Chapter 35: HIV- and AIDS-Related Drugs Nursing School Test Banks

Chapter 35: HIV- and AIDS-Related Drugs
Test Bank

MULTIPLE CHOICE

1. 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. has an increased risk of transmitting the HIV infection.
b. is less likely to develop AIDS than younger persons with HIV infection.
c. is less likely to respond to antiretroviral agents.
d. may have comorbid illnesses that can complicate HIV.
ANS: D
Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 470
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

2. 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. acute retroviral syndrome.
b. AIDS.
c. an increased viral load.
d. an opportunistic infection.
ANS: A
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 470
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

3. 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. Todays lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patients results?
a. A drug-resistant strain is likely.
b. The patient is progressing as expected.
c. The patients treatment goals have been met.
d. Treatment failure has occurred.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 470
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patients provider to order?
a. Abacavir/lamivudine/zidovudine (Trizivir)
b. Efavirenz/emtricitabine/tenofovir (Atripla)
c. Lamivudine/zidovudine (Combivir)
d. Rilpivirine/emtricitabine/tenofovir (Complera)
ANS: C
Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 474
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. 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 patients creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action?
a. Instruct the patient to take the medication 60 minutes prior to meals.
b. Notify the provider to discuss single-dose NRTI products.
c. Request an order for once-daily dosing of this medication.
d. Suggest that the patient increase fluid intake.
ANS: B
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 patients symptoms.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 476
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. 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
a. avoid development of psychiatric comorbidities.
b. prevent dizziness, sedation, and nightmares.
c. reduce viral resistance.
d. prevent severe rash and hepatotoxicity.
ANS: C
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 477
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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. allows decreasing the dosing from 3 times daily to twice daily.
b. can lead to increased cholesterol and triglycerides.
c. may worsen insulin resistance.
d. will require increased dietary restrictions.
ANS: A
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 478
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. 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. Consume a low-cholesterol diet.
b. Consume more acidic foods.
c. Take the pill on an empty stomach.
d. Take the pill with fatty foods.
ANS: A
Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 476
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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. Administration of a high dose of corticosteroids
b. Changing the regimen to a single antiretroviral drug
c. Temporarily discontinuing the antiretroviral therapy
d. Treating an underlying opportunistic infection
ANS: D
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 482
TOP: NURSING PROCESS: Evaluation/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take?
a. Ask the patients family members to administer the medications.
b. Avoid discussing adverse effects to prevent focus on negative aspects of ART.
c. Give a detailed list of medications and stress the need to adhere to the schedule.
d. Offer written and verbal information about each drugs purpose.
ANS: D
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 483
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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 patients blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond?
a. No treatment is necessary since the patient is receiving antiretroviral therapy.
b. We will treat you if the patients VL is > 20 copies/mL.
c. You will require 4 weeks of antiretroviral therapy.
d. You will undergo HIV testing and will be treated if you are positive.
ANS: C
Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 486-487
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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