Question 1

A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI)Combivir (lamivudine/zidovudine)twice daily.The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea.The patient's creatinine clearance is 40 mL/minute.Based on these findings,the nurse will perform which action?

Accepted Answer

Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min.The patient will need single-dose medications so that adjustments can be made.Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir,which should subside in the next week or so.This combination product is not given once daily.Increasing fluid intake will not affect this patient's symptoms.

Question 2

A pregnant patient is HIV-positive.Which antiretroviral agent will the nurse expect the patient's provider to order?

Accepted Answer

Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients.The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.

Question 3

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years.The nurse understands that this patient

Accepted Answer

Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

Question 4

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan),a protease inhibitor medication.The provider has ordered adding ritonavir (Norvir)to the regimen.The nurse will teach the patient that the addition of ritonavir

Accepted Answer

Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance.It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.

Question 5

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever,sore throat,myalgia,and night sweats.The nurse will notify the provider that this patient is most likely experiencing

Accepted Answer

Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response,resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop.This patient is experiencing symptoms of this syndrome.AIDS is a diagnosis that indicates advanced disease.Opportunistic infection symptoms are related to the type of infection.

Question 6

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past.Which action will the nurse take?

Accepted Answer

Patients often are more motivated to adhere to a drug regimen if they understand the purpose of the medications.Patients should be encouraged to take responsibility for their medications.Side effects need to be discussed so patients can plan ways to manage these before they occur.

Question 7

The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months.The nurse experiences a needlestick injury resulting in exposure to the patient's blood.The nurse asks the Occupational Health nurse if treatment is necessary.How will the Occupational Health nurse respond?

Accepted Answer

Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

Question 8

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS)with mild symptoms.What does the nurse expect that the provider will order?

Accepted Answer

IRIS is related to specific opportunistic infections that must be treated.Anti-inflammatory medications,such as corticosteroids,may be used if indicated after the underlying infection is treated.Changing or discontinuing the antiretroviral therapy regimen is not indicated.

Question 9

A patient with HIV infection has been receiving antiretroviral therapy for 2 months.At the initiation of treatment,the patient had a viral load (VL)of 60 copies/mL and a CD4 count of 450 cells/mm³.Today's lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm³.How will the nurse interpret the patient's results?

Accepted Answer

The treatment goal would be a VL of <20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm³.This goal should be achieved in 16 to 24 weeks.Since this patient has shown improvement,progress has been made,and treatment should continue.A drug-resistant strain is not likely to respond to therapy.Treatment failure is not evident.

Question 10

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir).What information will the nurse include when teaching the patient about dietary changes?

Accepted Answer

Protease inhibitors generally cause elevations of cholesterol and triglycerides,so patients should be counseled to consume a low-fat diet.

Question 11

A patient who has HIV infection will begin treatment with efavirenz.The nurse expects this agent to be given in the combination product Atripla in order to

Accepted Answer

Efavirenz is optimally given as a component of Atripla.The primary reason for using combination products is to reduce viral resistance.Efavirenz should not be given to patients who have psychiatric histories.Efavirenz may cause dizziness,sedation,nightmares,rash,and hepatotoxicity,but this is not minimized with combination therapy.

Quiz 29: HIV- and Aids-Related Drugs

A pregnant patient is HIV-positive.Which antiretroviral agent will the nurse expect the patient's provider to order?

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years.The nurse understands that this patient

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan) ,a protease inhibitor medication.The provider has ordered adding ritonavir (Norvir) to the regimen.The nurse will teach the patient that the addition of ritonavir

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever,sore throat,myalgia,and night sweats.The nurse will notify the provider that this patient is most likely experiencing

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past.Which action will the nurse take?

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms.What does the nurse expect that the provider will order?

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir) .What information will the nurse include when teaching the patient about dietary changes?

A patient who has HIV infection will begin treatment with efavirenz.The nurse expects this agent to be given in the combination product Atripla in order to