A patient with HIV and mucocutaneous HSV is being treated with ...

[erika]

A patient with HIV and mucocutaneous HSV is being treated with foscarnet after failing treatment with acyclovir. After 2 weeks, the patient's dose is increased to 90 mg/kg over 2 hours from 40 mg/kg over 1 hour.
 
  The patient reports numbness in the extremities and perioral tingling. What will the nurse do? a. Notify the provider and request an order for a serum calcium level.
  b. Notify the provider of potential foscarnet overdose.
  c. Request an order for a creatinine clearance level.
  d. Request an order of IV saline to be given before the next dose.

Question 2

A nurse provides teaching for a patient with cytomegalovirus (CMV) retinitis who will receive the ganciclovir ocular implant Vitrasert. Which statement by the patient indicates a need for further teaching?
 
  a. My vision may be blurred for 2 to 4 weeks after receiving the implant.
  b. Surgical placement of the implant is an outpatient procedure.
  c. The implant will remain in place perma-nently.
  d. The implant will slow progression of CMV retinitis.

[komodo7]

Answer to Question 1

A
Foscarnet frequently causes hypocalcemia and other electrolyte and mineral imbalances. Pares-thesias, numbness in the extremities, and perioral tingling can indicate hypocalcemia, so a calcium level should be drawn. These are not signs of foscarnet overdose. Nephrotoxicity may occur, but these are not signs of renal complications, so a creatinine clearance is not indicated. If nephrotoxicity occurs, prehydration with IV saline is indicated to reduce the risk of renal injury.

Answer to Question 2

C
Ganciclovir ocular implants must be replaced every 5 to 8 months and do not remain in place permanently. It is correct that vision may be blurred for 2 to 4 weeks after placement of the im-plant, that placement is an outpatient procedure, and that the implant will slow progression of CMV retinitis.

[erika]

TYSM

[kjohnson]

Excellent