Nokea
An HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. When assessing the patient, the nurse would immediately report which of the following to the primary health care provider?
- A. Peripheral neuropathy
- B. Headache
- C. Excoriation
- D. Taste alteration
- E. Nausea
Correct Answer: A
Rationale: The nurse should immediately report symptoms of peripheral neuropathy to the primary health care provider. Headache, taste alteration, and nausea are some of the mild adverse effects of the drug and are not cause for immediate concern. Excoriation is an adverse effect of imiquimod and does not occur in patients being administered didanosine.
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The nurse is reviewing the medical record of a client who is to receive ritonavir. Which medication if found in the medication history would lead the nurse to contact the primary health care provider because the prescribed drug would be contraindicated? Select all that apply.
- A. Triazolam (Halcion)
- B. Bupropion (Wellbutrin)
- C. Zolpidem (Ambien)
- D. Lisinopril (Prinivil)
- E. Procainamide (Procanbid)
Correct Answer: B,C,E
Rationale: Ritonavir (Norvir) is contraindicated if the client is taking bupropion (Wellbutrin), zolpidem (Ambien), or an antiarrhythmic drug.
The nurse is preparing to administer an antiviral drug to a client. Which of the following would the nurse include in the preadministration assessment? Select all that apply.
- A. Client's general state of health
- B. Blood glucose levels
- C. Resistance to infection
- D. Electrocardiogram findings
- E. Vital signs
Correct Answer: A,C,E
Rationale: The nurse's preadministration assessment of the client prior to administration of antiviral drugs should include determination of the client's general state of health and resistance to infection, record of client's symptoms and complaints, and record of vital signs. Blood glucose levels and electrocardiogram findings are not needed.
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.
A nurse is caring for a patient who is prescribed amantadine. The nurse would assess the patient for which of the following?
- A. Asthenia and abdominal pain
- B. Fever and dizziness
- C. Anorexia and dyspnea
- D. Hypotension and insomnia
- E. Nausea and vomiting
Correct Answer: D
Rationale: A nurse should monitor the patient for hypotension and insomnia, since these are adverse reactions of amantadine. Asthenia and abdominal pain are adverse reactions of adefovir. Fever and dizziness are adverse reactions of acyclovir. Anorexia and dyspnea are adverse reactions of cidofovir. Nausea and vomiting are not specific adverse reactions of amantadine.
A nurse is preparing to administer antiviral therapy. The nurse integrates knowledge of this therapy, administering the drugs cautiously to clients with which of the following? Select all that apply.
- A. Hepatic impairment
- B. Renal impairment
- C. Diabetes
- D. Low blood cell count
- E. Hypertension
Correct Answer: B,D
Rationale: Antivirals should be used cautiously in clients with renal impairment, low blood cell counts, history of epilepsy (rimantadine), and history of respiratory disease (zanamivir).