Pharm Chapter 37 Drugs for viral infections

A patient has been diagnosed with genital herpes and has been started on oral acyclovir (Zovirax). What should be included in the teaching instructions for this patient? (Select all that apply.) 1. Increase fluid intake up to 2 L per day. 2. Report any dizziness, tremors, or confusion. 3. Decrease the amount of fluids taken so that the drug can be more concentrated. 4. Take the drug only when having the most itching or pain from the outbreak. 5. Use barrier methods such as condoms for sexual activity.

Ans: 1,2,5 Rationale: Acyclovir can be renal toxic and fluids should be increased throughout therapy. Neuro- toxicity may occur and increasing dizziness, tremors, or any confusion should be reported immediately. Acyclovir does not prevent transmission of the disease and transmission may occur even if the host is asymptomatic. Barrier methods for sexual activity should be used. Options 3 and 4 are incorrect. Fluid intake should be increased, not decreased, and the drug must be taken consistently throughout the entire course of therapy. Suppressive therapy may also be ordered.

A patient is started on efavirenz (Sustiva) for HIV. What should the nurse teach the patient about this drug? 1. Efavirenz (Sustiva) will cure the disease over time. 2. Efavirenz (Sustiva) will not cure the disease but may signifcantly extend the life expectancy. 3. Efavirenz (Sustiva) will be used prior to vaccines. 4. Efavirenz (Sustiva) will prevent the transmission of the disease.

Ans: 2 Rationale: Drug therapy with efavirenz (Sus-tiva) and other HAART drugs has not produced a cure but has resulted in a significant number of therapeutic successes with increased life span. Options 1, 3, and 4 are incorrect. There is currently no vaccine for HIV although research is ongoing. The drug does not cure the disease. Evidence has shown that HIV treatment significantly decreases viral loads and thus decreases the risk of transmission, but this has not yet been proven in all cases of infection.

The nurse is teaching a community health class to a group of young adults who have recently immigrated to the United States about preventing hepatitis B. What is the most effective method of preventing a hepatitis B infection? 1. Peginterferon alfa-2a (Pegasys) 2. Hepatitis B vaccine (Engerix-B) 3. Adefovir dipivoxil (Hepsera) 4. Entecavir (Baraclude)

Ans: 2 Rationale: The best method of preventing hepatitis B (HBV) infections is to complete a series of the HBV vaccination. Three doses of the vaccine provide up to 90% of patients with protection following exposure to the virus. Options 1, 3, and 4 are incorrect. Treatment of acute HBV infection is symptomatic because no specific therapy is available. Interferons such as peginterferon alfa-2a (Pegasys) or antiviral drugs such as adefovir dipivoxil (Hepsera) or entecavir (Baraclude) only treat the disease by stopping viral replication to reduce the length of the disease process or by boosting the body's defenses.

A patient with HIV has been taking lopinavir with ritonavir (Kaletra) for the past 8 years and has noticed a redistribution of body fat in the arms, legs, and abdomen (lipodystrophy). The nurse will evaluate this patient for what other additional adverse effects associated with this drug? (Select all that apply.) 1. Renal failure 2. Hyperglycemia 3. Pancreatitis 4. Bone marrow suppression 5. Hepatic failure

Ans: 2,3,5 Rationale: Hyperglycemia, pancreatitis, and hepatic failure are adverse effects associated with lopinavir with ritonavir (Kaletra). Options 1 and 4 are incorrect. Renal failure and bone marrow suppression are not adverse effects associated with this drug.

Which of the following findings would suggest that myelosuppression is occurring in a patient who is taking zidovudine (Retrovir)? 1. Increase in serum blood urea nitrogen (BUN) levels 2. Increase in white blood cell (WBC) count 3. Decrease in platelet count 4. Decrease in blood pressure

Ans: 3 Rationale: Myelosuppression is the declining ability of the bone marrow to produce blood cells. A de- crease in platelet count may indicate myelosuppression is occurring. Options 1, 2, and 4 are incorrect. An increase in BUN or a decrease in blood pressure does not indicate myelosuppression. A decrease, rather than increase, in WBC count would be expected if myelosuppression is occurring.

A patient has received a prescription for zanamivir (Relenza) for flulike symptoms. The patient states, "I think I'll hold off on starting this. I don't feel that bad yet." What is the nurse's best response? 1. "The drug has a stable shelf life so you can save it for later infections." 2. "It can be saved for later but you will also require an antibiotic to treat your symptoms if you wait." 3. "It can be started within two weeks after the onset of symptoms." 4. "To be effective, it must be started within 48 hours after the onset of symptoms."

Ans: 4 Rationale: Zanamivir (Relenza) must be started within 48 hours after the onset of symptoms to be effective. Options 1, 2, and 3, are incorrect. Immunity begins approximately 2 weeks after influenza immunization. Waiting longer than 48 hours before taking the drug will not shorten the infection period, and the drug should not be saved for later.

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

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

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

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

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

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

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

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

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

Correct Answer: 2 Rationale 1: Auditory and visual hallucinations are not adverse effects of acyclovir (Zovirax). Rationale 2: Acyclovir (Zovirax) is nephrotoxic, so serum creatinine should be monitored. Rationale 3: Respiratory distress is not an adverse effect of acyclovir (Zovirax). Rationale 4: Bone marrow suppression is not an adverse effect of acyclovir (Zovirax).

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

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

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

Correct Answer: 2 Rationale 1: Over 20 new antiretroviral drugs have been developed. Rationale 2: Antiviral pharmacotherapy can be extremely challenging because of the rapid mutation rate of viruses, which can quickly render drugs ineffective. Rationale 3: Most people recognize that human immunodeficiency virus (HIV) infection is not rare. Rationale 4: After more than 30 years of research, the virus is mostly understood.

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

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

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

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

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

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

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

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

The client has acquired immune deficiency syndrome (AIDS) and has just learned she is pregnant. She tearfully asks the nurse if her baby will die of acquired immune deficiency syndrome (AIDS). What is the nurse's best response? 1. "There are special tests that we can do to see if your baby is positive before birth." 2. "I know that is a great worry for all of us." 3. "Drug therapy can help prevent your child from contracting the virus." 4. "There are drugs that can be given after birth to reverse AIDS."

Correct Answer: 3 Rationale 1: The patient's concern is about her baby dying from AIDS. Testing options is not the best answer. Rationale 2: Worrying about mother-to-baby transmission is a concern for all involved in this case, but this statement is not therapeutic. Rationale 3: A regime of oral zidovudine (Retrovir) will decrease the possibility of mother-to-baby transmission by 70%. Rationale 4: There are no drugs to "reverse" AIDS.

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

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

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

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