Antiviral Agents

1.

The nurse explains why viruses are so difficult to treat when making what statement?
A)
Viruses are contained inside the human cell and cannot be destroyed without destroying the cell.
B)
Release of interferons by the host cell makes the virus replicate more quickly allowing the virus to spread.
C)
Drugs exist to treat all viral infections but they carry serious adverse effects and the benefit often does not outweigh the risk.
D)
Individual antiviral drugs are often effective in treating many different viruses because one virus in a category behaves like others in the same category.
Ans:
A

Feedback:

Because viruses are contained inside human cells while they are in the body, researchers have difficulty developing effective drugs that destroy a virus without harming the human host. Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. Very few viruses are treatable with medications; a few more can be prevented through immunization but most have no known treatment. Each antiviral is generally only suited to treat the single virus it was developed for and will not be effective against other viruses.

2.

While calculating the drug dose of antiviral medications for children who have AIDS a pediatric nurse uses what?
A)
The viral complications
B)
The child’s age
C)
The severity of the virus
D)
The child’s weight
Ans:
D

Feedback:

Antiviral medication dosages for children are calculated according to weight. There is no scientific data available concerning dosages based on complications or severity of illness. The ethical dilemma using children in drug studies is always a concern. Children must be monitored very carefully for adverse effects on kidneys, bone marrow, and the liver. The complications and severity of the disease may determine which drug is prescribed.

3.

A patient taking nevirapine (Viramune) as part of combination therapy for treatment of HIV took 200 mg/daily PO for 14 days. The patient is now taking 200 mg PO bid. How many mg of the medication is the patient taking daily?
A)
100 mg
B)
200 mg
C)
300 mg
D)
400 mg
Ans:
D

Feedback:

The patient is to take 200 mg bid, which means twice a day. (200 times 2 equals 400 mg daily.)

4.

What medication is only administered intravenously and is used to treat cytomegalovirus (CMV)?
A)
Cidofovir (Vistide)
B)
Foscarnet (Foscavir)
C)
Valacyclovir (Valtrex)
D)
Valganciclovir (Valcyte)
Ans:
B

Feedback:

Foscarnet (Foscavir) is administered IV only. Ganciclovir and (Cytovene) can be administered by IV and orally. Valganciclovir (Valcyte) and Valacyclovir (Valtrex) are administered only by the oral route.

5.

A hospitalized patient is receiving an antiviral drug to treat cytomegalovirus. What is the nurse’s priority action after administering the antiviral drug?
A)
Monitor vital signs every hour.
B)
Decrease fluid intake.
C)
Keep side rails up.
D)
Encourage the patient to ambulate 10 minutes after each dose.
Ans:
C

Feedback:

Antiviral drugs for herpes and cytomegalovirus can cause confusion, dizziness, and other central nervous system (CNS) effects. Side rails should be up after administration to protect the patient from injury until risk for these adverse effects is lowered because not every patient will experience these effects. The patient should not be encouraged to walk after each dose because of the risk of falls if adverse effects occur. Fluid intake should be slightly increased to help decrease risk of nephrotoxicity. Vital signs should be monitored, but it would not be necessary to take them every hour unless serious adverse effects occur.

6.

A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient?
A)
A fasting blood sugar and 2-hour postprandial blood sugar
B)
Urine specific gravity and urine pH
C)
Serum alanine aminotransferase and bilirubin
D)
Arterial blood gases and O2 saturation
Ans:
C

Feedback:

Serum alanine aminotransferase and bilirubin are monitored when a protease inhibitor is used due to the risk of liver damage and the need to monitor liver function. Cholesterol and triglycerides may also be elevated by the drug and should be monitored. Protease inhibitors are metabolized in the liver and partially by the cytochrome P450 oxidase system. Although some cases of kidney stones have been related to protease inhibitors use, the greatest risk is to the liver and therefore urine specific gravity and urine pH, which indicate renal function, would be less critical to assess. Lab tests for blood sugar and arterial blood gases would not be directly affected by hepatic function.

7.

A patient with renal impairment and HIV has had a medication change. What drug would be considered the drug of choice for this patient?
A)
Atazanivir (Reyataz)
B)
Lopinavir (Kaletra)
C)
Nelfinavir (Viracept)
D)
Ritonavir (Norvir)
Ans:
C

Feedback:

Nelfinavir is the best choice for a patient with renal impairment because very little of the drug is excreted through the kidney, with most being excreted in feces. The other drugs are all excreted through both the urine and feces, so patients with renal impairment might need dosage adjustments to avoid toxicity.

8.

The nurse is caring for a patient with hepatitis B. The patient is taking adefovir (Hepsera). Which medication would the nurse question if it were ordered?
A)
Cimetidine (Tagament)
B)
Diltiazem (Cardizem)
C)
Diphenhydramine (Benadryl)
D)
Telbivudine (Tyzeka)
Ans:
D

Feedback:

Telbivudine is an anti–hepatitis B agent, and when given with adefovir (Hepsera) can result in severe hepatomegaly with steatosis, sometimes fatal. Cimetidine is a histamine-2 antagonist, diltiazem is a calcium channel blocker, and diphenhydramine is a first-generation antihistamine. These drugs are normally not considered nephrotoxic and could be used with adefovir.

9.

A nurse is caring for a stroke victim in the intensive care unit. The nurse notices a cold sore and requests medication. Docosanol (Abreva) is ordered. Before applying the medication, the nurse would first?
A)
Clean the area to be treated and then pat it dry.
B)
Assess the area for open lesions or abrasions.
C)
Put gloves on to protect herself.
D)
Prepare applicator for drug administration.
Ans:
B

Feedback:

The nurse would assess the area first to make sure no open lesions or abrasions could allow for systemic absorption of the drug. Then the nurse would clean the area and pat it dry. The nurse may apply the medication using gloves or an applicator.

10.

A patient with AIDS is taking an antiviral agent. What comment by the patient would indicate that the teaching plan was effective?
A)
“I feel like I do when I have the flu.”
B)
“I will continue to take the over-the-counter medication for my allergies.”
C)
“Excessive fatigue and a severe headache are common adverse effects of my medication.”
D)
“This drug will cure AIDS.”
Ans:
A

Feedback:

Common adverse effects of antiviral agents are flu-like symptoms, which may be related to the underlying disease. Excessive fatigue and a severe headache can indicate a serious complication and should be reported immediately. Antiviral agents do not cure the disease. HIV causes loss of helper T-cell function. This causes the immune system to be depressed and allows opportunistic infections to occur. Antiviral agents reduce the number of mutant viruses that are formed and spread to noninfected cells.

11.

The school nurse is preparing a lecture on hepatitis B for a health class in high school. What is an important teaching point for the nurse to include about the transmission of hepatitis B? (Select all that apply.)
A)
Hepatitis B is transmitted through the bite of an insect.
B)
Hepatitis B is transmitted through sexual contact.
C)
Hepatitis B is transmitted through blood-to-blood contact.
D)
Hepatitis B is transmitted from the mother to her unborn baby.
E)
Hepatitis B is transmitted through nonsexual household contact.
Ans:
B, C, D

Feedback:

Hepatitis B is transmitted from one person to another through sexual contact, blood-to-blood contact, or perinatally. It is not transmitted through casual contact. Several studies involving more than 1,000 uninfected, nonsexual household contacts with persons with hepatitis B infection (including siblings, parents, and children) have shown no evidence of casual transmission. Hepatitis B is not spread by mosquitoes or other insect vectors.

12.

A 21-year-old woman presents with cytomegalovirus (CMV). The LPN says, “I’ve never heard of CMV before.” The nurse explains to the LPN that this infection is most often seen with patients diagnosed with what?
A)
HIV
B)
Influenza
C)
Autoimmune disorder
D)
Hepatitis B
Ans:
A

Feedback:

CMV is an opportunistic infection that is most often diagnosed in patients with HIV or who are immunocompromised because those with a healthy immune system can fight off CMV. CMV would not be diagnosed in patients with influenza, an autoimmune disorder, or hepatitis B because the immune system would be strong enough to destroy the CMV pathogen.

13.

The nurse is assessing a patient admitted with AIDS who is taking a nonnucleoside reverse transcriptase inhibitor. What nursing diagnosis is most likely to be appropriate for this patient?
A)
Risk for injury related to central nervous system (CNS) effects of the drug
B)
Excess fluid volume related to renal failure
C)
Imbalanced nutrition: Less than body requirements, related to gastrointestinal (GI) effects of the drugs
D)
Ineffective health maintenance related to spiritual distress
Ans:
C

Feedback:

The adverse effects most commonly experienced with these drugs are GI related—dry mouth, constipation or diarrhea, nausea, abdominal pain, and dyspepsia. As a result, this patient is most at risk for imbalanced nutrition; less than body requirements. CNS effects are not common with this classification of drug. Renal failure is not a common adverse effect. Nothing indicates the possibility of spiritual distress in this situation.

14.

A patient has just been diagnosed with HIV. When developing the teaching plan, what information would the nurse share with this patient related to use of alternative or complementary therapies?
A)
“Complementary therapies such as acupuncture or herbal therapy are dangerous to patients with HIV and you are discouraged from exploring these types of therapy.”
B)
“Researchers have not looked at the benefits of alternative therapy for patients with HIV, so it is suggested you avoid these therapies until research data are available.”
C)
“Alternative therapies have benefits and risks. Are there any types of alternative or complementary therapies that you follow or are there any herbs or supplements that you take?”
D)
“You do not take herbs or practice some type of alternative medicine such as acupuncture, massage therapy, hypnosis, or diet therapy, do you?”
Ans:
C

Feedback:

With a new diagnosis of HIV, it is important for the nurse to assess the patient for use of alternative therapies because some alternative therapies are contraindicated while on antiviral medication. Options A and D are negative statements that discourage the patient from sharing information with the nurse. Option B gives the patient information, but does not elicit information in return and is therefore inappropriate for the nurse to use.

15.

The nurse is caring for a patient hospitalized with hepatitis B. The family comes to visit and a family member asks the nurse if it is safe to visit. What is the nurse’s best response?
A)
“You seem fearful. Why do you think you are at risk?”
B)
“Don’t worry, you will not contract the disease from the patient.”
C)
“There is no risk unless you come in contact with blood and body fluids.”
D)
“The patient should be isolated and have limited visitation.”
Ans:
C

Feedback:

Visitors should be reassured that they are not at risk of contracting the virus unless they come in contact with blood or body fluids. It is never appropriate to tell someone not to worry because it is neither effective nor appropriate. The reason the family member is fearful is obvious, so these questions are demeaning. Visitation does not need to be limited.