enzyme so the new viral particles cannot mature.

The nurse instructs a group of young adults about what method that is least likely to prevent sexually transmitted viral infections such as genital herpes? a) Avoiding sex when skin lesions are present b) Complete abstinence c) Use of a diaphragm when lesions are present d) Using condoms

Answer: Use of a diaphragm when lesions are present

The nursing student is learning about the different ways diseases are produced and demonstrates an understanding when identifying which of the following as the smallest infectious organism? a) Parasite b) Virus c) Bacterium d) Fungus

Answer: Virus Rationale: Compared with a fungus, parasite, and bacterium, the virus is a very small infectious organism

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

Antivirals do not eliminate existing viruses from tissues. 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.

A client who has been diagnosed with human immune deficiency syndrome is prescribed ganciclovir to prevent cytomegalovirus. As a result of the therapy, the client develops granulocytopenia resulting in severe bone marrow suppression. How long will it take for the granulocytes to regenerate after the ganciclovir is discontinued? A) 8 hours B) 7 days C) 3 weeks D) 1 month

B) 7 days

The mother of an infant infected with human immunodeficiency virus (HIV) has a low viral load and gives birth to a healthy baby boy. What is the most appropriate medical intervention? A) Administer the adult dose of stavudine to the infant. B) Administer zidovudine and nevirapine. C) Assess the infant's viral load. D) Perform HIV testing on delivery.

B) Administer zidovudine and nevirapine.

A nurse is caring for a client who has a new prescription for enfuvirtide to treat HIV infection. The nurse should monitor the client for which of the adverse reactions of this medications? SELECT ALL THAT APPLY. A) Bleeding B) Pneumonia C) Cerebral edema D) Localized erythema E) Hypotension

B) Pneumonia D) Localized erythema E) Hypotension

An older adult client with a creatinine level of 4.0 mg/dL and a diagnosis of herpes simplex is prescribed acyclovir. When preparing to administer this medication parenterally, what would the nurse expect in regard to medication dosage? A) The dose is smaller due to the herpes simplex. B) The dose is smaller based on the client's kidney function. C) The dose is higher in treating if treating genital herpes. D) The dose is higher if the creatinine is above 4.0 mg/dL.

B) The dose is smaller based on the client's kidney function.

A client diagnosed with cytomegalovirus (CMV) should be educated to the possible prescription of which drugs for the treatment of this disease? SELECT ALL THAT APPLY. A) ribavirin B) ganciclovir C) foscarnet D) valganciclovir E) cidofovir

B) ganciclovir C) foscarnet D) valganciclovir E) cidofovir

A 5-month-old infant is receiving ribavirin for respiratory syncytial virus. The nurse assesses the infant visually. Which of the following indicate that the infant's pulmonary status is impaired? A) shallow respirations B) nasal flaring C) respiratory rate of 36 breaths/min D) sleeping

B) nasal flaring

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? A) saquinavir mesylate B) oseltamivir phosphate C) lamivudine D) ribavirin

B) oseltamivir phosphate

An infant is born to a mother infected with human immunodeficiency virus (HIV). When is it appropriate to administer zidovudine? A) following a positive HIV test B) within 6 to 12 hours after birth C) within the first 2 days of life D) only if the viral load is decreased

B) within 6 to 12 hours after birth

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. Combination antiretroviral therapy 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 man with a fever, cough, and clear drainage from the nose presents to the clinic. A nurse practitioner diagnoses a viral infection. Which of the following describes the replication of the viral infection? A. The RNA of an infected person has invaded the man's mucous membranes. B. There are breaks in the cell membrane of the infected cells. C. Antibodies are defending against microbial cell invasion. D. The white blood cell count increases.

B. There are breaks in the cell membrane of the infected cells.

A patient began combination antiretroviral therapy 7 months ago and is being followed closely by a care team that includes members of several disciplines. When attempting to determine the efficacy of the patient's current drug regimen, the nurse should prioritize which of the following laboratory data? Viral load CD4 cell count Total leukocyte level Neutrophil level

CD4 cell count

When administering the fusion protein inhibitor enfuvirtide, the nurse should include which technique to assure the medication's continued effectiveness? A) Have the client gargle with normal saline immediately after taking the drug. B) Flush the client's central venous catheter with 100 Unit/mL heparin prior to administration. C) Inject the drug into the client's ventrogluteal site using the Z-track method. D) Regularly rotate the subcutaneous injection sites that are used.

D) Regularly rotate the subcutaneous injection sites that are used.

A high school student, who has experienced repeated outbreaks of cold sores, reports no success with an over-the-counter (OTC) topical cream. The nurse should recognize that this student used what OTC drug? A) ganciclovir B) valacyclovir C) famciclovir D) docosanol

D) docosanol

A man has an elevated uric acid level, and he receives a prescription for probenecid. He also has cold sores on his mouth due to exposure to the sun, which is being treated with acyclovir. What effect will occur with the administration of these medications? A) decreased serum acyclovir B) elevated aspartate aminotransferase and alanine aminotransferase C) increased serum uric acid D) increased serum acyclovir

D) increased serum acyclovir

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? A) oral suspension B) topical C) intravenous D) inhaled

D) inhaled

A 55-year-old woman takes oseltamivir for the treatment of influenza A. Which viral enzyme does it inhibit in the treatment of influenza? A) trypsin B) amylase C) lipase D) neuraminidase

D) neuraminidase

A patient has been admitted to the infectious disease division. The physician has ordered enfuvirtide 90 mg twice daily. What is the recommended route of administration of enfuvirtide? A) intravenous B) oral C) intramuscular D) subcutaneous

D) subcutaneous

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 of laboratory value? A) the client's C-reactive protein levels B) the client's erythrocyte sedimentation rate (ESR) C) the client's viral load D) the client's CD4 count

D) the client's CD4 count The most important consideration in decisions to initiate antiretroviral therapy is CD4 counts.

A 25-year-old man with asthma develops influenza A. Which of the following medications is contraindicated for the treatment of influenza A in this case? A) acetaminophen B) pseudoephedrine C) oseltamivir D) zanamivir

D) zanamivir

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

A. The CD4 count is an indication of the patient's current immunological status.

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. client's general state of health C. resistance to infection E. vital signs 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.

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

A. clients with renal impairment 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.

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. "You could skip it this year, but I would suggest you taking it next year." B. "If you don't get the flu vaccine, you could die if you get the flu." C. "If you have never had the flu, there is no reason for you to get the vaccine now." D. "All HIV-positive patients should receive the flu vaccine as prophylaxis."

D. "All HIV-positive patients should receive the flu vaccine as prophylaxis." Every HIV-positive patient should receive annual influenza virus prophylaxis. The preferred drug is inactivated trivalent influenza virus vaccine, one dose annually.

A non-nucleoside reverse transcriptase inhibitor has direct effects on the HIV virus activities within the cell. What drug is a non-nucleoside reverse transcriptase inhibitor? Econazole nitrate Efavirenz Oxaliplatin Olanzapine

Efavirenz

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 Subcutaneous Intramuscular Intravenous

Oral

The nurse is assessing a client admitted with AIDS whose current antiretroviral regimen includes a nonnucleoside reverse transcriptase inhibitor. What nursing diagnosis related to drug therapy is most likely to be appropriate for this client? risk for injury related to central nervous system (CNS) effects of the drug deficient fluid volume related to diuretic effects imbalanced nutrition: less than body requirements, related to gastrointestinal (GI) effects of the drugs excess fluid volume related to renal failure

imbalanced nutrition: less than body requirements, related to gastrointestinal (GI) effects of the drugs

An immunocompromised 3-year-old has been exposed to avian flu. The client is brought to the clinic, and the mother reports that the client has had flu-like symptoms for the past 12 hours. What medication should the nurse expect to administer? ribavirin zanamivir amantadine oseltamivir

oseltamivir *Oseltamivir is the only antiviral agent that has been shown to be effective in treating avian flu.*

A young adult, diagnosed with hepatitis B virus (HBV), has been prescribed treatment with lamivudine. Shortly after beginning treatment, the client reports experiencing intense abdominal pain. The nurse should recognize the possibility of what possible medication-associated adverse effect? A) gastroenteritis B) gastroesophageal reflux disease C) bowel obstruction D) pancreatitis A man is taking lamivudine. He states that he has severe upper abdominal pain. On assessment, he has guarding. What would the nurse suspect is wrong with the patient? A) hepatomegaly B) pancreatitis C) epiglottitis D) cardiomyopathy

pancreatitis

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? Which of the following blocks the protease enzyme so new viral particles cannot mature? (Choose one) entry inhibitors protease inhibitors reverse transcriptase inhibitors integrase inhibitors

protease inhibitors 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.

A child is prescribed ribavirin for a diagnosis of respiratory syncytial virus (RSV). The nurse should assess the client often for which possible adverse reaction(s)? Select all that apply. headache pulmonary embolism rhinitis bronchospasm conjunctivitis

rhinitis headache bronchospasm conjunctivitis

A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this medication? A) Increased TSH level B) Decreased ALT level C) Hypoglycemia D) Hyperlipidemia

D) Hyperlipidemia

As the nurse caring for Ms. Quil, you discuss home administration of zidovudine. Which statement by Ms. Quil indicates she needs additional teaching in order to understand correct self-administration? "I need to eat a high-carbohydrate diet while taking this medication." "I can eat just before taking the medication." "I will take the medication at the same time daily." "I can consume as many fats as I want."

"I can consume as many fats as I want." Assess the patient's typical dietary habits. Although zidovudine is taken without regard to meals, avoidance of fatty foods is important because these foods decrease the drug's absorption. Outline a high-carbohydrate, moderate-protein, low-fat diet.

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." "I was happy to learn that there aren't that many side effects of this drug." "I'm glad that there something I can take that will help to heal my lesions." "I know that this medication doesn't guarantee the infection won't return."

"It's a relief to know that this drug will stop me from spreading the infection."

The nurse is giving discharge instruction to a client who has been prescribed efavirenz as treatment for HIV. Which instruction is most important for the nurse to give this client to minimize the CNS adverse effects of this medication? "Take the medication at bedtime." "Take the medication with orange juice." "Take the medication with a high-fat meal." "Take the medication with herbal tea."

"Take the medication at bedtime."

The client is prescribed docosanol to treat a cold sore on the lip. The client tells the nurse, "I've read some bad things online about the side effects. Is it safe to use?" What is the nurse's best response? "Topical medications do not cause any adverse effects because the medication is just applied to the skin and doesn't enter circulation." "It is important to follow directions and do not stop use of this medication to avoid adverse effects." "Make sure to avoid using this drug if you are taking St. John's wort because that increases the risk of adverse effects." "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."

"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."

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

"This medication will maintain the symptoms and cure my disease." 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.

A nurse is teaching a client with herpes zoster to apply acyclovir ointment. What guidance should the nurse include in the instructions? "Wash the medication from your hands immediately after application." "If you miss a dose, apply twice as much ointment the next time." "Wear gloves when applying the ointment." "Take this drug orally."

"Wear gloves when applying the ointment."

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: 6 days. 8 days. 2 days. 4 days.

2 days.

A primary health care provider has prescribed 6000 mg of foscarnet per day to be administered intravenously. In the pharmacy, foscarnet is available in a 500 mL IV piggyback. The strength of the drug in the solution is 24 mg/mL. How many mL of the solution should the nurse administer to the client in a day? 1000 mL 500 mL 750 mL 250 mL

250mL

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? 1200 mg 600 mg 900 mg 300 mg

300 mg Each dose will contain 300 mg of acyclovir. (60 kg × 5 mg/kg = 300 mg.)

A client taking nevirapine as part of combination therapy for treatment of HIV took 200 mg/daily PO for 14 days. The client is now taking 200 mg PO twice daily. How many milligrams of the medication is the client taking daily?

400

Which nursing intervention is necessary when caring for a client diagnosed with hepatitis A? SELECT ALL THAT APPLY. A) Chlorine wipes are effective for disinfection purposes. B) Effective handwashing is vial in the prevention of cross infection. C) Treat jaundice as a rare but deadly symptoms of a hepatitis A infection. D) Educate the client that immunity rarely occurs and vaccination is necessary. E) Educate personal contacts that client is infectious for up to 10 days after symptoms appear.

A) Chlorine wipes are effective for disinfection purposes. B) Effective handwashing is vial in the prevention of cross infection. E) Educate personal contacts that client is infectious for up to 10 days after symptoms appear.

A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat HIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? SELECT ALL THAT APPLY. A) Fatigue B) Blurred vision C) Ataxia D) Hyperventilation E) Vomiting

A) Fatigue D) Hyperventilation E) Vomiting

A patient receives a prescription for valganciclovir for the prevention of cytomegalovirus infections following organ transplantation. Which of the following nursing interventions should be implemented? A) Instruct the patient to take the medication following a meal high in fat. B) Instruct the patient to take the meal with large amounts of fluids. C) Instruct the patient to report abdominal pain. D) Instruct the patient to report diminished sense of hearing.

A) Instruct the patient to take the medication following a meal high in fat.

What is the action of raltegravir? A) It blocks HIV integrase. B) It increases viral load. C) It diminishes cell membrane permeability. D) It increases white blood cell count.

A) It blocks HIV integrase.

Why would patients with genital herpes receive acyclovir? A) It decreases viral shedding and pain related to outbreak. B) It eliminates future viral outbreaks. C) It prevents sterility in infected patients. D) It prevents the development of cytomegalovirus.

A) It decreases viral shedding and pain related to outbreak.

An HIV-positive man who takes etravirine (Intelence) develops a fungal infection following a trip to the Caribbean. He is admitted to the hospital, where he receives intravenous amphotericin B for the fungal infection. What effect will etravirine have on amphotericin B? A) The antifungal activity will be diminished when combined with etravirine. B) The serum amphotericin B level will become toxic. C) The patient will require a stronger antifungal agent to prevent resistance. D) The two drugs are synergistic and will work together to fight the fungal infection.

A) The antifungal activity will be diminished when combined with etravirine.

A woman experiences recurrences of herpes simplex, with an outbreak on her lips. Which medication can she apply in the early stages of the viral illness? A) docosanol B) valganciclovir C) Neosporin D) tobramycin

A) docosanol

A man infected with HIV is taking nevirapine (Viramune) and zidovudine (AZT). He develops a fever, malaise, and jaundice. He is at risk for which of the following conditions? A) hepatic failure B) heart failure C) pneumonia D) methicillin-resistant Staphylococcus aureus

A) hepatic failure

Which of the following electrocardiographic changes warrant the discontinuation of saquinavir mesylate? A) prolongation of the QT interval B) inverted T wave C) elongated ST segment D) premature ventricular contraction

A) prolongation of the QT interval

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. "As long as I am taking the HAART therapy, I cannot transmit the virus to anyone else." 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.

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 E. Antitranscription

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

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? A. Avoid high-fat meals while taking this medication B. Limit fluid intake to 2 liters a day C. Limit sodium intake to 2 grams per day. D. Avoid meals high in protein while taking this medication

A. Avoid high-fat meals while taking this medication 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

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

A. Cytomegalovirus

Assessment of a client who is receiving nelfinavir reveals a severe life-threatening arrhythmia. The nurse would check the client's history for use of: A. Midazolam B. Warfarin C. Clarithromycin D. Quinidine

A. Midazolam

A client 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 client's HIV? A. Nelfinavir B. Indinavir C. Fosamprenavir D. Lopinavir

A. Nelfinavir

After the patient is settled in her room, what special precautions does the nurse implement based on the patient's diagnosis? (Select all that apply.) A. Keep the door closed at all times. B. Wear gloves when entering the room. C. Wear a mask when working within 3 feet of the patient. D. Wear a gown to prevent contact with contaminated items. E. Dedicated equipment should be used for this patient alone.

ANS: B, D, E The patient should be taught to perform frequent handwashing. Health care personnel and visitors should wear gloves upon entering the room to prevent contact with the patient, contaminated items, or uncontrolled body fluids. Handwashing should be performed before leaving the room. There should also be dedicated equipment for this patient to prevent the spread of infection. A mask should be worn with Airborne and Droplet Precautions. The door should be kept closed with Airborne Precautions, not Contact Precautions.

An hour later, the nurse is preparing to administer the patient's medications. Which drug was likely ordered by the provider to combat the patient's MRSA? A. Amoxicillin (Amoxil) B. Ciprofloxacin (Cipro) C. Vancomycin (Vancocin) D. Erythromycin (Erythrocin)

ANS: C MRSA is susceptible to only a few antibiotics such as vancomycin (Vancocin) and linezolid (Zyvox), as well as ceftaroline fosamil.

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 Activity level High-calorie diet Fluid intake

Alcohol use 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.

The nurse is teaching a client with HIV about his new antiviral drug regimen. Which of the following client statements would suggest that the teaching plan was effective? a) "I will have to remain on this drug regimen until I have been cured." b) "If I miss a dose, I should double the next dose to make up for it." c) "I should start taking herbal supplements to meet my nutritional needs." d) "I should expect some nausea and vomiting."

Answer: "I should expect some nausea and vomiting." Nausea, vomiting, diarrhea, and anorexia are common adverse effects of antiviral drugs. Effective therapy relies on adherence to the prescribed dosing schedule; although clients should avoid missing doses, they should not take additional doses to make up for those they missed. Clients should not take other medications or supplements without first speaking with the prescribing physician. Antiviral drugs may relieve the symptoms of HIV, but they will not cure the disease.

A college student is given valacyclovir for HSV-2 infection. He states that he is glad that the medicine will get rid of the infection so he doesn't have to worry about giving it to anyone else. What would be the nurse's appropriate response to that statement? a) "It's obvious you are sexually active with many people. You need to stop having intercourse with many partners and grow up. You are in college now and should be worried about your studies. Besides, you should always use condoms so that you don't become a father too soon." b) "Valacyclovir can give some people nausea and vomiting. It could help to eat something like crackers before taking this medication. Let me know if that happens to you for more than a couple of doses. If you don't get these side effects you are lucky and can continue to study hard for your final exams." c) "HSV-2 infections only occur on the genitals so you can't spread it anyway. If you had HSV-1 it would be more concerning because that can easily be spread by kissing or touching the lesion on the other person's face." d) "Valacyclovic does not cure HSV-2. It helps to alleviate the frequency and severity of outbreaks. You could still spread the disease to others through contact. You should talk to your partner and have him or her tested and then decide if you want to use barrier methods (such as condoms) to decrease the chance of spreading the disease."

Answer: "Valacyclovir does not cure HSV-2. It helps to alleviate the frequency and severity of outbreaks. You could still spread the disease to others through contact. You should talk to your partner and have him or her tested and then decide if you want to use barrier methods (such as condoms) to decrease the chance of spreading the disease."

Viral infections commonly occur in what age group? a) Infants b) Young children c) All age groups d) Older adults

Answer: All age groups

The nurse is caring for four patients, and understands that which is at greatest risk of infection? A. 19-year old with stomach pain. B. 24-year old with chronic kidney disease. C. 36-year-old prescribed a 10-day steroid tapper. D. 64-year-old with history of prostate hyperplasia.

Answer: B Rationale: The patient's immune status plays a large role in determining risk for infection. Congenital abnormalities, acquired health problems (for example, kidney injury, steroid dependence, cancer, AIDS) and advancing age can increase a patient's risk of developing immunologic deficiencies. Chronic physical and psychological stress can also depress the immune system, making the patient more susceptible to infection.

Cleansing hands with an alcohol-based hand rub is appropriate in which situation? A. After using the bathroom. B. To cleanse visibly soiled or sticky hands. C. After handing oral medications to a patient. D. After working with a patient who has diarrhea due to Clostridium difficile.

Answer: C Rationale: Alcohol-based hand rubs (ABHRs) are not appropriate if one's hands are visibly dirty, soiled, or feel sticky, or if you have just toileted. In these cases, wash your hands instead of using ABHRs. ABHRs are also ineffective against spore-forming organisms such as C. difficile.

A client who is one day postoperative organ transplant learns about the CMV-IGIV immunization agent from the nurse after voicing concern about the potential for a virus infection. The client confirms understanding of the information and then asks if the agent has adverse effects. The nurse spends additional time teaching the client about which of the following expected adverse reactions after CMV-IGIV administration a) CMV-IGIV can cause injection site pain and tenderness, muscle stiffness, headache, chills, and fever. b) CMV-IGIV can cause arthralgia, malaise, nausea, headache, chills, and fever. c) CMV-IGIV can cause blurred vision, dizziness, rhinitis, headache, chills, and fever. d) CMV-IGIV can cause itching, burning, rash, headache, chills, and fever.

Answer: CMV-IGIV can cause injection site pain and tenderness, muscle stiffness, headache, chills, and fever. Rationale: CMV-IGIV can cause injection site pain and tenderness, muscle stiffness, headache, chills, and fever. Itching, burning, rash, rhinitis, arthralgia, malaise, and nausea are not expected adverse reactions.

Ms. Kates has been treated with abacavir for the past 6 weeks. She contacts the physician's office with the following complaints: diarrhea, abdominal pain, sore throat, cough, and shortness of breath. Which of the following is the appropriate action to take for this situation? a) Discontinue the therapy and then reintroduce it. b) Reduce the dose. c) Discontinue the therapy. d) Administer the drug at bedtime.

Answer: Discontinue the therapy Rationale: 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.

What constitutes viral load? a) HIV RNA particles within the blood b) All sites of viral reproduction c) HIV DNA particles within the blood d) Viral levels in the tissues

Answer: HIV RNA particles within the blood

As a nursing student, you have been immunized against several viruses. Hepatic viruses, for which there are effective vaccines, include: a) Hepatitis A and B. b) HPV and HIV. c) Herpes zoster and hepatitis A. d) Influenza A and B.

Answer: Hepatitis A and B

Acyclovir is useful to treat which infection? a) Herpes zoster b) Hepatitis A c) RSV d) Influenza

Answer: Herpes zoster Its antiviral spectrum is limited to the herpesviruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV.

To prevent viral infections, what precaution should the general public take? Wear masks. Wear personal protective equipment. Use intermittent hand hygiene. Become vaccinated against prevalent virus infections.

Become vaccinated against prevalent virus infections.

A client, who began antiretroviral therapy several weeks ago, states to the nurse, "I've been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend." How should the nurse best respond to this client's statement? SELECT ALL THAT APPLY. A) "Remember that if you miss a dose, you need to take a double dose at the next scheduled time." B) "It's acceptable to miss an occasional dose as long as your symptoms don't get worse, but it's not really recommended." C) "Remember that your antiretroviral drugs will only be effective if you take them very consistently." D) "If you're not consistent with taking your medications, you're likely to develop more side effects." E) "Missing doses occasionally is alright but be sure you make up for the missed doses."

C) "Remember that your antiretroviral drugs will only be effective if you take them very consistently." D) "If you're not consistent with taking your medications, you're likely to develop more side effects."

A nurse is teaching a client who has a new prescription for combination oral NRTIs (abacavir, lamivudine, and dolutegravir) for treatment of HIV. Which of the following statements should the nurse include? A) "These medications work by blocking HIV entry into cells." B) "These medications work by weakening the cell wall of the HIV virus." C) "These medications work by inhibiting enzymes to prevent HIV replication." D) "These medications work by preventing protein synthesis within the HIV cell."

C) "These medications work by inhibiting enzymes to prevent HIV replication."

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 therapy may result in the development of AZT-resistant strains." C) "Zidovudine slows the progression of the disease but does not cure it." D) "Zidovudine prevents the occurrence of opportunistic infections."

C) "Zidovudine slows the progression of the disease but does not cure it." 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 man with human immunodeficiency virus is on hemodialysis for renal failure. Cytomegalovirus retinitis develops. Which of the following is most important when administering ganciclovir? A) Administer the medication on an empty stomach. B) Assess the patient's vision following the medication administration. C) Administer ganciclovir after dialysis is completed. D) Assess the patient's sodium level following dialysis.

C) Administer ganciclovir after dialysis is completed.

A woman is using topical acyclovir. Which of the following is the most important intervention to instruct the patient regarding medication administration? A) Administer the medication after meals to enhance absorption. B) Discontinue the medication when lesions are crusted over. C) Apply the medication to the lesions with a gloved hand. D) Increase oral fluids to enhance healing.

C) Apply the medication to the lesions with a gloved hand.

When caring for an infant receiving ribavirin, the nurse notes the fluid level is low in the SPAG-2 unit. What action should the nurse take? A) Discard the remaining fluid and add more fluid. B) Add 10 mL of normal saline to the SPAG-2 unit. C) Discard the SPAG-2 unit. D) Add sterile water to the SPAG-2 unit.

C) Discard the SPAG-2 unit.

A nurse is administering IV acyclovir to a client who has varicella. Which of the following actions should the nurse take? A) Administer a stool softener. B) Decrease fluid intake following infusion. C) Infuse acyclovir over 1 hr. D) Monitor for hypotension.

C) Infuse acyclovir over 1 hr.

A 2-year-old child is started on nelfinavir mesylate. The nurse is instructing the mother on the proper administration of the medication. Which of the following is most appropriate to teach the mother? A) Squirt the medication in the mouth with a syringe. B) Tilt the head back and place the medicine in a nipple. C) Mix the medicine with water, milk, or formula. D) Mix the medicine in orange juice.

C) Mix the medicine with water, milk, or formula.

A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following information should the nurse teach the client about resistance? A) Taking low dosages of antiretroviral medication minimizes resistance. B) Taking one antiretroviral medication at a time minimizes resistance. C) Taking medication at the same times daily without missing doses minimizes resistance. D) Changing the medication regimen when adverse effects occur minimizes resistance.

C) Taking medication at the same times daily without missing doses minimizes resistance.

A client is prescribed acyclovir for the treatment of genital herpes. What is the expected outcome of this medication? A) decreased testosterone production B) decreased libido C) decreased viral shedding D) decreased bacterial replication

C) decreased viral shedding

A woman is taking lamivudine for chronic hepatitis B. She reports that her stools float and are clay colored. In addition, she complains of musculoskeletal pain. What would the nurse suspect has contributed to the development of these clinical manifestations? A) cirrhosis B) ascites C) lactic acidosis D) pulmonary edema

C) lactic acidosis

A client has sought care after "feeling under the weather" for several days. What signs and symptoms would support the presence of a viral infection? SELECT ALL THAT APPLY. A) increased white cell count B) idiopathic bleeding C) malaise D) fever E) headache

C) malaise D) fever E) headache

A client, undergoing treatment for cytomegalovirus, received an initial dose of IV ganciclovir 3 days ago. When reviewing this client's most recent blood work, what abnormality should the nurse recognize as a possible adverse effect of this drug? A) hemoglobin 17 g/dL (high normal) B) prothrombin time (PT) 3.8 (high) C) platelet count 118,000/mm3 (low) D) leukocytes 11,900/mm3 (high)

C) platelet count 118,000/mm3 (low)

A physician prescribes maraviroc for a man with human immunodeficiency virus (HIV). The nurse should instruct the man to be alert for what adverse effect? A) edema B) cardiac abnormality with chest pain C) yellowing of skin D) bronchospasm

C) yellowing of skin

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? A. The patient should limit carbohydrates when taking this medication. B. The patient should limit proteins while taking this medication. C. The patient should not take this medication with grapefruit or pomegranate juice. D. The patient is not restricted to a specific diet while taking this medication.

C. The patient should not take this medication with grapefruit or pomegranate juice.

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 facilitate increased adherence to treatment. B. They decrease the length of illness. C. They have synergistic antiviral effects. D. They prevent the development of any opportunistic infections.

C. They have synergistic antiviral effects. Because the two types of drugs inhibit reverse transcriptase by different mechanisms, they may have synergistic antiviral effects. The use of two medications may decrease compliance because of the burden of taking two medications. The use of two medications will not decrease the length of the illness. They will not decrease all opportunistic infections.

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 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.

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? AST RBCs CD4 BUN

CD4

A client is diagnosed with HIV infection. What is the most important factor to consider when initiating chemoprophylaxis? Mr. Hart, 37 years old, is diagnosed with HIV infection. What is the most important factor to consider when initiating chemoprophylaxis? prior history of infections CD4 count band cells present WBC level

CD4 count CD4 cell counts are an indication of the current immunologic status of the patient. In the healthy patient, the CD4 cell count ranges from 800/mm3 to 1,200/mm3. In addition, the CD4 cell count is the most important consideration for initiating chemoprophylaxis for opportunistic diseases.

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 Kaposi's sarcoma Diarrhea Pneumocystis pneumonia

CMV retinitis

A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurse's best response? A. "There's no way to be sure you won't get HIV except to use condoms correctly." B. "The correct use of male and female condoms protects against the transmission of HIV." C. "There are new ways of protecting yourself from HIV that are being discovered every day." D. "Other than abstinence, only the consistent and correct use of condoms is effective in decreasing the risk of getting HIV."

D. "Other than abstinence, only the consistent and correct use of condoms is effective in decreasing the risk of getting HIV."

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? A. Cutaneous eruptions B. Erythema C. Cholestatic hepatitis D. Signs of microbial resistance

D. 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? A. The client can choose an alternative, less expensive medication and later shift to taking antiretroviral medications B. It is not the responsibility of the nurse to advise clients on the financial aspect of a treatment C. The client should consider a second opinion from another medical expert D. The client can approach social agencies and pharmaceutical companies that provide antiretroviral drugs on compassionate grounds

D. 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? A. The client has a diagnosis of type 2 diabetes and did not consistently monitor blood glucose levels prior to diagnosis with HIV. B. The client experienced an adverse reaction to an influenza immunization several years ago. C. The client's body mass index at the time of diagnosis was 27 (overweight). D. The client has hepatitis C and a history of heavy alcohol use.

D. 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 nurse is caring for a patient, who has been prescribed the antiviral drug amantadine. Which of the following adverse reactions specific to amantadine should the nurse monitor for? A. asthenia and abdominal pain B. fever and dizziness C. anorexia and dyspnea D. hypotension and insomnia

D. hypotension and insomnia

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 Dizziness Gastrointestinal bleeding Nasal congestion Hypertension

Dizziness Peripheral edema Rationale: When amantadine is given to prevent or treat influenza A, adverse effects include CNS effects (e.g., hallucinations, depression, confusion, dizziness) and cardiovascular effects (e.g., congestive heart failure, orthostatic hypotension, peripheral edema). Other adverse effects include dry nose and GI distress and mottling of the hands and arms.

A male patient is taking indinavir (Crixivan) for HIV. To decrease the risk of kidney stones, the nurse's teaching plan will include which of the following? Increase physical activity Drink 1 to 2 L of water a day Decrease fatty foods in his diet Avoid taking acetaminophen A client is prescribed indinavir sulfate for the treatment of human immunodeficiency virus (HIV) infection. What client teaching should be provided regarding renal function? A) Drink grape juice daily for antioxidants. B) Drink grapefruit juice to enhance absorption. C) Assess for pulmonary edema. D) Consume at least 48 ounces of fluid per day.

Drink 1 to 2 L of water a day D) Consume at least 48 ounces of fluid per day. Indinavir may produce severe adverse effects such as kidney stones. To decrease the potential for kidney stones, the patient should drink at least 1 to 2 L of water a day. Increasing physical activity, avoiding acetaminophen, or decreasing fatty foods will not decrease the risk of kidney stones.

Antiretroviral drugs have different mechanisms of action. Which action below is not a common antiretroviral mechanism? Blocking the protease enzyme. Inhibiting the reverse transcriptase enzyme. Inhibiting entry to a potential host cell. Facilitating exit from an infected host cell.

Facilitating exit from an infected host cell.

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 Decreased creatinine clearance Decreased CD4+ cell counts Increased red blood cell count

Increased CD4+ cell counts

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 Ribavirin Amantadine hydrochloride Oseltamivir

Ganciclovir

A client is receiving ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. What should the nurse do when administering this drug? Give it IV over 60 minutes Give it orally with food Give it orally at least 30 minutes before food or two hours after food Give it intramuscularly, preferably in the deltoid site

Give it IV over 60 minutes

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

HIV 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 10-year-old client is prescribed oseltamivir to treat influenza A. The nurse understands that what is an adverse effect of this drug?

Hallucinations Oseltamivir may be used in children 1 year of age and older. However, some serious adverse effects have been reported in children 16 years and younger who were taking oseltamivir. The adverse effects include neurologic and psychiatric problems (e.g., delirium, hallucinations, confusion, abnormal behavior, seizures, encephalitis) and a few severe skin reactions

Jeff's mother tells you that she finds it difficult to give ritonavir solution to him. Jeff is an 8-year-old boy suffering from HIV infection. Your advice is to combine the drug with chocolate milk, which will mask its bitter taste. Which of the following actions is important for Jeff's mother to learn? Keep the milk with the drug at room temperature. Drink the milk with the drug before bedtime. Refrigerate the milk and the drug. Have Jeff drink the milk with the drug within 1 hour of mixing.

Have Jeff drink the milk with the drug within 1 hour of mixing. Children are frequently given the ritonavir oral solution; however, it has a very bitter taste. As a result, it is advised to combine it with chocolate milk to mask its taste. However, one condition is to consume the drug and milk mixture within 1 hour of mixing. The room temperature, refrigeration, or drinking before bedtime does not have any implication on this advice

Retroviruses are often treated with a regiment of multiple antiretroviral drugs. What is this therapy called? Highly effective antiretroviral therapy Highly active antiretroviral therapy Multiple medication antiviral treatment plan Multi-viral drug therapy for retroviruses

Highly active antiretroviral therapy

A client is diagnosed with cytomegalovirus infection and is to receive foscarnet. The nurse would expect to administer this drug by which route? Oral Intramuscular Intravenous Topical

IV

The nurse admits a client for treatment of cytomegalovirus (CMV). The client has been ordered foscarnet, 40 mg/kg q12h given over 2 hours. By what route should the nurse expect to administer this drug? Sub q IM PO IV

IV

The patient receiving IV acyclovir should be monitored for which adverse reaction? Decrease in magnesium level Decrease in platelet count Decrease in white blood cell count Increased BUN and creatinine levels

Increased BUN and creatinine levels

A client with AIDS develops cytomegalovirus retinitis. The health care provider orders cidofovir. The nurse would prepare the client for administration of the drug by which route? Intravenous Oral Topical Subcutaneous

Intravenous

You are caring for a 32-year-old client who is receiving saquinavir, a protease inhibitor. What effect can saquinavir have on other medications that the client is already taking? It can increase metabolism of the other medications. It can significantly increase the risk of allergic reactions. It can increase the absorption of the other medications. It can increase the risk of toxicity associated with the other medications.

It can increase the risk of toxicity associated with the other medications.

A nurse is giving discharge instructions to a client taking entecavir. What is an important teaching point the nurse should provide about taking entecavir? It should be taken before bed each night. It should be taken immediately after eating a large meal. It should be taken with a small snack before bed. It should be taken on an empty stomach.

It should be taken on an empty stomach.

A hospitalized client with complex health needs is receiving amantadine. What is the nurse's priority action after administering this medication? Encourage the client to ambulate 10 minutes after each dose. Monitor vital signs every 30 minutes. Keep side rails up and ensure the client's call light is at hand. Decrease fluid intake to prevent drug dilution.

Keep side rails up and ensure the client's call light is at hand.

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

Liver function testing and HIV testing

What stage in the replication cycle of a virus represents viral DNA being injected into a host cell? Synthesis Replication Penetration Attachment

Penetration

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? Taste alteration Excoriation Headache Peripheral neuropathy

Peripheral neuropathy 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.

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. One drug combats the virus while the others are prescribed to diminish the adverse effects. Use of multiple drugs ensures sensitivity to various viral forms. The client's immune response is enhanced with multiple drugs.

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

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. Place the client's call light behind the client's bed on a table. Encourage independent ambulation at least every 2 hours. Have the client quickly change positions.

Provide for frequent rest periods. 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.

When providing care to a client with a viral infection, the nurse knows that ribavirin (Virazole) for inhalation is used to treat which virus? AIDS RSV RVS HIV

RSV

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 Neurologic function Respiratory function Cardiac function

Renal function 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.

The student nurse has learned that HIV is a retrovirus. Reverse transcriptase is the enzyme it contains. The student understands this enzyme when making which statement? Reverse transcriptase is used to turn the DNA of the virus into RNA. Reverse transcriptase has no role in the retrovirus. Reverse transcriptase is only important in regular viruses, and not retroviruses. Reverse transcriptase is used to turn the RNA of the virus into DNA.

Reverse transcriptase is used to turn the RNA of the virus into DNA.

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

Ribavirin

*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?* Herpes simplex Shingles Influenza CMV

Shingles The patient 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 24-year-old client is treated with acyclovir for herpes. The client has a history of epilepsy. What indication would the nurse see that would indicate a serious reaction? The client is having tremors more pronounced at rest. The client reports nausea after taking the medication. The client has a change in bowel elimination pattern. The client has an increase in urinary output since the medication.

The client is having tremors more pronounced at rest. IV acyclovir should be used with caution in patients with renal disease and preexisting neurologic disorders, especially seizures. Systemic acyclovir is excreted primarily by glomerular filtration and tubular secretion. Therefore, renal toxicity may occur in patients with renal disease. Patients with preexisting neurologic disorders have an increased risk of developing tremors and myoclonus.

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

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.

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 incidence and prevalence of hypersensitivity reactions The pathophysiology of the human immunodeficiency virus and its link to drug treatment The need to adhere rigidly to the prescribed drug schedule The need to report diarrhea or nausea to the provider immediately

The need to adhere rigidly to the prescribed drug schedule

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. 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.

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? Mr. Martinez, age 56, is being treated with saquinavir for AIDS. Mr. Martinez has the following history: BMI of 37.98%, hyperlipidemia, and sleep apnea. Based on Mr. Martinez' history, why would caution be used when he is started on saquinavir? Saquinavir has a possible association with cardiovascular events. 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.

There are potential adverse effects associated with hyperlipidemia. Saquinavir drug therapy should be used cautiously in patients 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 patients 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

Specific antiretrovirals work in different ways. Which describes one mechanism of action of antiretrovirals? They are entry inhibitors, which prevent the virus from breaking down DNA. They are protease inhibitors, which block the entry into the cell. They are protease inhibitors, which block the protease enzyme so the new viral particles cannot mature. They are entry inhibitors, which prevent the attachment of the RNA and DNA to the cell wall.

They are protease inhibitors, which block the protease enzyme so the new viral particles cannot mature.

A student nurse, under the supervision of a preceptor, is caring for a patient who is receiving ganciclovir. The preceptor asks the student to identify potential adverse effects of the drug. Which of the following would the student include in his response? Arrhythmias Thrombocytopenia Hypertension Stomatitis

Thrombocytopenia

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

True

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.

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

Viruses are tiny and replicate inside cells. 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.

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

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

What client is most vulnerable to infection with cytomegalovirus (CMV)? a client being treated for acquired immunodeficiency syndrome a client who has a lifelong history of getting cold sores a client who is being treated for influenza a client who contracted hepatitis C through recreations drug use

a client being treated for acquired immunodeficiency syndrome . CMV is an opportunistic infection that is most often diagnosed in clients with HIV or who are otherwise immunocompromised.

Ganciclovir has been prescribed for a patient by the primary healthcare provider. The patient is also using imipenem. Which of the following is the result of ganciclovir interacting with imipenem? a) Increases the risk of seizures b) Increases the risk of diarrhea c) Increases the risk of leukopenia d) Anorexia and weight loss

a) Increases the risk of seizures

You are writing a plan of care for an AIDS patient who was admitted to your unit with chronic severe diarrhea. What would be the most appropriate goal for this patient? a) Patient will show improved nutritional status evidenced by weight gain. b) Patient will show alleviation or reduction of signs and symptoms of AIDS. c) Patient will state that comfort and safety measures are effective and show compliance with the regimen. d) Patient will be able to demonstrate the effectiveness of the teaching plan.

a) Patient will show improved nutritional status evidenced by weight gain.

To reproduce, a virus needs the cellular material of another living cell (the host cell), which of the following are steps in the viral replication process? (Select all that apply.) a) Release of viral DNA and RNA inside the host cell b) Death of the host cell c) Exit of the virus from the host cell d) Replication of the viral DNA by the host cell e) Attachment of the virus to host cell

a) Release of viral DNA and RNA inside the host cell b) Death of the host cell d) Replication of the viral DNA by the host cell e) Attachment of the virus to host cell

Nursing diagnoses for client's receiving antiviral drugs can include which of the following? Select all that apply: a) Risk for imbalance nutrition b) Risk for impaired skin integrity c) Risk for injury d) Body image disturbances e) Acute pain

a) Risk for imbalance nutrition c) Risk for injury d) Body image disturbances e) Acute pain

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

a) Transmission can occur while on medication. b) Advise the patient about the adverse effect of granulocytopenia. c) Take drug therapy as prescribed. 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.

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 decrease the length of illness. decrease the risk of opportunistic infection. are more effective than single-drug therapy. increase compliance.

are more effective than single-drug therapy.

You are teaching a 21-year-old client with AIDS about zidovudine, a nucleoside reverse transcriptase inhibitor (NRTI) that the physician has prescribed for treatment of the disease. Which of the following client statements suggests that your teaching has been successful? a) "Headaches are a common side effect, but I can treat them with acetaminophen." b) "This medication will slow the progression of the disease but will not cure it." c) "This medication will inactivate the virus and prevent recurrence of the disease." d) "I will continue taking this medication until I recover from the disease."

b) "This medication will slow the progression of the disease but will not cure it."

Retroviruses are often treated with multiple antiretroviral drugs. What is this therapy called? a) Highly effective antiretroviral therapy (HEART) b) Highly active antiretroviral therapy (HAART) c) Multi-viral drug therapy for retroviruses d) Multiple medication antiviral treatment plan (MMATP)

b) Highly active antiretroviral therapy (HAART)

A nurse is giving discharge instructions to a client taking entecavir. What is an important teaching point the nurse should provide about taking entecavir? a) It should be taken immediately after eating a large meal. b) It should be taken one hour before, or two hours after, eating. c) It should be taken with a small snack before bed. d) It should be taken before bed each night.

b) It should be taken one hour before, or two hours after, eating.

A client is being treated for a herpes outbreak, and the healthcare provider has prescribed acyclovir. In order to screen for potential problems with the client's excretion of the drug, which assessment data should the nurse review? complete blood count and WBC differential GGT, AST, ALT and bilirubin levels blood urea nitrogen and creatinine levels nutritional status

blood urea nitrogen and creatinine levels

Some antiviral agents are given locally to treat local viral infections. How do these medications work? a) Interfere with cellular replication b) Interfere with cellular metabolic processes c) Interfere with viral metabolic processes d) Interfere with viral transcription

c) Interfere with viral metabolic processes

What is the term that describes use of a drug to treat a condition that is not officially approved by the U.S. Food and Drug Administration (FDA)? a) misprescribed use b) wrong use c) unlabeled use d) unwarranted use

c) unlabeled use

A patient who is being discharged is required to continue taking the drug zanamivir using a "Diskhaler" and a bronchodilator. Both the inhaler and the "Diskhaler" are prescribed at the same time. Which of the following should the nurse include in the teaching plan for the patient's education? a) Risk of transmission is minimal during therapy. b) Drug should be taken every six hours. c) Drug used with bronchodilator causes orthostatic hypotension. d) Use bronchodilator before zanamivir.

d) Use bronchodilator before zanamivir.

The physician prescribes zanamivir to a client. When developing the teaching plan, the nurse should include what important instructions? a) Applying the drug liberally to the cold sores. b) Taking the drug with 8 ounces of water on an empty stomach. c) Using a nebulizer to administer the drug via aerosol. d) Using the special inhaler included with the drug to administer it.

d) Using the special inhaler included with the drug to administer it.

A nurse is caring for a client who has been diagnosed with HIV. The client tells the nurse that he is considering supplementing his antiretroviral drug therapy with an herbal regimen that he read about recently. What should the nurse say in response? a) "Alternative medicine is a waste of money." b) "The herbal supplements will probably only have a placebo effect, but take them if they make you feel better." c) "As long as you buy your supplements from a reputable source, they shouldn't cause any harm." d) "Some herbal supplements could interfere with your medication, so talk with your physician first."

d) "Some herbal supplements could interfere with your medication, so talk with your physician first."

A patient is prescribed zanamivir (Relenza) to treat influenza B. The patient has a history of asthma. For which of the following symptoms should the nurse assess? a) Pulmonary embolism b) Pneumonia c) Bradycardia d) Bronchospasm

d) Bronchospasm

There are many antiviral medications on the market. What is the clinical reason for this? a) Each medication is effective against a large number of viral infections. b) It gives the provider many choices as to which medication can be prescribed. c) The client can help in the decision of which medication based on his or her insurance plan's coverage. d) Each medication is only effective against a small number of specific viral infections.

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

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? a) Infected with HIV b) Autoimmune deficient c) Infected with hepatitis B d) Immuocompromised

d) Immuocompromised

How is the risk of renal impairment best minimized when foscarnet is administered? a) Placing the client on fluid restriction b) Monitoring renal function two or three times weekly during induction c) Stopping the drug if creatinine clearance drops to less than 0.2 mL/min/kg d) Monitoring renal function at least every 2 to 3 months during maintenance therapy

d) Monitoring renal function at least every 2 to 3 months during maintenance therapy

An 80-year-old patient is admitted to the hospital with herpes simplex. The acyclovir (Zovirax) is to be administered parenterally. The nurse understands the action of this medication. Based on the administration of this medication, what would the nurse expect in regards to the dose? a) The dose is higher if the creatinine is above 4.0. b) The dose is smaller due to the herpes simplex. c) The dose is higher in treating genital herpes. d) The dose is smaller based on the age of the patient.

d) The dose is smaller based on the age of the patient.

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? having the client wear protective clothing to prevent further issues informing the client that the change is related to the disease and not the drug telling the client that this change indicates the drug is effective encouraging the client to verbalize feelings about body changes

encouraging the client to verbalize feelings about body changes 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.

A client newly diagnosed with HIV is receiving client teaching from the clinic nurse about antiretroviral medications. The nurse should teach the client to report what adverse effect to a healthcare provider most promptly? nausea dizziness constipation full body rash

full body rash

Which hepatic viruses can be prevented by vaccination? Select all that apply. hepatitis A hepatitis B hepatitis D hepatitis G hepatitis C

hepatitis A hepatitis B

While reviewing a newly admitted client's previous health records, the nurse 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) herpes simplex virus hepatitis B hepatitis A

herpes simplex virus

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? herpes simplex virus (HSV) rotavirus human immunodeficiency virus (HIV) cytomegalovirus (CMV)

human immunodeficiency virus (HIV) 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.

The nurse is caring for a school-aged child with human immunodeficiency syndrome (HIV). In order to confirm that the client's prescribed doses of antiretroviral medications are safe and effective, the nurse should obtain what assessment data? the client's age in months the client's weight the client's comorbidities the client's neutrophil leve

the client's weight

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: dosage recommendations for adults. the severity of the client's condition. the client's weight. the client's body surface area.

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

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. the dose should be escalated over a 2-week period. the drug will be administered three times daily in divided doses. the therapy should be reinitiated at half the previous dosage.

the therapy will be discontinued.