Chapter 10 Antiviral Agents PrepU
Nursing interventions for the patient receiving antiviral drugs for the treatment of HIV probably would include: A) Monitoring renal and hepatic function periodically during therapy B) Administering the drugs just once a day to increase drug effectiveness C) Encouraging the pt to avoid eating if GI upset is severe D) Stopping the drugs and notifying the prescriber if severe rash occurs
A
For which clients would treatment with acyclovir be most clearly indicated?
A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection
A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client?
Anemia and granulocytopenia
Which statement regarding antiviral medications is true?
Antivirals do not eliminate existing viruses from tissues.
A friend indicates he was diagnosed with oral herpes simplex and prescribed a topical antiviral for treatment of outbreaks. From your pharmacology class, you learned that:
Antivirals do not eliminate viruses from tissues.
What can the nurse do to maximize a patient's adherence to the medication regimen?
As an advocate of the patient, discuss benefits and risks of antiretroviral therapy as well as administration.
When describing the action of an integrate inhibitor, the nurse understands that this class of drug by what mechanism? A) Blocking the activity of an enzyme in HIV leading to an immature HIV particle B) Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication C) Blocking the receptor site that HIV needs to interact with to enter the cell D) Preventing the growth of viral DNA chain and its insertion into the host DNA
B
A pt with a history of intravenous drug use has been diagnosed with hepatitis C and the provider has just prescribed Boceprevir 800 mg PO t.i.d q8h. What is the nurse's best action? A) Contact the prescriber to confirm the dose B) Contact the prescriber to confirm the route C) Ensure that the pt will also receive Peginterferon and Ribavirin D) Administer antiemetics as prescribed 30 min before the drug
C
In assessing a pt a viral case might be suspected if the pt was diagnosed with: A) Tuberculosis B) Leprosy C) The common cold D) Gonorrhea
C
Naturally occurring substances that are released in the body in response to viral invasion are called: A) Antibodies B) Immunoglobulins C) Interferons D) Interleukins
C
A nurse is preparing to administer famciclovir to a patient with a herpes virus infection. The nurse would expect to administer this drug by which route?
Oral
A group of students are reviewing information about antiviral agents used to treat influenza and respiratory virus infections. The students demonstrate understanding of the material when they identify which drug as appropriate for treating Avian flu?
Oseltamivir
A nurse is preparing a presentation for a local community group after media reports about cases of avian influenza in the surrounding region. When explaining the treatment options for avian flu, the nurse should reference what drug?
Oseltamivir
A 22-year-old patient is HIV-positive. She is 8 months pregnant and did not receive antiretroviral therapy during her pregnancy. The nurse explains to the women that the best way to reduce the risk of transmitting the HIV virus to her baby is by receiving
intravenous zidovudine during labor.
A client has sought care from her primary care provider after "feeling under the weather" for several days. What signs and symptoms would support the presence of a viral infection? Select all that apply.
malaise fever headache
An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a health care provider to see if residents may be candidates for treatment with what drug?
oseltamivir phosphate
Virus infections have proved difficult to treat because they: A) Have a protein coat B) Inject themselves into human cells to survive and to reproduce C) Are bits of RNA or DNA D) Easily resist drug therapy
B
A pt with HIV has had a CCR5 coreceptor antagonist added to the antiretroviral regimen. What assessment should the nurse prioritize? A) Cardiac monitoring B) Respiratory function C) Kidney function D) Liver function
D
A pt's current drug regimen includes Docosanol. What nursing diagnosis most likely applies to this pt? A) Ineffective airway clearance B) Urinary retention C) Risk for constipation D) Impaired skin integrity
D
After reviewing information about the drugs used to treat herpes virus and CMV infections, a group of students demonstrate understanding about these drugs when they identify what drugs as being available for only intravenous administration? A) Ganciclovir B) Acyclovir C) Famciclovir D) Foscarnet
D
Herpes viruses cause a broad range of conditions but have not been identified as the causative agent in: A) Cold sores B) Shingles C) Genital infections D) Leprosy
D
Your patient is HIV positive and is involved in ART to decrease symptoms and increase lifespan and quality. The regimen currently involves a combination of antiretrovirals. The rationale to support this treatment regimen is: (Select all that apply.)
• To increase drug efficacy. • To decrease viral mutations.
Place the stages of the replication cycle of a virus in the correct order.
• Virus adheres to host cell surface • Virus enters host cell by pinocytosis • Virus sheds its coat • Viral nucleic acids replicate • Synthesis of viral protein capsid • Assembly of new virions and Host cell dies releasing virus to move to other cells
A client has sought care from her primary care provider after "feeling under the weather" for several days. What signs and symptoms would support the presence of a viral infection? Select all that apply.
• malaise • fever • headache
When assessing a client prescribed lamivudine therapy for adverse effects, which assessment should the nurse prioritize? Select all that apply.
• nerve pain • muscular pain • pancreatic function • gastrointestinal distress
A client is prescribed amantadine to prevent influenza A. The nurse should monitor the client for which adverse effects? (Select all that apply.)
-peripheral edema (swelling) -dizziness
The nursing instructor is giving memory aids to the students to help them to better remember the different drug classifications. When learning about antivirals the nurse instructs the students to look for which syllables?
-vir
A pt has been diagnosed with herpes and has been prescribed Acyclovir 8 mg/kg IV q8h. The pt weighs 143 lb. What will the pt's daily dose of Acyclovir be?
1,560 mg
A nurse is caring for a client hospitalized with AIDS. The family comes to visit and a family member asks the nurse about safety when visiting a client with AIDS. What is the best response for addressing the family member's fears?
"AIDS is commonly transmitted by contact with blood and body fluids."
The nurse is teaching a male client with HIV about his new antiviral drug regimen. Which client statement would suggest that the teaching plan was effective?
"I should expect some nausea and vomiting."
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A patient with AIDS is being prepared for discharge. The nurse caring for the patient with AIDS knows the patient receives Agenerase. What dietary counseling will the nurse provide based upon the patient's medication regimen?
Avoid high-fat meals while taking this medication High-fat meals decrease the blood concentration of this drug by 21%.
To prevent viral infections, what precaution should the general public take?
Become vaccinated against prevalent virus infections
The nurse should recognize that maraviroc belongs to what category of antiretroviral?
CCR5 antagonists
The patient with AIDS is infected with a retrovirus. This virus is better known as which of the following?
HIV
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?
It turns RNA into DNA, which helps reproduce more of the virus.
Which would be most important to stress with a client who is receiving adefovir for treatment of chronic hepatitis B?
Maintenance of a continuous adequate supply of drug
When providing care to a client with a viral infection, the nurse knows that ribavirin (Virazole) for inhalation is used to treat which virus?
RSV
A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient?
Serum alanine aminotransferase and bilirubin
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?
"All HIV-positive patients should receive the flu vaccine as prophylaxis."
The nursing instructor realizes that a student needs further explanation when the student makes which of the following statements?
"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.
What statement made by the patient indicates to the nurse that the patient does not understand the transmission of HIV?
"As long as I am taking the HAART therapy, I cannot transmit the virus to anyone else."
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 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.
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?
"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 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?
"Other than abstinence, only the consistent and correct use of condoms is effective in decreasing the risk of getting HIV."
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?
"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."
A nurse is teaching a client with herpes zoster to apply acyclovir ointment. What guidance should the nurse include in the instructions?
"Wear gloves when applying the ointment."
A 23-year-old client is prescribed zidovudine for treatment of human immunodeficiency virus (HIV). Which statement indicates that the client has understood the client teaching regarding the action of this medication?
"Zidovudine slows the progression of the disease but does not cure it."
Place the following stages of the replication cycle of a virus in the correct order. A) Virus sheds its coat B) Assembly of new virions C) Virus enters host cell by pinocytosis D) Host cell dies releasing virus to move to other cells E) Virus adheres to host cell surface F) Synthesis of viral protein capsid G) Viral nucleic acids replicate
1. E 2. C 3. A 4. G 5. F 6. B 7. D
A nurse is preparing to administer IV acyclovir to a client diagnosed with a herpes simplex viral infection. The health care provider has ordered 5 mg/kg every 8h. The client weighs 60 kg. How much medication will the nurse administer per dose?
300 mg
A nurse is preparing a presentation for a local community group after media reports about cases of avian influenza in the surrounding region. When explaining the treatment options for avian flu, the nurse should refer what drug? A) Oseltamivir B) Ribavirin C) Rimantadine D) Zanamivir
A
A pregnant pt's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this pt? A) Zidovudine B) Tenofovir C) Lamivudine D) Stavudine
A
For which of the following patients would treatment with acyclovir be most clearly indicated?
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.
SATA. The nurse is caring for a pt with a new diagnosis of HIV. The pt underwent testing as a screening process and is currently asymptomatic. The provider orders a combination of antiviral medications to prevent progression of the disease to AIDS. What teaching points should the nurse include in the teaching plan for the pt? A) The schedule for when to take medications B) Avoiding driving or operating heavy machinery initially C) Scheduling medications to allow for 8 hours of uninterrupted sleep D) Reporting nausea, vomiting, and diarrhea immediately E) The importance of seeing the health provider regularly
A B E
SATA. When explaining to a pt the reasoning behind using combination therapy in the treatment of HIV the nurse would include which of the following points? A) The virus can remain dormant within the T cell for a very long time; It can mutate while in the T cells B) Adverse effects of many of the drugs used to treat this virus include immunosuppression, so the disease could become worse C) The drugs are cheaper if used in combination D) The virus slowly mutates with each generation E) Attacking the virus at many points in its life cycle has been shown to be most effective F) Research has shown that using only one type of drug that targeted only one point in the virus life cycle led to more mutations and more difficulty in controlling the disease
A D E F
SATA. Appropriate nursing diagnoses related to the drug therapy for a pt receiving combination antiviral therapy for the treatment of HIV infection would include the following: A) Disturbed sensory perception related to the CNS effects of the drugs B) Imbalanced nutrition: More than body requirements related to appetite stimulation C) Heart failure related to cardiac effects of the drugs D) Adrenal insufficiency related to endocrine effects of the drugs E) Acute pain related to GI, CNS, or dermatological effects of the drugs F) Deficient knowledge regarding drug therapy
A E F
People have different levels of risk for becoming infected with HIV. Which client is more at risk of becoming infected with HIV?
A person having casual intercourse with multiple partners
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
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
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 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.
Antiviral therapy for influenza is being administered within your long-term care facility; it commenced about 3 weeks ago. The nurse would monitor for which adverse effects? (Select all that apply.)
Anorexia Nausea
A client is receiving a nonnucleoside reverse transcriptase inhibitor. Why should the nurse caution the client to avoid the concurrent use of St. John's wort?
Antiviral effects may be reduced.
A community health nurse is coordinating care for several pts during a local outbreak of influenza A. For which pt with influenza would treatment with Ribavirin most likely be contraindicated? A) A pt who received the pneumococcal vaccine 14 days ago B) A pregnant pt whose flu symptoms are becoming increasingly severe C) An 11 yr old pt with severe vomiting and diarrhea D) A 90 yr old pt who lives in a long-term care facility and who has multiple comorbidities
B
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?
Because of the potentially 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
To prevent viral infections, what precaution should the general public take?
Become vaccinated against prevalent virus infections.
The physician prescribes Zanamivir to a pt. When developing the teaching plan, the nurse should include what important instruction? A) Take the drug with 8 ounces of water on an empty stomach B) Apply the drug liberally to the cold sores C) Use the special inhaler included with the drug to administer it D) Use a nebulizer to administer the drug via aerosol
C
Which of the following would be an important teaching point for the patient receiving an agent to treat herpes virus or CMV? A) Stop taking the drug as soon as the lesions have disappeared B) Sexual intercourse is fine as long as you are taking the drug, you are not contagious C) Drink plenty of fluids to decrease the drug's toxic effects on the kidneys D) There are few if any associated GI adverse effects
C
The nurse is caring for a client receiving antiviral medications to treat HIV. What laboratory study should the nurse monitor most closely to determine the effectiveness of the medications?
CD4 count
Mr. Hart, 37 years old, is diagnosed with HIV infection. What is the most important factor to consider when initiating chemoprophylaxis?
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.
Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy?
CD4 counts The most important consideration in decisions to initiate antiretroviral therapy is CD4 counts.
A pt with a diagnosis of AIDS had been prescribed Valganciclovir. The nurse should expect that this patient has developed what AIDS-related complication?
CMV retinitis
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?
CMV-IGIV can cause injection site pain and tenderness, muscle stiffness, headache, chills, and fever. 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.
Which nursing intervention is necessary when caring for a client diagnosed with hepatitis A? Select all that apply.
Chlorine wipes are effective for disinfection purposes. Effective handwashing is vial in the prevention of cross infection. Educate personal contacts that the client is infectious for up to 10 days after symptoms appear.
Which microorganism is known to cause retinitis in people with HIV/AIDS?
Cytomegalovirus
The nurse is caring for a client who has been on ritonavir. The nurse identifies an adverse reaction in relation to body fat. What does the nurse see when assessing this client?
Fat has moved to the center of the body and the client appears to have thinners arms and legs
The nurse is caring for a client with AIDS who has developed cytomegalovirus (CMV). The nurse anticipates the health care provider will order which drug to treat this client?
Ganciclovir
A 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
An elderly patient is admitted to the medical floor with a fever, cough, sore throat, and stuffy nose. What virus should the nurse suspect this patient to have?
Influenza
A school nurse is talking with a health class of freshman high school students about human immunodeficiency virus (HIV). What patient would the nurse tell the students is at the greatest risk of contracting HIV?
Injecting drug user
In anticipation of a prescription for delavirdine mesylate, what instructions should the nurse provide to the client?
Mix the drug with water and drink the resulting solution.
How is the risk of renal impairment best minimized when foscarnet is administered?
Monitoring renal function two or three times weekly during induction
A patient is receiving treatment for HIV that includes zidovudine therapy. The patient is experiencing proximal muscle weakness as well as elevated creatinine kinase values. To what adverse effect does the nurse recognize these findings as attributable
Myalgia
A patient is receiving treatment for HIV that includes zidovudine therapy. The patient is experiencing proximal muscle weakness as well as elevated creatinine kinase values. To what adverse effect does the nurse recognize these findings as attributable?
Myalgia
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?
Nelfinavir
Which protease inhibitor would the nurse expect to administer to a patient who has renal impairment?
Nelfinavir
A 3-month-old infant has been diagnosed with respiratory syncytial virus (RSV) and will begin treatment with inhaled ribavirin. Which of the following measures should be taken in the care of this patient and administration of ribavirin?
Nurses who are pregnant or who may be pregnant should not administer the drug.
The nurse is performing an assessment of a patient taking saquinavir for HIV and observes the viral load is considerably higher than the previous test. What priority information should the nurse obtain from the patient?
Obtain information about adherence to the medication regimen. Assess the patient's ability and willingness to adhere to drug therapy. Adherence to the saquinavir drug regimen is crucial. Viral load may increase dramatically when saquinavir is not taken as directed, and as with other anti-HIV drugs, resistance is more likely when drugs are taken inconsistently.
Many of the residents of a long-term care facility have become sick with influenza this winter despite the fact that all residents were immunized earlier in the fall. A nurse who provides care in the facility should recognize the need to have which of the following drugs readily available at the facility?
Oseltamivir phosphate
A HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. Which of the following symptoms should the nurse monitor for and immediately report to the care provider?
Peripheral neuropathy
Which of the following blocks the protease enzyme so new viral particles cannot mature? (Choose one)
Protease inhibitors
A client who is hospitalized and receiving antiretroviral therapy has a nursing diagnosis of Risk for Injury related to weakness and dizziness. Which would be most appropriate for the nurse to do?
Provide for frequent rest periods
A client who is hospitalized and receiving antiretroviral therapy has a nursing diagnosis of Risk for Injury related to weakness and dizziness. Which would be most appropriate for the nurse to do?
Provide for frequent rest periods.
A patient being treated for HIV with saquinavir informs the nurse they he has been "suffering from depression" and taking St. John's wort to help. What is important for the nurse to discuss with this patient?
Refraining from use of St. John's wort, which can cause decreased effectiveness of saquinavir
When administering the fusion protein inhibitor enfuvirtide, the nurse should include which technique to assure the medication's continued effectiveness?
Regularly rotate the subcutaneous injection sites that are used
A 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following?
Renal Function
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
What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis?
Serum aminotransferases
A patient with HIV has developed Pneumocystis jiroveci pneumonia. What does the nurse anticipate the drug of choice for this illness will be?
Sulfamethoxazole-trimethoprim 1 DS tablet daily The first choice for the treatment of Pneumocystis jiroveci pneumonia is sulfamethoxazole-trimethoprim (SMZ-TMP) 1 DS tablet daily.
An HIV-positive patient is being treated for hypothyroidism with levothyroxine. The patient is also taking saquinavir therapy for HIV. Which clinical manifestations by the patient should the nurse be concerned about?
Tachycardia, intolerance to heat, weight loss Saquinavir may inhibit the metabolism of levothyroxine. The nurse should monitor for signs and symptoms of hyperthyroidism such as intolerance to heat, tachycardia, weight loss, and diarrhea
What would the nurse identify as the primary purpose of performing a CD4 count for a patient infected with HIV?
The CD4 count is an indication of the patient's current immunological status.
An immigrant and his wife are both HIV positive. The physician prescribes antiretroviral medications. However, the client, tell the nurse he is concerned about his ability to afford the treatment. What advice can the nurse provide to the client to help begin the treatment?
The client can approach social agencies and pharmaceutical companies that provide antiretroviral drugs on compassionate grounds
The nurse is caring for a patient who has HIV and is taking saquinavir therapy. What should the nurse include in the dietary education for this patient?
The patient should not take this medication with grapefruit or pomegranate juice
A patient with HIV is taking zidovudine and becomes pregnant. What does the nurse anticipate that the instructions will be for this patient?
The patient will be advised to continue taking the zidovudine.
A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which of the following would the nurse include as the primary reason?
The use of multiple drugs allows attack on the virus at different points in its life cycle. 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
Specific antiretrovirals work in different ways. Which describes one mechanism of action of antiretrovirals?
They are protease inhibitors, which block the protease enzyme so the new viral particles cannot mature
A client is administered a nucleotide reverse transcriptase inhibitor in combination with a nonnucleotide reverse transcriptase inhibitor. What is the rationale when administering these medications together?
They have synergistic antiviral effects.
A patient is administered a nucleotide reverse transcriptase inhibitor in combination with a non-nucleotide reverse transcriptase inhibitor. What is the expected outcome when administering these medications together?
They have synergistic antiviral effects.
A nurse starts an intravenous (IV) line on a patient. Not using the safety, the nurse punctures the finger on her left hand with the bloody needle. What is the nurse's risk of becoming infected with HIV?
This nurse has in increased risk of seroconversion. A needle stick with a needle visibly contaminated with the patient's blood or an exposure after a procedure that involved a needle being placed directly in a vein or artery would increase the risk of seroconversion.
A woman 45 years of age just received a heart transplant. One of her medications is ganciclovir. The nurse knows that the provider prescribed this medication for which of the following reasons?
To prevent CMV infection due to being immunocompromised Ganciclovir is given often to transplant clients to prevent CMV infection. Ganciclovir is not used for blood pressure regulation; it is an antiviral agent. Ganciclovir is not prescribed for prevention of influenza A; it is prescribed for prevention of CMV. Anemia and leukopenia are adverse reactions that can occur while being treated with ganciclovir.
Which of the following statements reflect the treatment of HIV infection?
Treatment of HIV infection for an individual patient is based on the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load). Although specific therapies vary, treatment of HIV infection for an individual patient is based on three factors: the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load). Treatment should be offered to all patients with the primary infection (acute HIV syndrome). In general, treatment should be offered to individuals with fewer than 350 CD4+ T cells/mm3 or plasma HIV RNA levels exceeding 55,000 copies/mL (RT-PCR assay).
What would the nurse expect the physician to prescribe as treatment for a patient who has a herpes simplex infection in the eye?
Trifluridine Trifluridine-ophthalmic ointment used to treat herpes simplex eye infections. Docosanol-oral and facial herpes simplex cold sores and fever blisters. Imiquimod-genital warts and perianal warts. Penciclovir-cold sores [herpes labialis] on the face and lips.)
A client may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbifudine therapy is stopped.
True
Children younger than the age of 12 years should not receive indinavir.
True
True or False: A pt may experience an acute exacerbation of hepatitis B if Entecavir, Adefovir, or Telbivudine therapy is stopped.
True
True or False: Children younger than the age of 12 years should not receive Indinavir.
True
True or False: Children younger than the age of 12 years should not receive indinavir.
True
True or False: Ribavirin is teratogenic and is classified as a pregnancy category X drug.
True
True or False: A patient may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbivudine therapy is stopped.
True (Rationale: It is extremely important to teach the patient to never stop taking or run out of their prescription because an acute exacerbation of hepatitis B may result. Withdrawal of the drug must be gradual and carefully monitored.)
The nursing instructor is discussing HIV/AIDS with the junior nursing class. The instructor tells the students that it is important to understand how HIV-1 integrates itself into a person's immune system and how immunity plays a role in the course of HIV disease. What else is this knowledge essential for?
Understanding medication therapy
A client with HIV is frustrated by the size and complexity of the current medication regimen. What should the nurse teach the client about combination therapy for the treatment of HIV?
Use of combination therapy attacks the virus at different stages of the life cycle
The nursing student asks the instructor why it is more difficult to develop antiviral drugs than anti-infectives. The nursing instructor's best reply would be which?
Viruses are tiny and replicate inside cells
The nursing student asks the instructor why it is more difficult to develop antiviral drugs than anti-infectives. The nursing instructor's best reply would be which?
Viruses are tiny and replicate inside cells.
A patient is being tested for HIV using the EIA (enzyme immunoassay). The EIA shows antibodies. The nurse expects the physician to order what test to confirm the EIA test results?
Western blot test
A female HIV-positive patient with a high CD4 count has been taking nevirapin (Viramune) for 9 weeks. What clinical manifestations indicate to the nurse that the patient is having complications from this medication?
Yellow sclera (whites of eyes) and hepatomegaly (liver enlargement)
A female HIV-positive patient with a high CD4 count has been taking nevirapine (Viramune) for 9 weeks. What clinical manifestations indicate to the nurse that the patient is having complications from this medication?
Yellow sclera and hepatomegaly
A pregnant client's prenatal blood work has returned positive for HIV. What antiretroviral medication would be safest to give this client?
Zidovudine
After reviewing information about the drugs used to treat herpes virus and CMV infections, a group of students demonstrate understanding about these drugs when they identify what drugs as being available for only intravenous administration? a. Foscarnet b. Famciclovir c. Ganciclovir d. Acyclovir
a. Foscarnet (Rationale: Foscarnet is available for intravenous use only. Acyclovir can be given orally or parenterally. Famciclovir is given orally. Ganciclovir is available in oral and IV forms.)
A group of students asks the instructor the reason why combination therapy is commonly prescribed for patients with HIV infection. What is the instructor's best response? a. Use of combination therapy attacks the virus at different stages of the life cycle. b. One drug combats the virus while the other diminishes the adverse effects. c. The patient's immune response is enhanced with multiple drugs. d. Use of multiple drugs ensures sensitivity to various viral forms.
a. Use of combination therapy attacks the virus at different stages of the life cycle. (Rationale: Because HIV mutates over time, combination therapy is effective in attacking the virus at various points in the life cycle to achieve maximum therapeutic effect with the least amount of toxicity. Sensitivity is not a reason for using combination therapy. The use of combination therapy can increase the patient's risk for adverse effects.)
The nurse is to administer enfuvirtide (Fuzeon) to a 27-year-old man. After the medication has been reconstituted with sterile water, the nurse will:
allow the solution to sit until it dissolves
What antiviral drug treatment should the nurse be prepared to administer to manage an outbreak of influenza A among residents of a long-term care facility?
amantadine hydrochloride
Nursing students are studying antiviral drug therapy in a pharmacology class. A student asks the instructor to explain why multi-drug regimens are used to treat HIV infections. The instructor responds that drug combinations are often prescribed because they:
are more effective than single-drug therapy
Nursing students are studying antiviral drug therapy in a pharmacology class. A student asks the instructor to explain why multi-drug regimens are used to treat HIV infections. The instructor responds that drug combinations are often prescribed because they
are more effective than single-drug therapy.
It will be most important for the nurse to monitor nevirapine therapy for a male patient during the first few months of therapy in order to:
assess for potentially life-threatening hepatotoxicity or skin reactions
The nurse is attending a seminar on the use of antiviral medications and learns that what tissue hormone is released in response to viral invasion and acts to block viral replication. a. RNA b. Interferon c. Progesterone d. DNA
b. Interferon (Rationale: Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. A single virus particle is composed of a piece of DNA or RNA inside a protein coat. To carry on any metabolic processes, including replication, a virus must enter a cell. Once a virus has fused with a cell wall and injected its DNA or RNA into the host cell, that cell is altered; that is, it is "programmed" to control the metabolic processes that the virus needs to survive.)
A nurse is preparing a presentation for a local community group about medications available to treat influenza. Which drug would the nurse describe as also being used to treat Avian flu? a. Rimantadine b. Oseltamivir c. Zanamivir d. Ribavirin
b. Oseltamivir (Rationale: Oseltamivir is the only drug approved for use to treat Avian flu.)
A patient is receiving a nonnucleoside reverse transcriptase inhibitor. Why does the nurse caution the patient to avoid the concurrent use of St. John's wort? a. The risk for atropine-like effects is increased. b. Life-threatening interactions are possible. c. Antiviral effects may be reduced. d. The risk for renal toxicity is increased.
c. Antiviral effects may be reduced. (Rationale: St. John's wort should not be used because a decrease in antiviral effects may occur. Life-threatening effects can occur when nonnucleoside reverse transcriptase inhibitors are taken with antiarrhythmics, clarithromycin, calcium channel blockers, antituberculosis drugs, warfarin, quinidine, indinavir, saquinavir, or dapsone. The risk for renal toxicity may be increased if the agent is combined with another drug that affects the kidneys. Nonnucleoside reverse transcriptase inhibitors are not associated with atropine-like effects.)
The nurse is caring for a patient with a new diagnosis of HIV. The patient underwent testing as a screening process and is currently asymptomatic. The provider orders a combination of antiviral medications to prevent progression of the disease to AIDS. What teaching points would the nurse include in the teaching plan for this patient? (Select all that apply.) a. Schedule medications to allow for 8 hours of uninterrupted sleep. b. Report nausea, vomiting, and diarrhea immediately. c. Schedule for when to take medications. d. Avoid operating heavy machinery initially. e. See your health care provider regularly.
c. Schedule for when to take medications. d. Avoid operating heavy machinery initially. e. See your health care provider regularly. (Rationale: Having just learned of an HIV diagnosis, this patient is likely to be very anxious, so it is important to draw up a written schedule of when each medication will be taken. Stress the importance of regular visits to the doctor in order for medication effectiveness to be monitored through lab studies and adverse effects to be managed. A patient who is asymptomatic may be noncompliant with medications if adverse effects of the drugs are bothersome, so helping to reduce the negative effects can increase compliance. Instruct the patient to avoid driving or operating heavy equipment until evaluation the effects the medication has on him or her because each patient will respond differently. If no CNS effects occur, the patient can return to normal driving habits. Nausea, vomiting, and diarrhea are likely to occur, so the patient should be instructed on strategies to manage these symptoms and should call the doctor only if they cannot be managed or become acute. Medications should be taken around the clock if necessary to maintain therapeutic effects.)
The nurse is caring for a patient receiving antiviral medications to control HIV. What laboratory study would the nurse monitor to determine the effectiveness of the medications? a. P24 Antigen test b. CBC with differential c. T cell count d. Liver function studies
c. T cell count (Rationale: HIV attacks the helper T cells (CD4 cells) within the immune system. Monitoring T cell count would indicate how effective the drug is at controlling the virus. CBC with differential does not include a T cell count. P24 antigen tests confirm the presence of the virus but do not indicate severity of the disease; it is either positive or negative. Liver function studies are not indicated unless liver function is damaged by the disease.)
A nurse is preparing an in-service program for a group of staff nurses about antiretroviral agents. The nurse would include which drug as being safe to administer during pregnancy? a. Tenofovir b. Stavudine c. Zidovudine d. Lamivudine
c. Zidovudine (Rationale: Only zidovudine has been proven to be safe to administer during pregnancy.)
A group of nursing students are reviewing information about viral infections. They demonstrate understanding of the information when they identify which as being caused by a virus? Select all that apply.
common cold wart influenza hepatitis C
The patient is prescribed docosanol (Abreva) to treat a cold sore on the lip. The patient asks the nurse, "I've heard that this drug can cause fatal adverse effects. Is it safe to use?" What is the nurse's best response? a. "Topical medications do not cause any adverse effects because the medication is just applied to the skin." b. "It is important to follow directions and do not stop use of this medication to avoid adverse effects." c. "Avoid using this drug if you are taking St. John's wort because that increases the risk of adverse effects." d. "This is a topical medication that is not absorbed into the body so adverse effects are local burning, stinging, or discomfort."
d. "This is a topical medication that is not absorbed into the body so adverse effects are local burning, stinging, or discomfort." (Rationale: These drugs are not absorbed systemically so systemic or serious adverse effects that would result in fatality have not been reported. The adverse effects most commonly reported are localized at the site of application such as local burning, stinging, and discomfort. These effects usually occur at the time of administration and pass with time. St. John's wort reduces the effectiveness of protease inhibitors. Anti-hepatitis B agents are the drugs that should not be stopped because of risk of exacerbating hepatitis B.)
A patient is receiving ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. The nurse administers the drug intravenously over what time span? a. 90 minutes b. 120 minutes c. 30 minutes d. 60 minutes
d. 60 minutes (Rationale: Ganciclovir is administered intravenously every 12 hours over a period of one hour.)
After teaching a group of students about the drugs used to treat HIV and AIDS, the instructor determines that the teaching was successful when the students identify which group as being one of the newest classes of drugs? a. Fusion inhibitors b. Protease inhibitors c. Nucleoside reverse transcriptase inhibitors d. CCR5 co-receptor antagonist
d. CCR5 co-receptor antagonist (Rationale: CCR5 co-receptor antagonist was introduced in 2007 and is the newest class of drugs developed to treat HIV infection. Nucleoside reverse transcriptase inhibitors was the first class developed to treat HIV infection. Protease inhibitors are not the newest class of drugs developed to treat HIV infection. Fusion inhibitors were first introduced in 2003, but these are not the newest class of drugs developed to treat HIV infection.)
When describing the action of an integrase inhibitor, the nurse understands that this class of drug acts by what mechanism? a. Preventing the growth of viral DNA chain and its insertion into the host DNA b. Blocking the receptor site that HIV needs to interact with to enter the cell c. Blocking the activity of an enzyme in HIV leading to an immature HIV particle d. Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication
d. Inhibiting the activity of a virus-specific encoded enzyme needed for viral replication (Rationale: Integrase inhibitors inhibit the activity of a virus-specific enzyme, integrase, an encoded enzyme needed for viral replication. Nucleoside reverse transcriptase inhibitors prevent the growth of the viral DNA chain and prevent it from inserting itself into the host DNA. Protease inhibitors block the activity of the enzyme protease, which is essential for the maturation of the infectious virus. CCR5 co-receptor antagonists block the receptor site HIV needs to interact with in order to enter the cell.)
The physician prescribes zanamivir to a patient. When developing the teaching plan, the nurse includes what important instructions? a. Use a nebulizer to administer the drug via aerosol. b. Take the drug with 8 ounces of water on an empty stomach. c. Apply the drug liberally to the cold sores. d. Use the special inhaler included with the drug to administer it.
d. Use the special inhaler included with the drug to administer it. (Rationale: Zanamivir must be delivered by a Diskhaler device that is supplied with every prescription. Because the drug is inhaled, it would not be impacted by an empty stomach or intake of water. This is not a topical drug but an inhaled medication. Only the special Diskhaler device that is supplied with every prescription can be used to administer the drug, not a nebulizer.)
A nurse is providing care to a client who is receiving a protease inhibitor with a nursing diagnosis of Disturbed Body Image related to a redistribution of fat to the abdomen. Which intervention would the nurse include in the client's plan of care?
encouraging the client to verbalize feelings about body changes
A nurse provides medication teaching related to the importance of adhering to the saquinavir drug regimen. In order to best minimize the risk of increased fatty-like tissue, the nurse will instruct the patient to
engage in regular exercise
A nurse, reviewing a newly admitted client's previous health records, notes that the client is currently prescribed acyclovir. The nurse should assess the client for signs and symptoms associated with what medical diagnosis?
herpes simplex virus
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean
his body has not produced antibodies to the AIDS 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?
human immunodeficiency virus (HIV)
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?
hypotension and insomnia
A nurse is caring for a client diagnosed with HIV. The client wants to know when they will be started on medication for their disease. What would be the nurse's best response?
if the client has a CD4 T-cell count less than 350 cells/mm3
A neonatal intensive care unit nurse is caring for an infant diagnosed with respiratory syncytial virus (RSV). What route of delivery will the nurse use when ribavirin is administered to this infant?
inhaled
A 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?
integrase inhibitors
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 medication-associated adverse effect?
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?
protease inhibitors
Antiviral drugs should be used during pregnancy only when the benefit outweighs the risk to the fetus. Which antiviral drug would the nurse identify as being absolutely contraindicated during pregnancy?
ribavirin
A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to
stay well hydrated by drinking at least eight 8-oz glasses of water daily.
A nurse is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to:
stay well hydrated by drinking at least eight 8-oz glasses of water daily.
A 42-year-old client, diagnosed with human immunodeficiency virus (HIV), has been receiving antiretroviral therapy for several years. Recently, raltegravir was added to the drug regimen. When appraising the success of this addition to the treatment, the nurse should prioritize which laboratory value?
the client's CD4 count
The nurse is caring for a 3-year-old with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on:
the client's weight
The nurse is caring for a 3-year-old with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on:
the client's weight.
The nurse is caring for a 3-year-old patient with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on
the patient'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.
A client 45-years-old just received a heart transplant. One of the clients medications is ganciclovir. The nurse knows this medication was prescribed why?
to prevent CMV infection.
Antiviral therapy for influenza is being administered within your long-term care facility; it commenced about 3 weeks ago. The nurse would monitor for which adverse effects? (Select all that apply.)
• Anorexia • Nausea
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.)
• Attachment of the virus to host cell • Release of viral DNA and RNA inside the host cell • Replication of the viral DNA by the host cell • Death of the host cell
The nursing student asks the instructor how a patient is classified with AIDS. According to the Centers for Disease Control and Prevention (CDC), what criteria should the instructor inform the student classifies AIDS? (Select all that apply.)
• HIV infection plus a CD4 cell count less than 200/mm • An opportunistic (AIDS-defining) illness The CDC defines AIDS as HIV infection with a CD4 cell count less than 200/mm or an opportunistic (AIDS-defining) illness such as an infection with tuberculosis or Pneumocystis jiroveci pneumonia.
What would the nurse recognize as the primary goal(s)of highly active antiretroviral therapy (HAART)? Select all that apply
• Suppress virema. • Delay drug-resistant mutations. • Preserve CD4 counts.
Administration of antiviral therapy for influenza requires monitoring of clients for which adverse effects? Select all that apply.
• anorexia • nausea • dizziness
What should the nurse's assessment of the client prior to administration of antiviral drugs include? (Select all that apply.)
• client's general state of health • resistance to infection • vital signs
A child is prescribed ribavirin for a diagnosis of respiratory syncytial virus (RSV). The nurse should the nurse assess the client often for which possible adverse reaction? Select all that apply
• rhinitis • headache • bronchospasm • conjunctivitis
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."
A client is receiving tenofovir as part of a therapy regimen for HIV infection. The nurse should provide what teaching related to what the client may experience?
"It's possible you might have changes in body fat distribution."
For which viral infection is drug therapy available? (Select all that apply.)
-Hepatitis B and C -HIV infection -Influenza -Cytomegalovirus
When focusing on the lifestyle of the patient with HIV, what are important teaching considerations? (Select all that apply.)
-Take drug therapy as prescribed -Transmission can occur while on medication -Advise the patient about the adverse effect of granulocytopenia
A group of nursing students are reviewing information about the different antiretroviral drugs. The students demonstrate understanding when they identify which as an example of an entry inhibitor? Select all that apply.
-maraviroc -enfuvirtide
A school nurse is teaching a health class to a group of high school students. The nurse is preparing a lecture on hepatitis B and knows to include what information about the transmission of hepatitis B in the lecture? SATA
-transmitted through sexual contact. -transmitted through blood-to-blood contact. -transmitted from the mother to her unborn baby.
Place the following steps in the stages of the replication cycle of a virus in the correct order. -Viral nucleic acids replicate -Virus sheds its coat -Virus enters host cell by pinocytosis -Host cell dies releasing virus to move to other cells -Virus adheres to host cell surface -Synthesis of viral protein capsid -Assembly of new virions
1. Virus adheres to host cell surface 2. Virus enters host cell by pinocytosis 3. Virus sheds its coat 4. Viral nucleic acids replicate 5. Synthesis of viral protein capsid 6. Assembly of new virions 7. Host cell dies releasing virus to move to other cells (Rationale: A single virus particle is composed of a piece of DNA or RNA inside a protein coat. To carry on any metabolic processes, including replication, a virus must enter a cell. Once a virus has fused with a cell wall and injected its DNA or RNA into the host cell, that cell is altered; that is, it is "programmed" to control the metabolic processes that the virus needs to survive. The virus, including the protein coat, replicates in the host cell. When the host cell can no longer carry out its own metabolic functions because of the viral invader, the host cell dies and releases the new viruses into the body to invade other cells.)
A patient with AIDS develops CMV retinitis and is to receive valganciclovir. The nurse would instruct the patient to take the drug twice a day for how long?
c. 21 days
A client comes to the health care facility reporting flulike symptoms. After a thorough assessment, the client is diagnosed with influenza and is to receive oseltamivir. The nurse understands that this drug has been prescribed because the client been symptomatic for less than:
2 days.
HIV selectively enters which of the following cells? A) B clones B) Helper T cells C) Suppressor T cells D) Cytotoxic T cells
B
Locally active antiviral agents can be used to treat: A) HIV infection B) Warts C) RSV D) CMV systemic infections
B
The antiviral regimen of a pt with HIV includes Abacavir. What health education should the nurse provide to the pt? A) Most pts see their HIV resolve within 8 to 12 months of starting Abacavir B) Make sure you call right away if you have any signs of hypersensitivity that we discussed C) It's very important that you avoid taking any vitamin B supplements while you're on Abacavir D) Plan your day that Abacavir is the first drug you take in the morning and the last one you take at night
B
A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient?
Combination antiretroviral therapy
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?
Have Jeff drink the milk with the drug within 1 hour of mixing.
A pt is receiving Ganciclovir for the long-term treatment and prevention of cytomegalovirus infection. What should the nurse do when administering this drug? Give it: A) Intramuscularly, preferably in the deltoid site B) Orally with food C) Orally at least 30 minutes before food or 2 hours after food D) IV over 60 minutes
D
A pt is receiving a nonnucleoside reverse transcriptase inhibitor. Why should the nurse caution the pt to avoid the concurrent use of St. John's wort? A) The risk for atropine-like effects is increased B) Life-threatening interactions are possible C) The risk for renal toxicity is increased D) Antiviral effects may be reduced
D
A client for whom antiretroviral therapy has been prescribed informs the nurse that the client is taking oral contraceptives. What should the nurse inform the client is one of the effects of combining birth control pills with antiretroviral therapy?
Decreases effectiveness of birth control pills
There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?
Disclosure of the client's condition
A client has been treated with abacavir for the past 6 weeks. The client contacts the physician's office with reports of diarrhea, abdominal pain, sore throat, cough, and shortness of breath. Which is the appropriate action to take for this situation?
Discontinue the therapy.
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?
Discontinue the therapy. 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.
A patient has been prescribed ribavirin for influenza A. The patient is experiencing nausea, vomiting, and diarrhea. What would the nurse be sure to include in the patient teaching about this medication?
Do not take with antacids.
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?
Drink 1 to 2 L of water a 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.
A client is receiving nevirapine as part of a treatment for HIV infection. The nurse would instruct the client about which adverse effects as most commonly experienced?
Dry mouth and dyspepsia (indigestion)
There are many antiviral medications on the market. What is the clinical reason for this?
Each medication is only effective against a small number of specific viral infections.
Antiretroviral drugs have different mechanisms of action. Which action below is NOT a common antiretrovirial mechanism?
Exit facilitators which remove the HIV from the cells
Antiretroviral drugs have different mechanisms of action. Which action below is not a common antiretroviral mechanism?
Facilitating exit from an infected host cell.
Locally active antiviral agents can be applied to open lesions.
False
True or False: Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication.
False
True or False: Rimantadine is a teratogenic drug, classified as a pregnancy category X drug.
False (Rationale: Ribavirin is teratogenic and classified as a pregnancy category X drug.)
True or False: Drugs used to combat influenza and respiratory viruses act to inhibit viral DNA replication.
False (Rationale: The exact mechanism of action of drugs to treat influenza and respiratory viruses is not known.)
Which drug would a nurse least likely expect to be prescribed for a client with chronic hepatitis B?
Fosamprenavir -Fosamprenavir is a protease inhibitor that may be indicated as part of combination therapy for symptomatic HIV infection
After reviewing information about the drugs used to treat herpes virus and CMV infections, a group of students demonstrate understanding about these drugs when they identify which of the following as being available only for intravenous administration?
Foscarnet
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
Antivirals are used to treat infections caused by viruses. In particular, acyclovir is useful to treat which infection?
Herpes zoster
Acyclovir is useful to treat which infection?
Herpes zoster Its antiviral spectrum is limited to the herpesviruses, including HSV, herpes zoster virus, Epstein-Barr virus, and CMV.
Which of the following would be least likely to cause a drug interaction when rimantadine is prescribed?
Ibuprofen
A nurse is caring for a client who is taking acyclovir. What is likely to be a priority nursing diagnoses for this client?
Imbalanced Nutrition: less than body requirements related to drug adverse effects
A 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?
Immunocompromised
A 58-year-old patient 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 patient knows that which of the following is a sign of effective drug therapy?
Increased CD4+ cell counts
A client is diagnosed with cytomegalovirus infection and is to receive foscarnet. The nurse would expect to administer this drug by which route?
Intravenous
A client is diagnosed with cytomegalovirus infection and is to receive foscarnet. The nurse would expect to administer this drug by which route?
Intravenous (IV)
A patient with chronic hepatitis B (HBV) infection is scheduled to begin a new treatment regimen that will include adefovir dipivoxil (Hepsera). What assessments should be prioritized before the initiation of this drug treatment?
Liver function testing and HIV testing
Mark, 24 years old, is treated with acyclovir for herpes. He also has a history of epilepsy. What would indicate a serious reaction to the drug?
Mark is having tremors, which are 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 client is receiving zanamivir. When describing this drug, the nurse understands that it is absorbed through which mechanism?
Respiratory tract
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 RNA of the virus into DNA.
The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug would the nurse expect the pediatrician to order?
Ribavirin
The nurse knows that pregnant caregivers should not inhale which medication while administering the medication to clients?
Ribavirin
The client with HIV is experiencing nausea and vomiting related to antiviral medications. The client has lost 20 pounds in the last 2 months since initiating the drug therapy regimen. What is the highest priority nursing diagnosis for this client?
Risk for imbalanced nutrition
When fighting the human immunodeficiency virus (HIV), the nurse knows that the drug regimen usually includes which of the following?
Several medications, which combined are the most effective treatment Several medications that work on different phases of the viral life cycle have been shown to be most effective in HIV treatment. A single medication is not as effective as multiple-medication treatment. How a client tolerates a medication is important, but with HIV it is not the reason for multiple medications. Providers do not try to make medication treatment plans difficult by prescribing multiple medications.
An elderly patient is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The physician prescribes the drug acyclovir (Zovirax). What disease is this patient demonstrating?
Shingles
A male patient has been prescribed efavirenz as monotherapy for HIV. On follow-up visits to the clinic, it will be most important for the nurse to assess for which of the following?
Signs of microbial resistance
A client's health care provider is considering the addition of efavirenz to the client's drug regimen for the treatment of recently diagnosed HIV. Which aspects of the client's medical history should prompt the nurse to question the use of this drug?
The client has hepatitis C and a history of heavy alcohol use.
A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client?
The client will experience fewer recurrences
A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client?
The client will experience fewer recurrences.
Your 45-year-old client is prescribed acyclovir for treatment of genital herpes. Which of the following is an expected outcome for this client?
The client will experience fewer recurrences.
A sixteen year old client suspected of having HIV/AIDS asks the nurse what causes AIDS. What should the nurse respond?
The human immunodeficiency virus
The lower the patient's viral load,
The longer the survival time
The nurse is providing health education to a client who has recently been diagnosed with HIV and will soon begin antiretroviral therapy. What teaching point should the nurse prioritize?
The need to adhere to the prescribed drug regimen
A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason?
The use of multiple drugs allows attack on the virus at different points in its life cycle
A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which of the following would the nurse include as the primary reason?
The use of multiple drugs allows attack on the virus at different points in its life cycle.
A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason?
The use of multiple drugs allows attack on the virus at different points in its life cycle.
A client is 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?
There are potential adverse effects associated with hyperlipidemia.
All infections regardless of type can be treated with antibiotics. Is this statement true or false?
false
In which of the following patients is the use of cidofovir contraindicated?
patients with renal impairment
A group of nursing students are reviewing information about the different antiretroviral drugs. The students demonstrate understanding when they identify which as an example of an entry inhibitor? Select all that apply.
• maraviroc • enfuvirtide
