Question 1

The nurse asks a graduate nurse, &#34;When a patient in the initial phase of HIV infection is assessed, which findings would you expect to see?&#34; The graduate nurse would be correct to respond with which conditions? (Select all that apply.)&#10;A) Respiratory distress&#10;B) Fever&#10;C) Myalgia&#10;D) Lymphadenopathy&#10;E) Insomnia

Accepted Answer

Fever, myalgia, and lymphadenopathy are early signs associated with HIV infection. Respiratory distress and insomnia are not consistent findings in the initial phase of HIV infection.

Question 2

The nurse is providing education to a group of patients who are HIV positive. The nurse is discussing the various medications used to treat HIV infection. A patient asks about nevirapine (Viramune). Which statements by the nurse most accurately reflect the facts about nevirapine? (Select all that apply.)

A) "Some herbal preparations can reduce the levels of this drug."
B) "This agent can damage the liver; therefore, liver function tests are needed periodically."
C) "Usually no adverse effects occur when this medication is used alone."
D) "The drug must be dosed 5 times per day at evenly spaced intervals."
E) "You should call your healthcare provider immediately if you develop a rash."

"Some herbal preparations can reduce the levels of this drug."
"This agent can damage the liver; therefore, liver function tests are needed periodically."
"You should call your healthcare provider immediately if you develop a rash."

Accepted Answer

Some herbal preparations can reduce the levels of nevirapine, which can damage the liver. The patient should call the healthcare provider immediately if a rash develops. Many adverse effects are associated with the use of nevirapine. In adults, nevirapine is dosed once daily initially, not 5 times a day.

Question 3

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine (Retrovir). The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?

A) "I may experience fatigue from anemia."
B) "I may be more susceptible to infection from neutropenia."
C) "I may have a deficiency of vitamin B₆."
D) "I may have a deficiency of folic acid."

Accepted Answer

The nurse should monitor the patient's CBC to determine whether the patient has anemia and neutropenia. Ketones are not an adverse effect of zidovudine. Nothing indicates a need to monitor the immunoglobulin levels or serum lactate dehydrogenase.

Question 4

What instruction should the nurse provide about the administration of a buffered, powdered formulation of didanosine (Videx)?&#10;A) &#34;Mix the powder with orange juice.&#34;&#10;B) &#34;Stir the powder into 4 ounces of water and drink it immediately.&#34;&#10;C) &#34;Prepare the solution at least 30 minutes before administration.&#34;&#10;D) &#34;Mix the solution in the morning, refrigerate it, and take it in the evening.&#34;

Accepted Answer

The nurse should instruct the patient to stir the powder into 4 ounces of water and drink all of it immediately. Didanosine should not be mixed with any acidic juice. Didanosine should not be mixed and taken later; the patient should drink it immediately after mixing.

Question 5

The nurse is caring for a patient who is HIV positive and has a previous history of drug and alcohol abuse. The patient is being treated with combination therapies, including didanosine (Videx). Which laboratory findings would most concern the nurse?

A) Increased serum amylase triglycerides and decreased serum calcium
B) Decreased serum amylase and serum triglycerides and increased serum calcium
C) Decreased hemoglobin and hematocrit
D) Increased serum amylase, decreased triglycerides, and increased platelets

Accepted Answer

The nurse should be concerned about increased serum amylase triglycerides and a decreased serum calcium, which are symptoms of pancreatitis, the major adverse effect of didanosine. The other laboratory test results and assessment findings are not consistent with pancreatitis and are not a concern for the nurse.

Question 6

The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine (Trizivir). The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1° F. What is the nurse's best course of action?

A) Tell the patient that this is an expected response to these medications and to continue the agents as prescribed.
B) Have the patient hold the medications and arrange for an immediate evaluation by the prescriber.
C) Have the patient continue the abacavir but discontinue the other two agents for 3 weeks.
D) Instruct the patient to continue all three medications and administer an antihistamine for the symptoms.

Accepted Answer

The patient should discontinue all the medications. Immediate assessment by the provider is required, because the patient is showing early symptoms of a fatal hypersensitivity reaction. This is not an expected response; it indicates a serious reaction, which the patient should report to the prescriber immediately. The patient should not continue the medications for any additional dosages.

Question 7

A patient taking stavudine (Zerit) telephones the clinic and reports numbness and tingling in the hands and feet. What should the nurse tell the patient?&#10;A) The numbness is an expected side effect of the medication and will diminish.&#10;B) The medication will probably be stopped, and the patient should come into the clinic for further evaluation.&#10;C) The dose may be too high, and the patient should cut the tablet in half.&#10;D) The patient should take the medication on a full stomach to reduce absorption of the drug.

Accepted Answer

The patient has early signs and symptoms of neuropathy, which may resolve if the drug is stopped. The patient should be taught early in treatment to report these symptoms immediately. Numbness is not an expected side effect. The patient should never be advised to cut the dose in half unless instructed to do so by a prescriber. Taking the medication on a full stomach will not affect the amount of medication absorbed.

Question 8

The nurse is caring for a patient on a protease inhibitor (PI). Upon review of the laboratory test results, the nurse notes that the patient has newly elevated plasma triglycerides and cholesterol. The nurse expects that the prescriber will manage these levels with:

A) lovastatin (Mevacor).
B) simvastatin (Zocor).
C) modified diet and exercise.
D) pancrease.

Accepted Answer

All PIs can elevate plasma levels of cholesterol and triglycerides. Potential interventions for hyperlipidemia include modified diet, exercise, and lipid-lowering agents. Lovastatin and simvastatin should be avoided, because they can accumulate to dangerous levels. Pancrease is not indicated to lower triglycerides and cholesterol.

Question 9

The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and is taking high doses of zidovudine (Retrovir). The nurse is providing patient education about the adverse effects of the medication. Which statement by the patient demonstrates a need for further teaching?

A) "I may experience fatigue from anemia."
B) "I may be more susceptible to infection from neutropenia."
C) "I may have a deficiency of vitamin B₆."
D) "I may have a deficiency of folic acid."

Accepted Answer

A deficiency of vitamin B₁₂, not vitamin B₆, would be expected; this statement indicates that further teaching is required. With high-dose zidovudine, the patient can expect anemia, neutropenia, and folic acid deficiency.

Question 10

A patient starting therapy with efavirenz (Sustiva) asks about the timing of the medication with regard to meals. What patient education about the administration of this medication should the nurse provide?

A) The drug must be taken within 30 minutes after a meal.
B) The drug is best taken with a high-fat meal.
C) The drug can be taken anytime without regard to meals.
D) The drug should be taken once daily on an empty stomach.

Accepted Answer

The nurse should advise the patient that the medication should be taken once daily on an empty stomach. Thirty minutes after a meal is too soon to take the medication. The medication is taken on an empty stomach, because high-fat meals increase plasma levels by 39% with capsules and by 79% with tablets. The medication must not be taken with high-fat meals.

Question 11

After starting an antiviral protease inhibitor, a patient with HIV telephones the nurse, complaining, "I'm so hungry and thirsty all the time! I'm urinating 10 or 12 times a day." The nurse recognizes these findings to be consistent with:

A) pancreatic infiltration by HIV.
B) allergic reaction.
C) nonadherence to the antiviral regimen.
D) hyperglycemia.

Accepted Answer

The answer of After starting an antiviral protease inhibitor, a...

Question 12

A nurse is preparing to administer medications to a patient recently started on
Delavirdine (Rescriptor). Which concurrent prescription should the nurse question before administration?

A) Alprazolam (Xanax)
B) Diphenhydramine (Benadryl)
C) Morphine
D) Penicillin

Accepted Answer

The answer of A nurse is preparing to administer medications...

Question 13

The nurse is preparing to discharge a patient with HIV who will be continuing to take enfuvirtide (Fuzeon) at home. The nurse is providing patient education about the medication. What information about the administration of enfuvirtide is most appropriate for the patient?

A) The importance of injecting the drug into two alternating sites daily
B) How to reconstitute and self-administer a subcutaneous injection
C) The importance of taking the drug with high doses of vitamin E
D) Likely drug interactions between enfuvirtide and other antiretroviral drugs

Accepted Answer

The answer of The nurse is preparing to discharge a...

Question 14

Which sign or symptom associated with the adverse effects of nelfinavir (Viracept) would most concern the nurse?&#10;A) Blood glucose level of 78 mg/dL&#10;B) Poor turgor and dry mucous membranes&#10;C) Tingling in the extremities&#10;D) Weight loss of 5 pounds in 2 weeks

Accepted Answer

The answer of Which sign or symptom associated with the...

Deck 94: Antiviral Agents 2: F Drugs for Hiv Infection and Related Opportunistic Infections