Chapter 29: HIV- and AIDS-Related Drugs

2. A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection.

A. Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.

5. A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient's creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action? a. Instruct the patient to take the medication 60 minutes prior to meals. b. Notify the provider to discuss single-dose NRTI products. c. Request an order for once-daily dosing of this medication. d. Suggest that the patient increase fluid intake.

B

The health care provider is considering placing the patient on ritonavir. The patient tells the nurse that the patient has recently been diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? A) notify the pharmacist that a larger dose will be needed B) notify the health care provider of the new information C) instruct the patient to monitor blood sugars more often D) instruct the patient to keep an accurate glucose log

B) notify the health care provider of the new information The health care provider should be notified of this new information. Patients with diabetes mellitus or hyperglycemia may experience an exacerbation of their condition during ritonavir treatment.

A patient diagnosed with human immunodeficiency virus (HIV) is in her first trimester of pregnancy. The nurse will teach this patient about which medication? A) delavirdine B) efavirenz C) nevirapine D) zidovudine

C) nevirapine Nevirapine may be used as an alternative therapy for women who are pregnant, especially in the first trimester of pregnancy. The other drug choices are not recommended for pregnant patients.

Immigrants from which regions have the highest prevalence of foreign-acquired cases of tuberculosis in the United States? (Select all that apply.) A. Africa B. Caribbean C. Middle East D. Latin America E. Asia F. Eastern Europe

D. Latin America E. Asia Hispanic and Asian immigrants have the highest incidence of foreign-acquired TB.

The patient has been taking ritonavir for a week and informs the nurse that the patient is experiencing occasional episodes of abdominal discomfort. What patient teaching will the nurse provide to the patient? (Select all that apply) A) reassure the patient that this is an expected side effect of the medication B) instruct the patient to report episodes that increase in intensity or frequency C) instruct the patient to stop taking the medication D) instruct the patient to maintain a symptom diary E) take an over-the-counter h2 antagonist

A) reassure the patient that this is an expected side effect of the medication B) instruct the patient to report episodes that increase in intensity or frequency D) instruct the patient to maintain a symptom diary Abdominal discomfort is an expected side effect of the medication and is not indicative of any significant problem with the medication. However, the patient should certainly report episodes of discomfort that increase in intensity and/or frequency. Use of a symptom diary can assist with the reporting process. The patient should not add any over-the-counter medications.

A patient is to start on efavirenz. Which points are important for the nurse to include in health teaching for this patient? (Select all that apply) A) the dose is given at bedtime to minimize central nervous system adverse effects B) alcohol should be avoided because of adverse effects to the liver C) the dose should be taken after breakfast to minimize central nervous system adverse effects D) high-fat meals can increase absorption of the medication E) hyperglycemia, jaundice, and diabetes mellitus are side effects

A) the dose is given at bedtime to minimize central nervous system adverse effects B) alcohol should be avoided because of adverse effects to the liver D) high-fat meals can increase absorption of the medication Look at orange chart on pg. 414 in the textbook.

In collaboration with a patient on antiretroviral therapy, the nurse formulates a plan of care. Which items are appropriate to include in planning? (Select all that apply) A) the patient's viral load will become and remain undetectable B) the patient will not experience secondary infection C) the patient will promptly report new onset of symptoms and side effects D) laboratory blood work will be within normal limits E) the patient will adhere to the medication regimen and will report any difficulties related to adherence

A) the patient's viral load will become and remain undetectable B) the patient will not experience secondary infection C) the patient will promptly report new onset of symptoms and side effects E) the patient will adhere to the medication regimen and will report any difficulties related to adherence The goal, laboratory blood work will be within normal limits, is not reasonable for a patient with HIV.

A patient takes isoniazid, rifampin (Rifadin), and ethambutol (Myambutol). Which instruction should the nurse include in patient teaching to prevent the most likely adverse effects of this therapy? (Select all that apply.) A. Avoid all alcoholic beverages. B. Avoid over-the-counter agents. C. Drink 2 to 3 L/day of fluid. D. Take this medication with food. E. Report nausea, vomiting, or itching. F. Report visual changes or eye pain.

A. Avoid all alcoholic beverages. B. Avoid over-the-counter agents. E. Report nausea, vomiting, or itching. F. Report visual changes or eye pain.

Which individual(s) should undergo tuberculin skin testing? (Select all that apply.) A. Home health care nurses B. Patients in a nursing home C. Students living off-campus D. Counselors at a summer camp E. Inmates of correctional centers F. Individuals in homeless shelters

A. Home health care nurses B. Patients in a nursing home E. Inmates of correctional centers F. Individuals in homeless shelters

A patient must start antitubercular therapy after a sputum culture reveals Mycobacterium tuberculosis, but the sensitivity results from the culture are not available. Which antitubercular agents are classified in the group of drugs used to treat patients at this stage of therapy? (Select all that apply.) A. Pyrazinamide B. Isoniazid C. Rifampin (Rifadin) D. Rifabutin (Mycobutin) E. Levofloxacin (Levaquin) F. Ethambutol (Myambutol)

A. Pyrazinamide B. Isoniazid C. Rifampin (Rifadin) F. Ethambutol (Myambutol) Pyrazinamide, isoniazid, rifampin, and ethambutol or streptomycin are the four medications used to treat patients in whom tuberculosis has been diagnosed before the sensitivity results are known.

3. A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Today's lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patient's results? a. A drug-resistant strain is likely. b. The patient is progressing as expected. c. The patient's treatment goals have been met. d. Treatment failure has occurred.

B The treatment goal would be a VL of < 20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.

A patient is receiving antiretroviral therapy (ART). Which outcome indicates a therapeutic response to the medication therapy? A) elevation of HIV RNA levels B) CD4 T-cell increase C) decreased T-cell reactivity D) increased immune system functioning

B) CD4 T-cell increase The expected outcome of ART is a suppression of HIV RNA levels and CD4 T-cell increases in patients. Elevated HIV RNA levels, decreased T-cell reactivity, and increased immune system functioning are not indicative of a therapeutic response to medication therapy.

A patient asks the nurse what part of the body is most affected by the HIV virus. The nurse informs the patient that HIV primarily affects which system? A) cardiovascular B) immune C) renal D) hepatic

B) immune HIV destroys the CD4 T cells which are part of the body's immune system.

Which intervention is a priority for a patient who is taking ART? A) increase fluids to 2400 mL/day B) teach adherence to the medication regimen C) refer the patient for preventive care measures D) teach hand washing to the patient

B) teach adherence to the medication regimen Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority.

A patient who takes isoniazid, pyrazinamide, rifampin (Rifadin), and ethambutol (Myambutol) complains about sharp nighttime pain in the right great toe. Which laboratory test is the nurse's priority to help prevent renal dysfunction? A. Glucose B. Uric acid C. Creatinine D. Potassium

B. Uric acid

The nurse has instructed a patient diagnosed with human immunodeficiency virus (HIV) on the use of zidovudine. Which patient statement demonstrates a need for additional teaching? A) I may get a headache from this medication B) I might have difficulty sleeping with this medication C) I do not need to use condoms as long as I take my medication as prescribed D) I do not have to worry about taking the medication on an empty stomach or not

C) I do not need to use condoms as long as I take my medication as prescribed Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions such as using condoms. Zidovudine can cause headaches and insomnia and can be taken without regard to food.

6. A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to a. avoid development of psychiatric comorbidities. b. prevent dizziness, sedation, and nightmares. c. reduce viral resistance. d. prevent severe rash and hepatotoxicity.

C. Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.

11. The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient's blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond? a. "No treatment is necessary since the patient is receiving antiretroviral therapy." b. "We will treat you if the patient's VL is > 20 copies/mL." c. "You will require 4 weeks of antiretroviral therapy." d. "You will undergo HIV testing and will be treated if you are positive."

C. Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

A health care provider has been exposed to HIV while caring for a patient. Following the postexposure prophylaxis regimen (PEP), the health care provider will most likely receive treatment for how long? A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks

D) 4 weeks Look at pg. 419 in the textbook.

The nurse recognizes that compliance with ART regimens is often problematic for patients. What level of compliance is needed to help ensure ongoing success with this therapy? A) 50% B) 65% C) 80% D) 95%

D) 95% Adherence challenges are common with any drug therapy, but ART presents a greater challenge because patients are asked to achieve an adherence of 95% or greater. Nonadherence can result in HIV viral replication and can potentiate drug resistance.

When a patient does not appear for a routine clinic visit, the nurse calls to ask about the missed visit. The patient says, "I don't need to come any longer. I'm so glad I no longer have HIV." The nurse learns that recent laboratory results indicated an "undetectable" HIV viral load and that the patient stopped his medication several weeks earlier. What is the nurse's best response? A) inform the patient that he must be seen immediately because the undetectable viral load indicates that his medication stopped working B) have the patient reschedule his clinic visit C) congratulate the patient on his treatment success D) educate the patient about the continued need for his medications and ongoing laboratory monitoring

D) educate the patient about the continued need for his medications and ongoing laboratory monitoring

During routine prenatal testing, a patient is diagnosed with human immunodeficiency virus (HIV) infection. To help prevent perinatal transmission of HIV to the fetus, what is the nurse's best action? A) provide the patient with contact information for an acquired immunodeficiency syndrome support group B) educate the patient about the risks of HIV disease to the fetus C) notify the Centers for Disease Control and Prevention of the patient's diagnosis D) provide written and oral education about the use of antiretroviral therapy during pregnancy

D) provide written and oral education about the use of anti-retroviral therapy during pregnancy

The nurse identifies which condition as a common bacterial opportunistic infection seen in patients with HIV? A) cytomegalovirus B) candidiasis C) toxoplasmosis D) tuberculosis

D) tuberculosis Tuberculosis is the only one that is a bacterial infection. Cytomegalovirus is a viral infection, candidiasis is a fungal infection, and toxoplasmosis is a protozoan infection.

9. A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order? a. Administration of a high dose of corticosteroids b. Changing the regimen to a single antiretroviral drug c. Temporarily discontinuing the antiretroviral therapy d. Treating an underlying opportunistic infection

D. IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.

1. The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient a. has an increased risk of transmitting the HIV infection. b. is less likely to develop AIDS than younger persons with HIV infection. c. is less likely to respond to antiretroviral agents. d. may have comorbid illnesses that can complicate HIV.

D. Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

Which patient assessment is the nurse's priority before initiating therapy that includes ethambutol (Myambutol) and isoniazid? A. Serum blood urea nitrogen and creatinine levels B. Motivation to adhere to the therapeutic regimen C. Discrimination of high-pitched sound D. Color discrimination and visual acuity

D. Color discrimination and visual acuity Ethambutol can produce dose-related optic neuritis, resulting in blurred vision, constriction of the visual field, and disturbances of color discrimination. Color discrimination and visual acuity should be assessed before treatment and monthly thereafter and compared to the baseline assessment for early detection of neurologic complications. Additional baseline data, including data on hearing acuity, BUN and creatinine for renal function, and motivation for adherence, should be collected before therapy is begun to aid the planning of additional nursing care.

The nurse is explaining antitubercular therapy to a patient. The patient asks, "Why do I have to take so many different medications?" What is the nurse's best response? a. "It helps to prevent the tuberculosis from becoming resistant to the drugs." b. "It makes sure that the disease is cured." c. "These medications will reduce symptoms imme- diately." d. "You will have fewer side effects."

a. "It helps to prevent the tuberculosis from becoming resistant to the drugs."

The nurse is reviewing the medication list of a patient who has been newly diagnosed with tuberculosis and will be taking rifampin (Rifadin). Which class of drugs, if taken with rifampin, may cause increased metabolism? (Select all that apply.) a. Beta blockers b. Proton pump inhibitors c. Selective serotonin reuptake inhibitors d. Oral anticoagulants e. Oral antidiabetic drugs

a. Beta blockers d. Oral anticoagulants e. Oral antidiabetic drugs

A patient newly diagnosed with tuberculosis asks the nurse how long he will need to take "all this medicine." The nurse replies that drug therapy for active tuberculosis may need to last how long? a. 6 months b. 12 months c. 24 months d. A lifetime

c. 24 months

The nurse would correctly identify the method of action of isoniazid (INH) as which of the following? a. Inhibiting protein synthesis. b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Its method of action is unknow

c. Altering cell wall synthesis

which antitubercular drug must you not use when patient has gout or liver disease or pregnant

pyrazinamide

what can happen to skin sweat tears feces and saliva when on antitubercular therapy

red-brown-orange

The nurse would correctly identify the method of action of ethambutol (Myambutol) as which of the following? a. Inhibiting protein synthesis. b. inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Its method of action is unknown

a. Inhibiting protein synthesis.

A patient will be receiving long-term isoniazid (INH) therapy. What laboratory tests are most important for the nurse to monitor during therapy? a. Liver enzyme levels b. Hematocrit and hemoglobin level c. Creatinine level d. Platelet count

a. Liver enzyme levels

The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a. Orange discoloration of sweat and tears b. Darkened urine c. Dizziness d. Fatigue e. Visual disturbances f. Jaundice

b. Darkened urine d. Fatigue f. Jaundice when taking antitubercular drugs it is important to teach patients to wear _____ outside

this antitubercular drug can cause serious eye issues

ethambutol

when taking antitubercular drugs it is important to teach patients to wear _____ outside

sunscreen

7. A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir a. allows decreasing the dosing from 3 times daily to twice daily. b. can lead to increased cholesterol and triglycerides. c. may worsen insulin resistance. d. will require increased dietary restrictions.

A

The nurse advises HIV-positive patients about blood draws to obtain a CD4+ count. What is the correct information to give them about when and how this laboratory blood work should be done? A) at the same laboratory at approximately the same time of day whenever possible B) after a 10-hour fast C) approximately 1 hour after taking antiretroviral medications D) at any laboratory at any time of day

A) at the same laboratory at approximately the same time of day whenever possible

When providing teaching for the patient being discharged home on antiretroviral therapy for HIV, which statement will the nurse include? A) do not eat raw fish B) limit food intake to proteins only C) avoid ingesting bananas D) applesauce may cause you to experience side effects of the medication

A) do not eat raw fish The nurse should teach the patient to avoid ingesting raw eggs, raw fish, and raw meat. The patient should cook all meats at the advised temperature and should implement the BRAT diet (bananas, rice, applesauce, toast) to manage diarrhea.

The patient has been started on stavudine (d4T). After taking the drug for 3 days, the patient contacts the nurse to report that the patient has started experiencing muscle pain and weakness. What is the nurse's highest priority action? A) instruct the patient to hold doses of the medication until further notice B) reassure the patient that this is an expected side effect of the medication C) instruct the patient to self-medicate with an NSAID medication D) reassure the patient that the symptom is time-limited and will resolve

A) instruct the patient to hold doses of the medication until further notice The patient should not take any more doses of the medication until the health care provider can evaluate the patient. Muscle pain and weakness may be related to lactic acidosis, a serious side effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.