Pharmacology Prep U Chapter 10 Antiviral Agents
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."
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."
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."
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 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 nurse is reviewing the medication instruction for the client taking acyclovir. Which statement by the client would indicate the need for additional teaching?
"This medication will maintain the symptoms and cure my disease."
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 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
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
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 client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client?
Anemia and granulocytopenia
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.
Which statement regarding antiviral medications is true?
Antivirals do not eliminate existing 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.
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
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 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
A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient?
Combination antiretroviral therapy
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.
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
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.
Locally active antiviral agents can be applied to open lesions.
False
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
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 client with active AIDS is infected with a retrovirus. This virus is better known as which?
HIV
Which of the following would be least likely to cause a drug interaction when rimantadine is prescribed?
Ibuprofen
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
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 providing care to a client with HIV, the nurse knows that reverse transcriptase, an enzyme found in retroviruses, affects RNA and DNA in which way?
It turns RNA into DNA, which helps reproduce more of the virus.
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
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 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
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 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
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.
A nurse is preparing to administer famciclovir to a client with a herpes virus infection. The nurse should 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
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
In which of the following patients is the use of cidofovir contraindicated?
Patients with renal impairment
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
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.
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 client is receiving zanamivir. When describing this drug, the nurse understands that it is absorbed through which mechanism?
Respiratory tract
The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug should 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
An elderly female client is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The health care provider prescribes the drug acyclovir (Zovirax). What disease is this client demonstrating?
Shingles
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
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 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 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 rigidly to the prescribed drug schedule
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.
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 may experience an acute exacerbation of hepatitis B if entecavir, adefovir, or telbifudine therapy is stopped.
True
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.
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 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
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.
In which clients are the use of cidofovir contraindicated?
clients with renal impairment
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
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 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
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
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
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
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.
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
Administration of antiviral therapy for influenza requires monitoring of clients for which adverse effects? Select all that apply.
• anorexia • nausea • dizziness
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
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 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 client believed he had "pinkeye" and waited several days before seeking care. The health care provider's assessment reveals that the client has a herpes simplex infection in the eye. The nurse should teach the client about what medication?
Trifluridine
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
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.
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.
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 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
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
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 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