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A client diagnosed with HIV infection is receiving HAART. The client, who is alert and oriented, complains of anorexia, nausea, and vomiting. He has lost 10 pounds in the last 6 weeks. Additional assessment reveals pale, pink skin without any irritation or breakdown. He denies any complaints of pain. Which nursing diagnosis would the nurse identify as the priority for this client?
- A. Risk for Injury
- B. Risk for Imbalanced Nutrition: Less Than Body Requirements
- C. Risk for Impaired Skin Integrity
- D. Acute Pain
- E. Ineffective Coping
Correct Answer: B
Rationale: The client's complaints along with his weight loss strongly suggest a nursing diagnosis of Risk for Imbalanced Nutrition: Less Than Body Requirements as a priority. The client is alert and oriented, so his risk for injury is significantly low. There is no evidence of impaired skin integrity at present. However, this may become a concern if the client begins toæ??æ³? experience skin breakdown secondary to his poor nutritional status. The client denies any pain, so Acute Pain would be inappropriate. Ineffective Coping is not supported by the provided assessment data.
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A nursing instructor is describing the different categories of antiretroviral agents used in treatment for HIV infection. The instructor determines that the teaching was successful when the students identify which category as affecting an enzyme so that new viral particles cannot mature?
- A. Protease inhibitors
- B. Reverse transcriptase inhibitors
- C. Nonnucleoside reverse transcriptase inhibitors
- D. Integrase inhibitors
- E. Entry inhibitors
Correct Answer: A
Rationale: Protease inhibitors block the protease enzyme so the new viral particles cannot mature. Reverse transcriptase inhibitors block the reverse transcriptase enzyme so the HIV material cannot change into DNA in the new cell, preventing new HIV copies from being created. Nonnucleoside reverse transcriptase inhibitors latch on to the reverse transcriptase molecule to block the ability to make viral DNA. Integrase inhibitors prevent enzymes from inserting HIV genetic material into the cell's DNA. Entry inhibitors block HIV from entering the cell.
A nurse is reviewing information about cidofovir in preparation for administration. The nurse understands that which of the following are true? Select all that apply.
- A. It should not be given to clients who have renal impairment.
- B. The drug should not be given to clients receiving aminoglycosides.
- C. Cidofovir is used in the treatment of cytomegalovirus retinitis.
- D. It is administered by placing one drop in both eyes twice daily.
- E. The drug should not be given with HMG-CoA reductase inhibitors.
Correct Answer: A,B,C
Rationale: Cidofovir should not be given to clients who have renal impairment or who are receiving other nephrotoxic drugs, such as aminoglycosides. The drug is used to treat cytomegalovirus retinitis and is administered IV.
After teaching a group of nursing students about antiretroviral drugs, the instructor determines that the teaching was successful when the students identify that these drugs are used to treat which infections? Select all that apply.
- A. Hepatitis C virus (HCV)
- B. Human immunodeficiency virus (HIV)
- C. Acquired immunodeficiency syndrome (AIDS)
- D. Herpes simplex virus (HSV) 1
- E. Herpes simplex virus (HSV) 2
Correct Answer: B,C
Rationale: Antiretroviral drugs are used to treat HIV and AIDS.
A patient with skin lesions due to a viral infection has been prescribed a topical antiviral agent. When teaching the patient about this therapy, which of the following would the nurse emphasize?
- A. The drug will not prevent the spread of the disease to others.
- B. Topical drugs should be applied using the hand, not a finger cot or gloves.
- C. All lesions should be left open and not covered in any way.
- D. Sexual contact when lesions are present is permissible if barrier methods are used.
- E. Apply the drug twice daily for best results
Correct Answer: A
Rationale: The nurse should inform the patient that application of the drug does not prevent the spread of the disease to others. Topical drugs should be applied with a finger cot or gloves but not with bare hands. The nurse should instruct the patient to cover all lesions and not leave them open. The nurse should also stress the importance of avoiding sexual contact when lesions are present irrespective of contraceptive measures. The frequency of application depends on the specific drug prescribed.
Which of the following would the nurse identify as a goal for a client who is receiving an antiviral drug? Select all that apply.
- A. Adverse reactions are identified and treated.
- B. Adequate nutritional status is maintained.
- C. Perceptions of body changes are managed successfully.
- D. Skin integrity is successfully maintained.
- E. Therapeutic response is achieved.
Correct Answer: A,B,C,D,E
Rationale: The goals for a client taking antiviral drugs can include the following: adverse reactions are identified and treated, adequate nutritional status is maintained, perceptions of body changes are managed successfully, skin integrity is successfully maintained, and therapeutic response is achieved.