Unit5: Chapter 10 (Karch 7th Ed) - Antiviral Agents

Question 1

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.

Answer 1

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.

Question 2

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

Answer 2

Ans: D
Feedback: 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.

Question 3

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

Answer 3

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

Question 4

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)

Answer 4

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.

Question 5

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.

Answer 5

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.

Question 6

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

Answer 6

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.

Question 7

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)

Answer 7

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.

Question 8

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)

Answer 8

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.

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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 Tcell
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.

Question 11

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.

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

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?

Answer 14

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

Question 15

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.

Answer 15

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.

Question 16

16. A patient newly diagnosed with HIV is receiving patient teaching from the clinic nurse about antiviral
    medications. What would the nurse tell the patient needs to be reported to a health care provider?
    A) Dizziness
    B) Constipation
    C) Vomiting
    D) Rash

Answer 16

Ans: D
Feedback:
All options provided have the potential to be an adverse effect of antiviral medications prescribed to
treat HIV. Most can be managed through diet or over-the-counter medications but a rash needs to be
reported immediately because it could indicate a potentially serious reaction and requires immediate
intervention.

Question 17

17. The nurse is planning care for an AIDS patient admitted with chronic severe diarrhea secondary to
    adverse effects of the antiviral drugs prescribed. What would be the most appropriate goal for this
    patient?
    A) Patient will show improved nutritional status evidenced by weight gain.
    B) Alleviation or reduction of signs and symptoms of AIDS.
    C) Patient will be able to demonstrate the effectiveness of the teaching plan.
    D) Patient will state that comfort and safety measures are effective and show compliance with the
    regimen.

Answer 17

Ans: A
Feedback:
Severe chronic diarrhea is likely to result in malnutrition and weight loss along with potential
alterations in fluid and electrolyte balance. The best indicator of improvement would be an
improvement in nutritional status as indicated by weight gain. Although the other outcomes might be
applicable to a patient with AIDS, weight gain is the priority concern for a patient with severe chronic
diarrhea.

Question 18

18. A nurse practitioner is teaching a health class in the local high school. The NP informs the class about
    hepatitis B. What occupation does the NP inform the class is at the greatest risk for contracting
    hepatitis B?
    A) Policemen
    B) Health care workers
    C) Educators
    D) Fire fighters

Answer 18

Ans: B
Feedback:
Health care workers are at especially high risk for contracting hepatitis B due to needle sticks and
contact with the blood of infected patients. Policemen, educators, and fire fighters are not considered at
high risk for contracting hepatitis B although they do face some risk because of contact with blood and
body fluids.

Question 19

19. What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver
disease such as hepatitis?
A) Clotting factors
B) SGGT
C) Serum aminotransferases
D) Alkaline phosphatase

Answer 19

Ans: C
Feedback:
Antiviral drugs are indicated for the treatment of adults with chronic hepatitis B who have evidence of
active viral replication and evidence of either persistent elevations in serum aminotransferases or
histologically active disease. The drugs inhibit reverse transcriptase in the hepatitis B virus and cause
DNA chain termination, leading to blocked viral replication and decreased viral load. Clotting factor
alterations will be seen only in cases of severe liver damage. Serum gamma-glutamyl transferase and
alkaline phosphatase may elevate with liver damage, but serum aminotransferases are the best indicator
of hepatitis B

Question 20

20. What drug would the nurse administer to treat chronic hepatitis C in children and adults who relapse after interferon-alfa therapy?
A) Zanamivir (Relenza)
B) Acyclovir (Zovirax)
C) Cidofovir (Vistide)
D) Ribavirin (Virazole)

Answer 20

Ans: D
Feedback:
Ribavirin is used in combination with interferon alfa-2b as an oral drug for the treatment of chronic
hepatitis C in children and adults who relapse after inferferon alfa therapy. Cidofovir is used to treat
cytomegalovirus (CMV) in AIDS patients. Virazole is used to treat uncomplicated infuenza infections.
Acyclovir is used for herpes infections.

Question 21

21. Some antiviral agents are given locally to treat local viral infections. How do these medications work?
    (Select all that apply.)
    A) Interfere with viral metabolic processes
    B) Interfere with viral cellular replication
    C) Interfere with host metabolic processes
    D) Interfere with viral transcription
    E) Increase antibody production

Answer 21

Ans: A, B
Feedback:
These antiviral agents act on viruses by interfering with normal viral replication and metabolic
processes. They are indicated for specific local viral infections. The medications do not interfere with
the invaded cell or with viral transcription and they do not increase antibody production

Question 22

22. What drug used to treat influenza A should not be used by nursing mothers?
A) Ribavirin (Rebetron)
B) Rimantadine (Flumadine)
C) Valganciclovir (Valcyte)
D) Acyclovir (Zovirax)

Answer 22

Ans: B
Feedback:
Rimantadine is embryotoxic in animals and should be used during pregnancy only if the benefits
clearly outweigh the risks. The drug should not be used by nursing mothers because it crosses into
breast milk and can cause toxic reactions in the neonate. Valganciclovir is used to treat
cytomegalovirus-related retinitis in AIDS patients. Acyclovir is used to treat herpes simplex outbreaks.
Ribavirin is used as a treatment of influenza A, respiratory syncytial virus (RSV), and herpes virus
infections; treatment of children with RSV; has undergone testing for use in several other viral
conditions. It is teratogenic and is rated pregnancy category X, but no warnings are related to breastfeeding
mothers.

Question 23

23. A 25-year-old female patient presents at the clinic with fever, chills, and achy joints. The patient is
    diagnosed with influenza A, and ribavirin is prescribed. What should the nurse include in patient
    teaching about this medication?
    A) Advise women of childbearing age to remain on oral contraceptives for at least 1 month after
    finishing this medication.
    B) Advise women of childbearing age that this drug is also an abortifacient.
    C) Advise women of childbearing age to use barrier contraceptives.
    D) Advise women of childbearing age that this drug is safe for the fetus.

Answer 23

Ans: C
Feedback:
For ribavirin, advise women of childbearing age to use barrier contraceptives if they are taking this
drug. The drug has been associated with serious fetal effects, but it has not been associated with
spontaneous abortions. Oral contraceptives should not be stopped and barrier contraceptives should be
used in addition.

Question 24

24. A patient has been prescribed ribavirin for influenza A. The patient is experiencing nausea, vomiting,
    and diarrhea. What would the nurse be sure to include in the patient teaching about this medication?
    A) Do not take with anticholinergic medications.
    B) Do not take with acetaminophen or aspirin.
    C) Do not take with antiarrhythmics.
    D) Do not take with antacids.

Answer 24

Ans: D
Feedback:
Ribavirin levels may be reduced if given with antacids. Patients who receive amantadine or rimantadine
may experience increased atropine-like effects if either of these drugs is given with an anticholinergic
drug. Patients taking rimantadine may also experience a loss of effectiveness of aspirin and
acetaminophen if these are also being used. Rifampin is known to decrease the effectiveness of many
drugs, including antiarrhythmics.

Question 25

25. The nurse is caring for a patient who is prescribed cidofovir, IV. What other medication will the nurse
administer with cidofovir?
A) Probenecid
B) Paroxetine hydrochloride
C) Penciclovir
D) Prostigmin

Answer 25

Ans: A
Feedback:
Cidofovir, which is given by IV infusion, reaches peak levels at the end of the infusion; in studies, it
was cleared from the system within 15 minutes after the infusion was completed. It is excreted
unchanged in the urine and must be given with probenecid to increase renal clearance of the drug.
Paroxetine hydrochloride is Paxil, an antidepressant; Penciclovir is an antiviral cream; Prostigmin is an
anticholinesterase agent used in myasthenia gravis. None of these drugs are used with cidofovir except
for probenecid.

Question 26

26. The nurse admits a patient for treatment of cytomegalovirus (CMV). The patient has been ordered
    foscarnet (Foscavir), 40 mg/kg q8 12h given over 2 hours. By what route would the nurse administer
    this drug?
    A) Sub q
    B) IV
    C) IM
    D) PO

Answer 26

Ans: B
Feedback:
Foscarnet is available in intravenous (IV) form only. It reaches peak levels at the end of the infusion
and has a half-life of 4 hours. About 90% of foscarnet is excreted unchanged in the urine making it
highly toxic to the kidneys. Use caution and at reduced dosage in patients with renal impairment.
Options A, C, and D are incorrect.

Question 27

27. A patient comes to the clinic with a herpes outbreak. The nurse notes from the patient’s chart that the
    patient is just beginning a course of antibiotics prescribed by another physician in the clinic. What
    classification of antibiotic should not be taken with an antiviral medication used to treat herpes?
    A) Penicillin
    B) Beta-Lactam
    C) Aminoglycoside
    D) Macrolide

Answer 27

Ans: C
Feedback:
The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and
cytomegalovirus are used in combination with other nephrotoxic drugs, such as the aminoglycoside
antibiotics. No contraindication exists for penicillins, beta-lactams, or macrolide antibiotics.

Question 28

28. A nonnucleoside reverse transcriptase inhibitor has direct effects on the HIV virus activities within the
    cell. What drug is a nonnucleoside reverse transcriptase inhibitor?
    A) Econazole nitrate (Spectazole)
    B) Oxaliplatin (Eloxatin)
    C) Olanzapine (Zyprexa)
    D) Efavirenz (Sustiva)29.

Answer 28

Ans: D
Feedback:
The nonnucleoside reverse transcriptase inhibitors now available include: delavirdine (Rescriptor),
efavirenz (Sustiva), and nevirapine (Viramune). Econazole nitrate is an antifungal cream, olanzapine is
an atypical antipsychotic, and oxaliplatin is an antineoplastic agent.

Question 29

29. An immunocompromised 3-year-old has been exposed to avian flu. The patient is brought to the clinic
    and the mother reports that the patient has had flu-like symptoms for the past 12 hours. What
    medication would you expect the physician to order for this patient?
    A) Oseltamivir (Tamiflu)
    B) Amantadine (Symmetrel)
    C) Ribavirin (Rebetron)
    D) Zanamivir (Relenza)

Answer 29

Ans: A
Feedback:
Oseltamivir is the only antiviral agent that has been shown to be effective in treating avian flu.
Therefore Options B, C, and D are incorrect.

Question 30

30. The nurse is providing discharge teaching for a patient going home on the medication entecavir
    (Baraclude). What is the priority teaching point for this patient?
    A) Take the whole course of the medication as prescribed.
    B) Take this medication with grapefruit juice.
    C) Do not stop taking this medication or allow the prescription to run out.
    D) The patient will take this medication for the rest of his life.

Answer 30

Ans: C
Feedback:
A potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach
patient the importance of not running out of the drugs and using extreme caution when discontinuing
these drugs. Options A, B, and D are incorrect responses.

Question 31

31. The nurse is caring for a patient who is taking adefovir to treat hepatitis B. The nurse would hold the medication and notify the health care provider if assessing the signs and symptoms of what? (Select all
that apply.)
A) Lactic acidosis
B) Hepatotoxicity
C) Headache
D) Nausea
E) Asthenia

Answer 31

Ans: A, B
Feedback:
Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or
hepatotoxicity because these adverse effects can be life threatening. Headache, nausea, and asthenia are
potential adverse effects but are not life threatening and would not require withdrawal of the drug.

Question 32

32. The nurse is caring for an asymptomatic preschool-aged child who has cystic fibrosis and has been
    exposed to influenza A before receiving the appropriate immunization. What antiviral medication might
    the nurse administer to this child?
    A) Rimantadine (Flumadine)
    B) Zanamivir (Relenza)
    C) Oseltamivir (Tamiflu)
    D) Amantadine (Symmetrel)

Answer 32

Ans: C
Feedback:
Amantadine is indicated for the prevention of respiratory virus infections and can be given to children
older than 1 year of age. This would be appropriate in a child with a chronic respiratory illness who
could die as the result of developing a respiratory virus. Zanamivir is not indicated for children younger
than 7 years of age. Rimantadine is administered as prophylaxis against influenza A virus in children
older than 10 years of age. Oseltamivir is indicated for patients who are symptomatic for less than 2
days, but this child is asymptomatic.

Question 33

33. For what viruses might the nurse administer acyclovir (Zovirax)? (Select all that apply.)
A) Herpes simplex virus
B) Shingles
C) Chickenpox
D) HIV
E) Cytomegalovirus (CMV)

Answer 33

Ans: A, B, C
Feedback:
Acyclovir is indicated for the treatment of herpes simplex virus, shingles, and chickenpox as well as
topically for treating herpes labialis. Acyclovir is not effective against HIV or CMV.

Question 34

34. The nurse is caring for a patient whose condition has continued to decline on other antiviral
    medications and is now prescribed nevirapine (Viramune). What other medications will the nurse
    assess for to avoid a drug drug interaction with this new prescription? (Select all that apply.)
    A) Oral contraceptives
    B) Protease inhibitors
    C) St. John’s wort
    D) Ergot derivatives
    E) Antiarrhythmics

Answer 34

Ans: A, B, C
Feedback:
Effectiveness may be lessened if nevirapine is combined with hormonal contraceptives or protease
inhibitors. St. John’s wort should not be used with this drug or any nonnucleoside reverse transcriptase
inhibitors because a decrease in antiviral effects can occur. Antiarrhythmics are contraindicated when
taking delavirdine, not nevirapine. Ergot derivatives are contraindicated with efavirenz, not nevirapine

Question 35

35. The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What
    medication would the nurse expect to administer to reduce the risk of maternal to fetal transmission of
    the virus?
    A) Lamivudine (Epivir)B) Zidovudine (Retrovir)
    C) Stavudine (Zerit XR)
    D) Tenofovir (Viread)

Answer 35

Ans: B
Feedback:
AZT, or zidovudine is administered to prevent the transmission of HIV from mother to child and can be
administered to both after birth to treat symptomatic HIV. The other medications (options A, C, and D)
are not used for this purpose.