Chapter 40: Antiviral
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? "I might experience a headache when taking this medication." "I should lie down after I take this medication to prevent dizziness." "I still need to use condoms even though I'm taking this medication." "I don't have to worry about taking the medication on an empty or full stomach."
"I should lie down after I take this medication to prevent dizziness." The patient should be instructed to remain upright or with the head of the bed elevated while administering the medication and for up to 30 minutes afterward to prevent esophageal ulceration. Headaches and insomnia are side effects of zidovudine. Antiretroviral agents do not stop the transmission of HIV, and patients need to continue standard precautions. Absorption of oral dosage forms of zidovudine is not impeded by taking the drug with food or milk. p. 657
What are the common adverse effects of the antiviral drug ribavirin? Anemia Conjunctivitis Peripheral neuropathy Orthostatic hypotension Bone marrow suppression
Anemia Conjunctivitis Ribavirin is a synthetic nucleoside analogue of guanosine. The adverse effects associated with ribavirin include anemia and conjunctivitis. Peripheral neuropathy is an adverse effect of zalcitabine. Orthostatic hypotension is an adverse effect of rimantadine. Bone marrow suppression is an adverse effect of zidovudine. 646
The nurse is caring for a patient taking foscarnet. What will the nurse monitor to identify potential side effects of this medication? Platelets Stool guaiac Hemoglobin and hematocrit Blood urea nitrogen and creatinine
Blood urea nitrogen and creatinine Foscarnet can cause kidney damage. Blood urea nitrogen and creatinine should be closely monitored. Platelets, stool guaiac, and hemoglobin and hematocrit would not be monitored to identify potential side effects of this medication. p. 655
What is the dose-limiting toxicity of ganciclovir treatment? Pancreatitis Renal toxicity Peripheral neuropathy Bone marrow suppression
Bone marrow suppression The dose-limiting toxicity of ganciclovir is bone marrow suppression. Pancreatitis is an adverse effect of didanosine. Renal toxicity is the dose-limiting toxicity of foscarnet. Peripheral neuropathy is an adverse effect of zalcitabine and didanosine. p. 655
What is the primary assessment the nurse should make for a patient who is taking ganciclovir sodium? Input and output Bowel elimination Blood urea nitrogen Complete blood count
Complete blood count Bone marrow suppression is a dose-limiting toxicity of ganciclovir, and a complete blood count should be monitored. Input and output, bowel elimination, and blood urea nitrogen would not be the primary assessments for a patient taking ganciclovir. p. 655
Which antiviral drug causes lipodystrophy as a major adverse effect? Darunavir Zalcitabine Zidovudine Didanosine
Darunavir Protease inhibitors such as darunavir cause lipodystrophy, or redistribution of fat stores under the skin, resulting in cosmetically undesirable outcomes. Zalcitabine causes peripheral neuropathy as an adverse effect. Zidovudine causes bone marrow suppression as an adverse effect. Didanosine causes pancreatitis as an adverse effect. p. 652
Administration of amprenavir may exacerbate which health problem? Diabetes Glaucoma Hypertension Urinary tract infection
Diabetes Amprenavir, like indinavir, increases blood glucose concentration. Therefore, the nurse has the additional responsibility of monitoring blood glucose concentrations along with hemoglobin A1C. Amprenavir does not cause glaucoma, hypertension, or urinary tract infection. p. 652
Which antiretroviral drug is classified as a fusion inhibitor? Abacavir Efavirenz Enfuvirtide Amprenavir
Enfuvirtide Enfuvirtide is the only drug that is classified as a fusion inhibitor. Abacavir is a nucleoside reverse transcriptase inhibitor. Efavirenz is a nonnucleoside reverse transcriptase inhibitor. Amprenavir is a protease inhibitor. p. 651
A patient is being discharged to continue with antiviral therapy for acquired immune deficiency syndrome (AIDS). What information should the nurse provide to the patient to improve adherence to the antiviral therapy regimen? When viruses replicate, they continually reverse their DNA to form mutations. Viruses are usually well established in the host before clinical indicators appear. Viral illnesses are difficult to treat, because viruses replicate outside of host cells. Treatment for viral illnesses is more limited than is treatment for bacterial illnesses.
Viruses are usually well established in the host before clinical indicators appear. The nurse should instruct the patient to adhere to therapy because by the time a diagnosis is made, the virus is well established in the host. Eradication of the virus is more difficult, because a larger viral load is involved. Normally only retroviruses reverse their DNA to form mutations. Viruses replicate inside the host cell, making treatment difficult, because the primary health care provider must balance the toxic effects of the antiviral agent against the host cell for the eradication of the virus. With the appearance of AIDS, antiviral drug research began generating more antiviral drugs for human immunodeficiency virus and other viral illness, and the Food and Drug Administration approves antiviral agents faster than it does any other type of drug. pp. 642, 643
Which precaution should the nurse implement for self-protection when a patient who has herpes simplex virus type 2 (HSV-2) needs to receive acyclovir? Wear a face shield and a gown. Wear an N-95 mask and gloves. Keep the hands away from the eyes. Instruct the patient to self-administer the drug.
Keep the hands away from the eyes. When a patient requires acyclovir, the nurse must keep the hands away from the eyes to prevent autoinoculation. A face shield and gown are not indicated unless the nurse expects splashing of fluids. Use of an N-95 mask to prevent inhalation of the virus is indicated in the care of a patient who is shedding Varicella zoster in chickenpox. Instructing the patient to self-administer acyclovir does not eliminate the risk of autoinoculation because it may happen during demonstrations as well. 656
Which of the following acid-base imbalances does the nurse consider an adverse effect for a patient who is receiving lamivudine therapy? Which of the following acid-base imbalances does the nurse consider an adverse effect for a patient who is receiving lamivudine therapy? Lactic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Lactic acidosis Lamivudine belongs to the group of nucleoside reverse transcriptase inhibitors. Some of the serious adverse effects of lamivudine include pancreatitis, peripheral neuropathy, and hepatotoxicity. Lactic acidosis, rhabdomyolysis, hepatomegaly, splenomegaly, steatosis, bone marrow suppression, and hypersensitivity reactions are additional serious reactions associated with lamivudine therapy. Metabolic alkalosis, respiratory acidosis, and respiratory alkalosis are not direct adverse effects of lamivudine therapy. 654
A nurse is administering intravenous (IV) acyclovir to a patient. What should the nurse remember to ensure safe administration of the drug? Monitor the IV site. Avoid diluting the drug. Limit fluid intake during therapy. Administer the drug as an IV push.
Monitor the IV site. Intravenous acyclovir can cause venous irritation and phlebitis. Therefore, the nurse should monitor the IV site for redness, heat, pain, swelling, or red streaks. The drug should be adequately diluted to prevent venous irritation. The nurse should ensure adequate hydration during therapy to prevent renal toxicity. The drug should be given diluted over more than an hour to prevent renal tubular damage. p. 656
A patient with acquired immune deficiency syndrome (AIDS) receives a change in therapy after developing a hump on the neck with retroviral therapy. The hump has diminished with the change in therapy. Which therapeutic agent is most likely to have caused this change? Darunavir Nevirapine Amprenavir Fosamprenavir
Nevirapine The patient in this case might be prescribed nevirapine, which is a nonnucleoside reverse transcriptase inhibitor (NNRTI) usually used to replace a protease inhibitor. Protease inhibitors cause humplike outgrowths and bony skeletal face appearance. Darunavir, amprenavir, and fosamprenavir are protease inhibitors. p. 652
Nevirapine is in which drug class? Fusion inhibitor Protease inhibitor Nucleoside reverse transcriptase inhibitor Nonnucleoside reverse transcriptase inhibitor
Nonnucleoside reverse transcriptase inhibitor Nevirapine falls under the category of nonnucleoside reverse transcriptase inhibitors (NNRTIs). The NNRTIs are diverse chemicals that inhibit reverse transcriptase, similar to nucleoside agents. Included among this group of drugs are delavirdine, efavirenz, and nevirapine. Enfuvirtide is an example of a fusion inhibitor. Indinavir is an example of a protease inhibitor. Ribavirin is a synthetic nucleoside analogue. p. 651
During the assessment of a pregnant patient, a nurse finds that the patient has active genital herpes lesions. What is the best strategy to prevent the spread of infection to the newborn? Administering folic acid supplements to the patient Performing a cesarean section for the patient during labor Delivering the child during the eighth month of pregnancy Administering intravenous antiviral medications to the patient
Performing a cesarean section for the patient during labor Genital herpes is caused by herpes simplex virus type 2. It is characterized by genital warts and spreads by physical contact and sexual transmission. Neonatal herpes infection is often considered to be life threatening, because the antiviral medications given for the treatment may be fatal to the newborn. The best treatment strategy to prevent the spread of the infection to the newborn is delivery via cesarean section. This helps to prevent contact between the newborn and the site of infection. Folic acid supplements help to prevent spina bifida. They do not help to prevent the spread of infection. Delivering the child during the eighth month increases the risk of infection, because research has suggested that preterm children have reduced immunity. Administering antiviral medication during pregnancy by the intravenous route may cause congenital abnormalities in the fetus.
A patient who has acquired immune deficiency syndrome (AIDS) exhibits convulsions while receiving antiretroviral therapy that includes maraviroc. Which anticonvulsive drug is contraindicated in this patient because it is likely to decrease the effectiveness of the therapy? Diazepam Phenytoin Topiramate Phenobarbital
Phenytoin Phenytoin may decrease the effectiveness of maraviroc, because it is a cytochrome P3A4 hepatic enzyme inducer; this means that the metabolism of maraviroc occurs more quickly, leading to a lower concentrations circulating in the blood for a shorter period. Diazepam, topiramate, and phenobarbital may be indicated in the treatment of AIDS-associated convulsions. p. 654
The nurse is caring for a patient with acquired immune deficiency syndrome and makes sure that the patient maintains adequate hydration to prevent drug toxicity. Which class does the drug belong to? Fusion inhibitors Protease inhibitors Nucleoside reverse transcriptase inhibitors Nonnucleoside reverse transcriptase inhibitors
Protease inhibitors Protease inhibitors like indinavir and nevirapine are likely to cause stones in the kidney. Therefore, the patient should have adequate hydration. Other classes of drugs, such as fusion inhibitors, nucleoside reverse transcriptase inhibitors, and nonnucleoside reverse transcriptase inhibitors, do not cause nephrolithiasis (kidney stones) as a side effect. Fusion inhibitors may cause bone marrow suppression. Protease inhibitors may cause metabolic disorders such as dyslipidemia, hyperglycemia, and insulin resistance. Nucleoside reverse transcriptase inhibitors are associated with lactic acidosis and lipodystrophy. Nonnucleoside reverse transcriptase inhibitors are usually associated with rashes. p. 653
A patient with acquired immune deficiency syndrome (AIDS) has candidiasis of the mouth and esophagus and carcinoma of the cervix. Which intervention is the nurse's highest priority? Improving the patient's nutritional status Reinforcing the need to adhere to therapy Instructing the patient to avoid bathing in a tub Protecting the patient from environmental pathogens
Protecting the patient from environmental pathogens A patient who has AIDS, candida overgrowth in the mouth and esophagus, and carcinoma of the cervix most likely has stage 4 AIDS. As a result, the patient's CD4 count is likely to be dangerously low, indicating a major decline in immune function and a high risk for additional opportunistic infection. For this reason, the patient's immune system cannot be relied on for protection, so the nurse places the patient in protective isolation to keep potential pathogens from invading. The patient's nutritional status is likely to be poor, because oral candidiasis can cause extremely painful lesions in the esophagus, impairing the patient's ability to eat. Reinforcing the need for adherence to therapy is a reasonable intervention for a patient with complex health care issues, because failure to adhere to therapy can result in disease progression. Tub baths should be avoided because the carcinoma is likely to provide a port of entry for pathogens. However, none of these is the highest priority at this time.
Which antiviral drug is contraindicated in pregnant women because of its teratogenic properties? Ribavirin Cidofovir Foscarnet Amantadine
Ribavirin Ribavirin is an antiviral drug that has teratogenic properties; therefore, it is contraindicated in pregnant women and their male sexual partners. Cidofovir and foscarnet are contraindicated in patients with renal dysfunction. Amantadine is contraindicated in children younger than 12 months.
A patient taking amantadine is experiencing anxiety and dizziness. What intervention should the nurse perform first? Call the health care provider. Request a consultation for counseling. Take the patient's blood pressure sitting and standing. Evaluate the patient for other central nervous system effects from the medication.
Take the patient's blood pressure sitting and standing. The side effects and adverse reactions to amantadine include insomnia, nervousness, lightheadedness, anorexia, nausea, anticholinergic effects, orthostatic hypotension, and blurred vision. The nurse should evaluate the patient for orthostatic hypotension first to address safety issues. Nervousness is a known side effect of amantadine and is not necessarily an indication that the patient requires counseling. Additionally, the safety concern of orthostatic hypotension would be the first priority before other interventions.
Which of the following body systems manifests amantadine toxicity? The skin The muscle The endocrine system The central nervous system
The central nervous system Amantadine toxicity manifests primarily in the central nervous system with confusion, hallucinations, and severe mental or mood changes. The skin, muscle, and endocrine system are not directly related to amantadine toxicity. pp. 646, 647
Which antiretroviral therapy is most likely to induce dyslipidemia in a patient who has acquired immune deficiency syndrome (AIDS)? Maraviroc Tipranavir Enfuvirtide Delavirdine
Tipranavir Tipranavir is a protease inhibitor and impairs liver function. It is most likely to induce dyslipidemia in patients who have AIDS. In addition to dyslipidemia, protease inhibitor therapy can cause lipodystrophy, resulting in a hump at the base of the neck, redistribution of body fat, and a skeleton-like appearance. Maraviroc, enfuvirtide, and delavirdine do not cause any of the adverse effects caused by tipranavir. p. 652
Which agent is used to treat most infections caused by herpes simplex viruses and varicella-zoster virus? Acyclovir Zanamivir Ganciclovir Amantadine
Acyclovir Acyclovir, the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster viruses, is used to suppress replication of the herpes virus. Zanamivir is used to treat influenza in adults. Ganciclovir is the drug used most commonly in the treatment of cytomegalovirus. Amantadine is used to prevent and treat influenza. p. 645
Which drug is most commonly used to treat severe varicella infection? Acyclovir Trifluridine Famciclovir Valacyclovir
Acyclovir Intravenous acyclovir is the most commonly used drug to treat severe varicella infection, and it may prevent fatalities or disability. Trifluridine is used to treat herpes simplex keratitis. Famciclovir and valacyclovir are used to treat less severe varicella infections. p. 647
Which type of interaction is associated with the use of zidovudine along with acyclovir? Increased risk for seizures Increased risk for neurotoxicity Increased risk for hematologic toxicity Increased adverse anticholinergic effects
Increased risk for neurotoxicity Zidovudine, when administered along with acyclovir, increases the patient's risk for neurotoxicity because of drug interactions. Imipenem, when administered along with ganciclovir, increases the patient's risk for seizures. Zidovudine, when administered along with ganciclovir, increases the patient's risk for hematologic toxicity. Anticholinergic drugs, when administered along with amantadine, increase adverse anticholinergic effects. p. 646
A patient who has acquired immune deficiency syndrome takes indinavir, zidovudine, maraviroc, and zanamavir. Which medication should the nurse first administer in the morning before breakfast to maximize its effectiveness? Indinavir Maraviroc Zanamavir Zidovudine
Indinavir The nurse should administer indinavir on an empty stomach, because high-fat or high-protein food in the patient's stomach will impair its absorption. The other medications would be provided sequentially after indinavir. Maraviroc, zanamavir, and zidovudine may be used as prescribed after indinavir is administered. pp. 653, 657
A patient who is treated with zidovudine develops blistering rashes, fever, and myalgia. What should the nurse do first? Ask the patient to take bed rest. Administer antipyretic medications. Administer antihistamine medications. Inform the primary health care provider.
Inform the primary health care provider. Rashes, blistering, fever, and myalgia indicate ineffectiveness of the therapy and worsening of symptoms. Therefore, the nurse should immediately inform the health care provider about it. Taking bed rest may make the patient comfortable but may not help to reduce the symptoms. Antipyretics may help to treat fever but may not reduce viral symptoms. The nurse should not administer antihistamines, because the rashes are not caused by an allergy.
The nurse observes that a patient has cold sores around the mouth. Which virus would have caused this condition? Herpes simplex type 1 Herpes simplex type 2 Cytomegalovirus (CMV) Varicella-zoster virus (VZV)
Herpes simplex type 1 Cold sores or fever blisters around the mouth are the manifestations of mucocutaneous herpes, which is an infection caused by herpes simplex type 1. Thus this virus may be present in the patient. Herpes simplex type 2 causes genital herpes. CMV causes a serious viral infection of the eye called CMV retinitis. VZV is responsible for both chickenpox and shingles. p. 644
Which microorganism is directly affected by acyclovir? Herpes zoster Proteus vulgaris Pneumocystis carinii Staphylococcus aureus
Herpes zoster Acyclovir in its oral form is used as prophylaxis for and in the treatment of Herpes zoster. Proteus vulgaris, Pneumocystis carinii, and Staphylococcus aureus are not cured with acyclovir. There are other antiviral remedies for P. vulgaris, P. carinii, and S. aureus. P. vulgaris is treated with antibiotics such as sulfonamides. P. carinii is treated with antiprotozoal drugs such as atovaquone. Ciprofloxacin is used to treat S. aureus. p. 645
A nurse is assessing a patient who has a serious eye infection. Which herpesvirus may cause this infection? Human herpesvirus type 3 Human herpesvirus type 4 Human herpesvirus type 5 Herpes simplex virus type 1
Human herpesvirus type 5 There are many strains of herpesvirus, each of which is responsible for different infections. Human herpesvirus type 5 is also called cytomegalovirus; it causes cytomegalovirus retinitis, which is a serious eye infection. Human herpesvirus type 3 causes chickenpox. Human herpesvirus type 4 causes chronic fatigue syndrome. Herpes simplex virus type 1 (HSV-1) causes mucocutaneous herpes—usually in the form of perioral blisters ("fever blisters" or "cold sores"). p. 644
Which antiviral drug is contraindicated in patients who have an allergy to penciclovir? Ribavirin Cidofovir Famciclovir Amantadine
Famciclovir Famciclovir is contraindicated in patients who have an allergy to penciclovir, a related drug. Ribavirin is contraindicated in pregnant women. Cidofovir is contraindicated in patients who already have severely compromised renal function. Amantadine is contraindicated in lactating women, children younger than 12 months, and patients with an eczematous rash. p. 645
Enfuvirtide belongs to which class of antiviral medication? Fusion inhibitor Protease inhibitor Nucleoside reverse transcriptase inhibitor Nonnucleoside reverse transcriptase inhibitor
Fusion inhibitor Enfuvirtide belongs to the category of fusion inhibitors. It is the first of its kind. Fusion inhibitors currently have a limited role in the management of acquired immune deficiency syndrome. Indinavir is an example of a protease inhibitor. Ribavirin is an example of a synthetic nucleoside analogue. Nevirapine belongs to the category of nonnucleoside reverse transcriptase inhibitors. 653
A patient with a herpes simplex virus type 1 (HSV-1) infection must apply topical acyclovir to the lesions. What instructions should the nurse provide to the patient to help prevent the transmission of HSV-1? "Keep the ointment in a pocket for touch-ups." "Wash the applicators with soap and hot water." "Apply the ointment with a clean, gloved hand." "Avoid applying the ointment to multiple lesions." "Do not touch the ointment after touching the lesion." "Use a new part of the hand each time after touching the container."
"Apply the ointment with a clean, gloved hand." "Avoid applying the ointment to multiple lesions." "Do not touch the ointment after touching the lesion." "Use a new part of the hand each time after touching the container." To help prevent transmission of HSV-1, the nurse instructs the patient to wear fresh gloves to apply the medication and to touch the container of ointment with a different, fresh part of the glove's surface each time. This means that the patient should not touch the lesion and then touch the container, because this will contaminate the container with HSV-1. The nurse also instructs the patient to apply ointment to each lesion individually, meaning that the patient should use a fresh surface to move the ointment from the container to the lesion. The nurse instructs the patient to consider the gloved hand contaminated after touching a lesion with it and to use a new, fresh surface to move the ointment to the next lesion. p. 658
A patient is prescribed zidovudine. The nurse understands that the drug may cause esophageal ulceration if not taken properly. What instruction will the nurse give to the patient to prevent this adverse effect? "Lie down after taking the drug." "Avoid taking the drug with milk." "Avoid taking the drug with food." "Sit upright when taking the drug."
"Sit upright when taking the drug." Zidovudine is an antiviral drug that may cause esophageal ulceration if regurgitated. Therefore, the patient should be instructed to sit upright or keep the head elevated when taking the drug. The patient should be instructed not to lie down immediately after taking the drug; the patient should sit upright for at least 30 minutes after taking the drug to prevent regurgitation. The drug can be taken with milk or food, because these do not interfere with absorption of the drug. p. 657
To be effective for treating chickenpox, acyclovir should be initiated within how many hours of the appearance of the rash? 8 16 24 56
24 The oral administration of acyclovir is used in the prophylaxis and treatment of genital herpes infections in both immunocompromised and immunocompetent patients. It is also used to treat varicella infections (chickenpox) in immunocompetent children if used within 24 hours of the appearance of the rash. Acyclovir does not need to be administered within 8 or 16 hours. Acyclovir should be administered before 56 hours. p. 658
Which nurse should not be assigned to treat a patient who is receiving ribavirin in an aerosol formulation? A nurse who is pregnant A nurse who has a low-grade fever A nurse who has not had chickenpox A nurse on light duty because of a back injury
A nurse who is pregnant Ribavirin is a teratogenic (category X) drug and should be avoided in those who are pregnant or trying to conceive. Nurses who have a low-grade fever, who haven't had chickenpox or have a back injury are not susceptible to the teratogenic properties of ribavirin. 645
A patient has been diagnosed with genital herpes. What drug will be used to treat and manage this infection? Ribavirin Acyclovir Zidovudine Amantadine
Acyclovir Acyclovir is indicated for the treatment of genital herpes. Ribavirin is used in the treatment of respiratory syncytial virus and in combination with simeprevir and interferon for the treatment of hepatitis C. Zidovudine is used to increase the life expectancy of patients suffering from acquired immune deficiency syndrome. Amantadine is used to prevent herpes simplex virus (HSV)-1 and HSV-2. p. 647
A nurse is caring for a patient who has been diagnosed with genital herpes. Which medication is the drug of choice for this patient? Ribavirin Acyclovir Zidovudine Amantadine
Acyclovir Acyclovir is the drug of choice to treat herpes simplex infections. Ribavirin is effective against respiratory syncytial virus (RSV); zidovudine is effective against HIV, and amantadine is effective against Haemophilus influenzae type A. p. 645
The health care provider orders ritonavir for a patient who has acquired immune deficiency syndrome. About what adverse effect will the nurse inform the patient? Pancreatitis Photophobia Bone marrow suppression Bony appearance of the face
Bony appearance of the faceThe antiviral drug prescribed to the patient is ritonavir, which may be mixed with chocolate milk or a nutritional drink about an hour before administration to improve palatability. Ritonavir is a protease inhibitor, which causes adverse effects such as bony appearance of the face and a hump on the posterior side of the neck. Pancreatitis, photophobia, and bone marrow suppression are not adverse effects of ritonavir. p. 652
A patient is diagnosed with cytomegalovirus (CMV) retinitis. Which drug should the nurse expect to administer to this patient? Ribavirin Cidofovir Acyclovir Amantadine
Cidofovir Cidofovir is an antiviral drug that is used to treat CMV infection. It is effective against CMV retinitis. Ribavirin is used to treat respiratory syncytial virus infection. Acyclovir is effective against herpes simplex types 1 and 2, herpes zoster, and chickenpox. Amantadine is an antiviral drug used to treat influenza A. 645
Which antiviral drug is used in the treatment of cytomegalovirus infection? Ribavirin Cidofovir Trifluridine Amantadine
Cidofovir Cidofovir is an antiviral drug that is used in the treatment of cytomegalovirus infection. Ribavirin is an antiviral drug that is indicated for respiratory syncytial virus infection. Trifluridine is an antiviral drug that is indicated for herpes simplex keratitis. Amantadine is an antiviral drug that is indicated for influenza viruses. p. 645
A patient who has undergone a heart transplant contracts cytomegalovirus retinitis while receiving cyclosporine therapy. Which antiviral therapy for the treatment of cytomegalovirus retinitis is contraindicated in this patient? Cidofovir Valganciclovir Ganciclovir sodium Ganciclovir for ocular use
Cidofovir Cidofovir, indicated in the treatment of cytomegalovirus retinitis, is contraindicated in a patient receiving cyclosporine, because both agents are nephrotoxic. For this reason, the primary health care provider must use an alternative therapy. The types of ganciclovir variants, including valganciclovir, are indicated in the treatment of cytomegalovirus retinitis. 647, 648
A patient has been prescribed acyclovir. What precautionary measure should the nurse implement to minimize kidney damage associated with this drug? Use the solution within 24 hours Infuse acyclovir over at least 1 hour Provide ice chips during the infusion Assess the intravenous site frequently for redness
Infuse acyclovir over at least 1 hour As a means of reducing the risk of crystalluria and renal tubule damage, the nurse infuses acyclovir over at least 1 hour, because renal damage is associated with too rapid infusion of this drug. In addition, the nurse prehydrates the patient and maintains hydration during and for several hours after the infusion to induce hemodilution. Acyclovir infusions are stable for 12 hours at room temperature. Ice chips are inadequate to maintain hydration; however, they are suitable for supplemental fluid and comfort. Assessing the intravenous site is an important nursing intervention during the infusion; however, looking for redness at the site is a means of detecting potential phlebitis, not a renal-protective measure.
A patient has been prescribed tenofovir. After taking the drug for 3 days, the patient contacts the nurse to report experiencing muscle pain and weakness. What is the nurse's highest priority action? Reassure the patient that the symptom is time limited and will resolve. Instruct the patient to hold doses of the medication until further notice. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to self-medicate with a nonsteroidal antiinflammatory medication.
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 adverse effect of the medication. The nurse's scope of practice does not allow for adjusting the patient's medication regimen.
Which patient group should receive the Zostavax vaccine? Children Newborns Pregnant patients Patient 50 years of age and older
Patient 50 years of age and older Zostavax is a herpes zoster vaccination given to older patients to prevent zoster lesions known as shingles. It is prescribed for patients who are 50 years of age or older. Children are not administered Zostavax; instead, varicella vaccination is given to prevent chickenpox. Zostavax is a live attenuated vaccine and is contraindicated in pregnant patients. Newborns should not receive the Zostavax vaccine. p. 645
A patient is prescribed cidofovir to treat retinitis. After checking the patient's medication history, the nurse finds that the patient also takes cyclosporine, and asks the health care provider to change the prescription. Which adverse effect is the nurse trying to prevent? Cardiotoxicity Hepatotoxicity Nephrotoxicity Bone marrow suppression
Nephrotoxicity The patient who is on cyclosporine is at high risk of developing nephrotoxicity, because the drug may affect the nephrons. Cidofovir may worsen the nephrotoxic effect if given in combination with cyclosporine, because this drug also has renal elimination. Cardiotoxicity, hepatotoxicity, and bone marrow suppression are not potential adverse effects observed with this combination of drugs. pp. 647, 648
A patient with cytomegalovirus infection and renal insufficiency is to receive antiviral therapy. Which diagnostic results should the nurse monitor to prevent complications of the antiviral therapy prescribed for this patient? Culture Viral load CD4 count Neutrophils
Neutrophils The nurse must evaluate the patient's bone marrow function by monitoring the counts of neutrophils, platelets, and other cells from bone marrow. Renal function should be evaluated with the administration of other medications indicated for treatment of cytomegalovirus infection. The viral load should be measured to ensure the parameters of the drug regimen are kept under control. The CD4 count is relevant with antiretroviral therapy in human immunodeficiency virus infections. pp. 656, 657
The health care provider is considering prescribing a patient ritonavir. The patient tells the nurse about recently being diagnosed with type 2 diabetes mellitus. What is the nurse's highest priority action? Instruct the patient to keep an accurate glucose log. Notify the health care provider of the new information. Instruct the patient to monitor blood sugars more often. Notify the pharmacist that a larger dose will be needed.
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. 652
A patient is receiving ribavirin for the treatment of respiratory syncytial virus. Which are the appropriate routes to administer the prescription? Oral Inhalation Intravenous Subcutaneous Intramuscular
Oral Inhalation Oral ribavirin is used in combination with interferon or peginterferon in the treatment of hepatitis C. Inhaled ribavirin is indicated for serious viral pneumonia caused by the respiratory syncytial virus. Ribavirin cannot be administered through the subcutaneous, intravenous, or intramuscular routes. pp. 647, 648
A nurse is preparing to administer a non-human immunodeficiency virus antiviral drug to an infant. Before administering the drug, the nurse asks the family if any close family members are pregnant. What is the patient's diagnosis? Herpes virus infection Influenza virus infection Cytomegalovirus infection Respiratory syncytial virus infection
Respiratory syncytial virus infection Respiratory syncytial virus (RSV) infection is a viral infection that is treated with ribavirin. RSV is not usually treated in adults, and the drug is strictly contraindicated in pregnant woman and their male partners, because the drug has teratogenic effects. Herpesvirus infections are treated with acyclovir, which may be used to treat viral infections during pregnancy. Influenza virus is not contraindicated in pregnancy; pregnant patients are vaccinated for influenza. Cytomegalovirus infections are treated with cidofovir and foscarnet, which can be administered during pregnancy.
Which drug is used to manage viral pneumonia in a patient with respiratory syncytial virus? Ribavirin Flucytosine Amantadine Griseofulvin
Ribavirin Ribavirin is indicated for serious viral pneumonia caused by the respiratory syncytial virus. Flucytosine and griseofulvin are used as antifungal drugs. Amantadine is used as a dopamine modulator. p. 645
The stool reports of a patient confirm gastroenteritis. Which viral infection should the nurse suspect the patient to have? Rotaviruses Adenoviruses Papovaviruses Hepadnaviruses Norwalk-like viruses
Rotaviruses Norwalk-like viruses Rotaviruses and Norwalk-like viruses are the types of viruses responsible for causing gastroenteritis. Adenoviruses cause sore throat and conjunctivitis. Papovaviruses are responsible for causing warts. Hepadnaviruses are responsible for causing hepatitis. 643
A child has contracted chickenpox and is treated successfully. Which infection is the child prone to develop as an adult? Shingles Retinitis Gastroenteritis Kaposi sarcoma
Shingles Shingles, or herpes zoster, is caused by reactivation of varicella-zoster virus, which causes chickenpox. The virus that causes chickenpox may lie dormant in the nerve cells of the person for many years, only to be reactivated by any trigger. When reactivated, it causes shingles. Retinitis is usually caused by cytomegalovirus. Gastroenteritis is unrelated to a history of chickenpox. Kaposi's sarcoma is a cancer associated with acquired immune deficiency syndrome and is caused by Kaposi's sarcoma herpesvirus. p. 644
A patient who is resistant to several antiretroviral therapies is prescribed maraviroc. What substance in the patient's history would decrease the therapeutic effect of the drug? Ginger St. John's wort Acetaminophen Oral contraceptives
St. John's wort Maraviroc is a new class of antiviral drugs that is used to treat patients who have developed resistance to antiretroviral therapies. Maraviroc has a reduced effect when given in combination with St. John's wort, which is an herbal medication that is used for depression. St. John's wort quickly processes maraviroc, reducing its absorption time and thereby reducing its effect. The drug does not interact with ginger, acetaminophen, or oral contraceptives. p. 646
Which intervention is a priority for a patient who is taking highly active antiretroviral therapy (HAART)? Increase fluids to 2400 mL/day. Teach hand washing to the patient. Teach adherence to the medication regimen. Refer the patient for preventive care measures.
Teach adherence to the medication regimen. Although all of these interventions should be carried out, teaching adherence to the regimen is the highest priority. 652, 658
A patient who is being treated with zidovudine develops respiratory syncytial virus (RSV) infection and is prescribed treatment for it. The nurse reviews the prescription of the patient and requests that the primary health care provider (PHP) recheck the prescription. What could be the most likely reason for the nurse to make this request? The combination of drugs would cause neurotoxicity in the patient. The combination of drugs would increase the risk of hematologic toxicity. The combination of drugs would increase serum levels of the antiviral drug. The combination of drugs would antagonize the antiviral action of the drug.
The combination of drugs would antagonize the antiviral action of the drug. Zidovudine is an antiviral drug used to treat acquired immune deficiency syndrome. Ribavirin is the only antiviral drug available for the treatment of RSV infection. If the drugs are coadministered, the antiviral action of zidovudine will be reduced, resulting in absence of the desired therapeutic effect. The combination therapy of these drugs is not associated with neurotoxicity, increased risk of hematologic activity, or increase in serum levels of the antiviral drug. Zidovudine may cause neurotoxic effects if administered along with acyclovir. Zidovudine interacts with ganciclovir to cause increased hematologic activity. Interferon beta interacts with zidovudine and increases the serum levels of zidovudine.
An adult patient who weighs 65 kg is prescribed intravenous acyclovir for the treatment of shingles. What would be the maximum dose of the drug that can be safely administered to the patient in a day? Record your answer using a whole number with no punctuation. mg of acyclovir per day
The intravenous (IV) dose of acyclovir for the treatment of shingles is 5 to 10 mg/kg/8 h in an adult patient. Therefore, the patient requires 5 to 10 mg/kg three times daily. The patient's weight was 65 kg. Thus, the minimum dose received by the patient in a day can be calculated as 5 × 65 × 3 = 975 mg. Similarly, the maximum dose received by the patient in a day can be calculated as 10 × 65 × 3 = 1950 mg.
The nurse is assessing a pregnant patient who has active herpes simplex virus type 2 (HSV-2). What precautions should the nurse suggest to the patient to ensure the newborn's safety? To receive a vaccination To take antiviral therapy in first trimester To increase the intake of iron supplements To give birth via cesarean section (C-section)
To give birth via cesarean section (C-section) Patients infected with HSV-2 are usually recommended to give birth via C-section to prevent the baby from contracting the infection. Herpes vaccination and antiviral medications are contraindicated in pregnancy, because they may have teratogenic effects. Iron supplements would not help to prevent infection in the baby. p. 644
Why is a patient advised to drink at least 48 oz of liquids every day while taking indinavir? To prevent lactic acidosis To prevent nephrolithiasis To prevent Kaposi's sarcoma To prevent bone marrow suppression
To prevent nephrolithiasis Indinavir may cause nephrolithiasis, or the presence of calculi in the kidney; the patient is advised to drink at least 48 oz of liquids every day to prevent this. Lactic acidosis is caused by tenofovir, not indinavir. Kaposi's sarcoma is a tumor caused by infection with human herpesvirus and is treated with antiretroviral drugs. Bone marrow suppression is an adverse effect of zidovudine.
What will the nurse monitor to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection? Viral load Lymphocyte counts Red blood cell counts Megakaryocyte counts
Viral load All antiretroviral agents work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood. Lymphocyte counts, red blood cell counts, and megakaryocyte counts are not used to evaluate the effectiveness of antiviral agents administered to treat human immunodeficiency virus infection. p. 652
A patient who has undergone a heart transplant contracts cytomegalovirus retinitis while undergoing cyclosporine therapy. Why might valganciclovir be a better choice of anticytomegalovirus retinitis therapy than ganciclovir sodium for this patient? Ganciclovir sodium is a parenterally administered drug. Ganciclovir sodium is more myelosuppressive than valganciclovir. Valganciclovir should be less nephrotoxic than ganciclovir sodium. Valganciclovir has a higher oral bioavailability than does ganciclovir sodium.
Valganciclovir has a higher oral bioavailability than does ganciclovir sodium. Valganciclovir, a prodrug of ganciclovir, may be a better choice for a heart transplant patient with cytomegalovirus retinitis because it has a higher bioavailability, meaning that the medication may be administered less frequently. Anticytomegalovirus therapies that are administered by way of injection include foscarnet and cidofovir. Valganciclovir and ganciclovir sodium cause myelosuppression but not renal toxicity. pp. 647, 648
A nurse is reviewing the lab reports for a patient with human immunodeficiency virus (HIV) who is taking zidovudine. Which finding in the patient suggests possible drug-related adverse effects? Blood urea nitrogen of 10 mg/dL Serum sodium levels of 120 mEq/L Alkaline phosphatase levels of 100 IU/L White blood cell count 1000 cells/mcL of blood
White blood cell count 1000 cells/mcL of blood Zidovudine reacts with different blood proteins, leading to bone marrow suppression. The levels of all blood cells are greatly reduced in bone marrow suppression. The normal white blood cell count is 4500 to 10,000 cells/mcL of blood. A white blood cell count of 1000 cells/mcL of blood would suggest that the patient has bone marrow suppression. Alterations in blood urea levels would indicate renal dysfunction. These levels are normal in the patient; moreover, zidovudine does not affect renal function. Sodium levels are not altered in the patient. Moreover, zidovudine does not affect electrolyte levels. Alkaline phosphatase levels are indicators of liver function. Zidovudine does not affect liver function in the patient. Moreover, the alkaline phosphatase levels of the patient are within normal range. pp. 654, 655
