Chap 37 Pharm_Exam#3

This drug acts by inhibiting the release of newly formed flu viruses from infected cells in the respiratory epithelium A. Zanamivir B. Ganciclovir C. Ribavirin D. Boceprevir

A. Zanamivir

The client with acquired immune deficiency syndrome (AIDS) asks the nurse why he must take so many medications. What is the best response by the nurse? 1. "To decrease the possibility of the virus developing resistance to the medications." 2. "Research has shown single medications to be ineffective." 3. "Because the earlier we start multiple medications, the better for you." 4. "To provide you with the most effective treatment for your illness."

Correct Answer: 1 Rationale 1: Decreasing the possibility of resistance is the key; single drugs can be effective, but viral resistance is a problem. Rationale 2: Multiple medications will provide the best treatment, but this is not as good an answer as avoiding drug resistance. Rationale 3: It is debatable if multiple drugs should be used early in the course of the disease. Rationale 4: Single medications can be effective, but drug resistance is more likely the reason.

The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication noncompliance in the acquired immune deficiency syndrome (AIDS) population? 1. The necessity of having to take multiple medications throughout the day 2. A lack of understanding for the reason to take the medications 3. The weight gain associated with the medications 4. The difficulty with availability of medications to treat acquired immune deficiency syndrome (AIDS)

Correct Answer: 1 Rationale 1: Multiple medications are required throughout the day. The higher the number of medications taken daily equates with a higher noncompliance rate. Rationale 2: A lack of understanding could be a factor, but it is the schedule of taking multiple drugs that leads to noncompliance. Rationale 3: Some medications may cause weight gain, but this is not a primary reason for noncompliance. Rationale 4: Medications are generally available for clients with acquired immune deficiency syndrome (AIDS) today.

The nurse is caring for a client receiving atazanavir (Reyataz). The nurse would observe for adverse effects of 1. nausea. 2. constipation. 3. dizziness. 4. increased urinary output.

Correct Answer: 1 Rationale 1: Nausea is a common adverse effect of atazanavir (Reyataz) and similar protease inhibitors.. Rationale 2: Diarrhea, not constipation, is a common adverse effect of this medication. Rationale 3: Dizziness is not a common adverse effect of these medications. Rationale 4: Increased urinary output is not an adverse effect.

The drug most likely to be ordered for the client with herpes simplex virus is which of the following? 1. Acyclovir (Zovirax) 2. Zidovudine (Retrovir) 3. Nystatin (Fungizone) 4. Methonidazole (Flagyl)

Correct Answer: 1 Rationale 1: The drug acyclovir (Zovirax) is an antiviral drug used for herpes viruses and is most effective against HSV-1 and HSV-2. Rationale 2: Zidovudine is an antiviral mainly used in the treatment of HIV. Rationale 3: Nystatin is an antifungal medication. Rationale 4: Methonidazole is an antifungal medication

A nurse is preparing an education session for a group of public school teachers regarding prevention of influenza. What topics should be included in this session? Select all that apply. 1. They need to discuss immunization with their personal health care providers due to contact with children. 2. Encourage students and staff to stay home if they are ill. 3. Encourage frequent handwashing for all students and staff. 4. There is little we can do to prevent a pandemic. 5. Anti-influenza drugs should be reserved only for adults who have been diagnosed with influenza.

Correct Answer: 1,2,3 Rationale 1: The public school teachers should consider taking the influenza immunization because of contact with a large population of children. Rationale 2: If those who are ill stay home they are less likely to expose others to the illness. Rationale 3: Children learn by example and they should see their teachers and other adults performing frequent handwashing. Rationale 4: People, like teachers, who influence large numbers of individuals can help health care providers prevent or slow influenza outbreaks, epidemics, and pandemics. Rationale 5: Anti-influenza drugs are used for children and are sometimes used for prevention as well as treatment after diagnosis.

The nurse plans to teach a client with human immunodeficiency virus (HIV) infection about zidovudine (Retrovir). What will the best plan by the nurse include?. Select all that apply. 1. Zidovudine (Retrovir) will need to be stopped if bone marrow depression occurs. 2. Zidovudine (Retrovir) will slow the disease, but not cure it. 3. Zidovudine (Retrovir) prevents spread of the virus through sexual contact. 4. Zidovudine (Retrovir) was the first drug developed to treat acquired immune deficiency syndrome (AIDS). 5. Zidovudine (Retrovir) therapy frequently results in the development of anemia.

Correct Answer: 1,2,4,5 Rationale 1: Stopping zidovudine (Retrovir) if bone marrow depression occurs allows the bone marrow time to recover. Rationale 2: The drug only slows the disease; it will not cure it. Rationale 3: Zidovudine (Retrovir) will slow the progression of the disease; it will not prevent its transmission. Rationale 4: Zidovudine (Retrovir) was the first drug developed to treat AIDS. Rationale 5: Treatment with zidovudine (Retrovir) frequently results in anemia.

The client receives zidovudine (Retrovir) for treatment of human immunodeficiency virus (HIV) infection. The nurse would increase assessment surveillance for which adverse reactions from this treatment? Select all that apply. 1. The client complains of fatigue and generalized weakness. 2. The client complains of new onset headache. 3. Constipation 4. Edema 5. The client's liver is palpable on physical examination

Correct Answer: 1,2,5 Rationale 1: Fatigue and weakness are experienced by many clients taking zidovudine. Rationale 2: Headache will occur in the majority of clients taking this medication. Rationale 3: Diarrhea is a more expected adverse reaction. Rationale 4: Edema is not an expected adverse reaction. Rationale 5: Hepatomegaly can occur and may require dosage adjustments or discontinuation of this drug.

The nurse educates clients with acquired immune deficiency syndrome (AIDS) about the nature of viruses. The nurse evaluates that learning has occurred when the clients make which responses? Select all that apply. 1. "Viruses are nonliving particles." 2. "The structure of viruses is complex." 3. "Viruses can infect plants as well as animals." 4. "A virion is a mature virus." 5. "Viruses are intracellular parasites."

Correct Answer: 1,3,4,5 Rationale 1: Viruses are nonliving agents that infect bacteria, plants, and animals. Rationale 2: The structure of viruses is quite primitive compared to the simplest cell. Rationale 3: Viruses can infect plants as well as animals. Rationale 4: A mature infective particle is called a virion. Rationale 5: Viruses must use intracellular machinery to replicate, so they are called intracellular parasites.

A client has just recovered from a long course of therapy for shingles. The client says, "What can I do to keep from having that again?" What information should the nurse provide? Select all that apply. 1. Try to find healthy outlets for your stress. 2. Once you have had shingles, you are not likely to get it again. 3. Try to keep as physically healthy as possible. 4. There is little you can do to prevent outbreaks. 5. Try to keep your immune system strong by taking good care of your physical and emotional health.

Correct Answer: 1,3,5 Rationale 1: Challenges such as emotional stress can promote active replication of the virus with lesion appearance. Rationale 2: The virus that causes shingles can lay dormant for years and then become active. Multiple outbreaks over time are not uncommon. Rationale 3: Physical health challenges suppress the immune system and make it more likely the client will have a shingles outbreak. Rationale 4: The client can take some active steps to lessen the likelihood of recurrence. Rationale 5: Challenges to physical and emotional health can suppress the immune system which allows the virus to replicate actively.

The client asks the nurse why there aren't better drugs for human immunodeficiency virus (HIV) infection when so much money is spent on research. What is the best response by the nurse? 1. "Developing new drugs is difficult because we still do not have enough money." 2. "Developing new drugs is difficult because the virus mutates so readily." 3. "Developing new drugs is difficult because people think acquired immune deficiency syndrome (AIDS) is a 'gay' disease." 4. "Developing new drugs is difficult because we still do not understand the virus."

Correct Answer: 2 Rationale 1: More money is spent on human immunodeficiency virus (HIV) infection research than just about any other illness. Rationale 2: Antiviral pharmacotherapy can be extremely challenging because of the rapid mutation rate of viruses, which can quickly render drugs ineffective. Rationale 3: Most people recognize human immunodeficiency virus (HIV) infection as a heterosexual, not homosexual, disease. Rationale 4: After more than 20 years of research, the virus is mostly understood. Global Rationale:

The primary purpose of agents for herpes viruses is to 1. inhibit HIV protease. 2. prevent viral DNA synthesis. 3. bind directly to reverse transcriptase DNA. 4. create a defective DNA strand.

Correct Answer: 2 Rationale 1: Protease inhibitors for HIV inhibit HIV protease. Rationale 2: Herpes antivirals prevent viral DNA synthesis. Rationale 3: Non-nucleoside reverse transcriptase inhibitors for HIV bind directly to reverse transcriptase DNA. Rationale 4: Nucleoside and nucleotide reverse transcriptase inhibitors create a defective DNA strand.

The nurse provides care for clients with acquired immune deficiency syndrome (AIDS). Which laboratory test is the best indicator of effective treatment with antiviral medications? 1. CD4 count 2. Viral load 3. T4 lymphocyte count 4. Absolute neutrophil count

Correct Answer: 2 Rationale 1: The viral load, not a CD4 count, is the best test. Rationale 2: The viral load is an actual count of viral presence, and is the best test. Rationale 3: The viral load, not a T4 lymphocyte count, is the best test. Rationale 4: The viral load, not an absolute neutrophil count, is the best test.

The purpose of general pharmacotherapy for human immunodeficiency virus (HIV)/AIDS is to 1. eliminate viral load. 2. relieve symptoms for a longer period of time. 3. cure the disease. 4. kill the virus.

Correct Answer: 2 Rationale 1: Viral load cannot be eliminated. Rationale 2: The purpose is to remain symptom-free for longer. Rationale 3: Anti-retroviral drugs cannot cure the disease. Rationale 4: Anti-retroviral drugs will not kill the virus.

The nurse is aware that the major structural components of viruses are 1. extracellular parasites. 2. intracellular parasites. 3. extracellular bacteria. 4. intracellular bacteria.

Correct Answer: 2 Rationale 1: Viruses are not extracellular parasites. Rationale 2: Viruses are intracellular parasites. They must be inside a host cell to cause infection. Rationale 3: Viruses are not bacteria. Rationale 4: Viruses are not bacteria.

The client receives efavirenz (Sustiva) as treatment for acquired immune deficiency syndrome (AIDS). The nurse assesses the client for which serious adverse effect? 1. Cardiac arrest 2. Rash 3. Bone marrow suppression 4. Seizures

Correct Answer: 2 Rationale 1: Cardiac arrest is not an expected adverse effect of efavirenz (Sustiva). Rationale 2: A serious adverse effect of efavirenz (Sustiva) is Stevens-Johnson rash, which can be life threatening. Rationale 3: Stevens-Johnson rash, not bone marrow suppression, is an adverse effect of efavirenz (Sustiva). Rationale 4: Stevens-Johnson rash, not seizures, is an adverse effect of efavirenz (Sustiva).

A client has been prescribed oseltamivir (Tamiflu) after complaining of influenza-like symptoms. What information should the nurse provide for this client?: Select all that apply. 1. This medication is given by inhalation. 2. Get this prescription filled and begin taking the medication immediately. 3. This medication will keep you from getting the flu. 4. This is an expensive medication. 5. This medication will be helpful if you have influenza or a cold.

Correct Answer: 2,4 Rationale 1: Zanamivir (Relenza) is given by inhalation, but oseltamivir is given orally. Rationale 2: The effects of oseltamivir are best if it is started within 48 hours of onset of symptoms. Rationale 3: This medication reduces the length of illness, but does not prevent the illness. Rationale 4: Oseltamivir is expensive. Rationale 5: These antivirals are not effective against the common cold virus.

The client has acquired immune deficiency syndrome (AIDS) and has just learned she is pregnant. She tearfully asks the nurse if her baby will die of acquired immune deficiency syndrome (AIDS). What is the best outcome for this client? 1. The client will take penciclovir (Denavir) as prescribed. 2. The client will take tipranavir (Aptivus) as prescribed. 3. The client will take zidovudine (Retrovir) as prescribed. 4. The client will take indinavir (Crixivan) as prescribed.

Correct Answer: 3 Rationale 1: Penciclovir (Denavir) is a topical medication used to treat herpes viruses Rationale 2: Tipranavir (Aptivus) is an eyedrop used to treat herpes infection. Rationale 3: A regime of oral zidovudine (Retrovir) will decrease the possibility of mother-to-baby transmission by 70%. Rationale 4: Zidovudine (Retrovir), not indinavir (Crixivan), will decrease the possibility of mother-to-baby transmission by 70%.

Which of the following laboratory tests best evaluates HIV disease? 1. Platelets 2. Liver function studies 3. CD4 count 4. Complete blood count

Correct Answer: 3 Rationale 1: Platelets are not indicated. Rationale 2: Liver function studies can be used, but do not assess the progress. Rationale 3: CD4 count best determines the progress of the disease. Rationale 4: Complete blood count can be used, but does not assess the progress.

A nurse is preparing to administer prescribed medication to a client exposed to hepatitis A. Which information should the nurse provide to this client? Select all that apply. 1. I am giving you HAV vaccine. 2. You will likely need another injection, or booster, in 6 months. 3. I am giving you hepatitis A immunoglobulin (HAIg). 4. This injection will keep you from contracting hepatitis A. 5. You will not need to worry about contracting hepatitis A for the next 5 to 8 years.

Correct Answer: 3 Rationale 1: The vaccine is given to prevent hepatitis A, but is not the likely medication given when exposure is documented. Rationale 2: Boosters are given for immunizations, not treatments after exposure is documented. Rationale 3: Postexposure treatment includes administration of hepatitis A immunoglobulin. Rationale 4: Immunoglobulins are only about 85% effective at preventing HAV. Rationale 5: The vaccine has a 5-8 years window of effectiveness, but that is not likely what this client is receiving.

The nurse does health teaching with a client who has acquired immune deficiency syndrome (AIDS) and who has been started on antiviral medications. The nurse recognizes that teaching has been effective when the client makes which statement? 1. "I will need to limit my travel to avoid people with other infections." 2. "I will need to be on a high-calorie diet to enhance the effect of the medication." 3. "I will still need to take precautions to avoid spreading the virus to others." 4. "I will not be able to continue working at my high-stress job anymore."

Correct Answer: 3 Rationale 1: There is no need to limit travel at this point. Rationale 2: A well-balanced diet is the best diet for a client with acquired immune deficiency syndrome (AIDS). Rationale 3: Precautions are still necessary to avoid spreading the virus to others. Rationale 4: A high-stress job is not ideal, but at this point the client doesn't need to stop working.

The client has just begun highly active antiretroviral therapy (HAART) for the treatment of acquired immune deficiency syndrome (AIDS). Which teaching point is a priority for this client? 1. Medications must be taken for 3 years after viral load is not measurable. 2. The goal of highly active antiretroviral therapy (HAART) is to reduce plasma human immunodeficiency virus (HIV) ribonucleic acid (RNA) to the lowest possible level. 3. Taking medications as scheduled is vital to successful treatment. 4. Know which medications target which phases of the human immunodeficiency virus (HIV) replication cycle.

Correct Answer: 3 Rationale 1: Medications must be continued for the lifetime of the client. Rationale 2: The goal of highly active antiretroviral therapy (HAART) is to reduce plasma human immunodeficiency virus (HIV), but this is not as important as medication compliance. Rationale 3: Taking medicines, as scheduled, is vital to maintain adequate treatment and prevent resistance to the medication. Rationale 4: The client may be interested in knowing which medications target which phases of the human immunodeficiency virus (HIV) ribonucleic acid (RNA) reproduction cycle, but this is not as important as medication compliance.

The nurse is preparing to discharge a client on an antiretroviral agent. Which of the following should the nurse include? 1. Take your blood pressure daily. 2. Weigh yourself daily. 3. Take your pulse daily. 4. Practice good handwashing.

Correct Answer: 4 Rationale 1: Taking a blood pressure daily temperature is not necessary. Rationale 2: Daily weight is not necessary. Rationale 3: Taking the pulse is not necessary. Rationale 4: Handwashing is a technique the client and family members can use to control infection.

The nurse accidentally sticks herself with a needle after starting an intravenous (IV) line on a client with acquired immune deficiency syndrome (AIDS). The nurse tells the supervisor about the accident. What is the best initial response by the supervisor to decrease anxiety in the nurse? 1. "If you are started on medications soon, it will decrease the severity of the disease." 2. "Workers compensation will cover the cost of your illness and medications." 3. "Did you use the hospital protocols for starting intravenous (IV) lines on a client with acquired immune deficiency syndrome (AIDS)?" 4. "Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small."

Correct Answer: 4 Rationale 1: The risk of transmission of human immunodeficiency virus (HIV) from client-to-health care worker is very small, and telling the nurse to start on medication will not reduce anxiety. Rationale 2: If the nurse did contract human immunodeficiency virus (HIV), workers compensation would cover the cost, but the risk of human immunodeficiency virus (HIV) transmission is small and this response will not reduce anxiety. Rationale 3: Asking the nurse if she used protocols is very non-therapeutic at this point, and will most likely increase anxiety. Rationale 4: There have been only about 56 cases of client-to-health care worker transmission; the risk is very small.

The client receives acyclovir (Zovirax) for treatment of genital herpes. What is a priority assessment by the nurse? 1. Auditory and visual hallucinations 2. Increased serum creatinine 3. Respiratory distress 4. Thrombocytopenia

Rationale 1: Kidney failure, not auditory and visual hallucinations, is an adverse effect of acyclovir (Zovirax). Rationale 2: Acyclovir (Zovirax) is nephrotoxic, so serum creatinine should be monitored. Rationale 3: Kidney failure, not respiratory distress, is an adverse effect of acyclovir (Zovirax). Rationale 4: Kidney failure, not bone marrow suppression, is an adverse effect of acyclovir (Zovirax).

The client receives acyclovir (Zovirax) as treatment for herpes simplex type 1 virus (genital herpes). What is the best, expected outcome for this client? 1. The client will prevent a reoccurrence of infection in the affected area. 2. The client will identify the names of sexual contacts in the past month. 3. The client will report decreased pain using the approved pain scale. 4. The client will report a decrease in the number of lesions in the affected area.

Rationale 1: Pain is a major problem associated with this infection; the best outcome is decreased pain. Rationale 2: It is not necessary to provide the names of sexual contacts, and this is not related to acyclovir (Zovirax). Rationale 3: Pain is a major problem associated with this infection; the best outcome is decreased pain. Rationale 4: Decrease in lesions is not an outcome goal of treatment with acyclovir (Zovirax).