A patient with HIV infection has been receiving antiretroviral ...

[123654777]

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

Question 2

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 patient's 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.

[Natalie4ever]

Answer to Question 1

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.

Answer to Question 2

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 patient's symptoms.

[123654777]

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[Natalie4ever]

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