The nurse teaches a patient who is prescribed nirmatrelvir/ritonavir (Paxlovid). Which of these should be included in the patient teaching about Paxlovid?
The patient must be 12 years or older to take Paxlovid.
Paxlovid treatment is initiated within 5 days of symptom onset.
Report to the provider if the patient develops a rash.
Inform the patient of potential alteration in taste.
Significant weight gain is an adverse reaction of Paxlovid.
Correct Answer : B,C,D
Choice A rationale
The Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for nirmatrelvir/ritonavir (Paxlovid) specifies that it is authorized for use in adults and pediatric patients who are 12 years of age and older and weigh at least 40 kg. Stating only the age is insufficient, as the weight criterion is also essential for safe and effective dosing in the pediatric population, ensuring appropriate pharmacokinetics and minimizing toxicity risks.
Choice B rationale
Nirmatrelvir/ritonavir (Paxlovid) must be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. This timeframe is crucial because the drug works by inhibiting the SARS-CoV-2 main protease, which is most effective during the early viral replication phase before the viral load peaks and significant organ damage occurs, thus maximizing therapeutic benefit.
Choice C rationale
A rash, especially one that is severe or progresses, can be a sign of a hypersensitivity reaction to nirmatrelvir or ritonavir, such as Stevens-Johnson syndrome (SJS) or Toxic Epidermal Necrolysis (TEN). The patient must report this immediately so the medication can be discontinued and appropriate supportive care initiated to prevent life-threatening complications.
Choice D rationale
Dysgeusia (altered taste sensation), often described as a metallic taste, is a frequently reported adverse effect of nirmatrelvir/ritonavir (Paxlovid). This occurs due to the drug's excretion in saliva. Informing the patient proactively helps to manage expectations and ensure adherence to the medication regimen despite this temporary and bothersome side effect.
Choice E rationale
Significant weight gain is not a recognized common or serious adverse reaction of nirmatrelvir/ritonavir (Paxlovid). Common side effects include dysgeusia, diarrhea, hypertension, and myalgia. Weight loss might be seen in the context of severe COVID-19 infection, but not as an expected drug effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Naloxone is an opioid receptor antagonist that competes with and displaces opioid molecules from μ-opioid receptors in the central nervous system. Its pharmacological action directly reverses the life-threatening effects of acute opioid overdose, primarily respiratory depression. It does not pharmacologically influence or immediately eliminate the patient's underlying drug-seeking behavior.
Choice B rationale
Opioid overdose causes respiratory depression and bradycardia (slowed heart rate), often below the normal range of 60-100 beats per minute. Naloxone reverses the respiratory depression, which then leads to improved oxygenation, and subsequent heart rate normalization (reversal of bradycardia). The primary immediate effect is reversing respiratory depression, which secondarily helps normalize the heart rate.
Choice C rationale
The rapid displacement of opioids by naloxone can precipitate an acute opioid withdrawal syndrome, characterized by symptoms like nausea, vomiting, sweating, and agitation. While this is a common consequence of administering the antagonist, the most immediate therapeutic goal in this life-threatening scenario is the reversal of inadequate ventilation to restore oxygenation and prevent hypoxia-related organ damage.
Choice D rationale
The most immediate life-threatening sign of opioid overdose is respiratory depression (patient's rate of 4 breaths per minute is dangerously low; normal is 12-20 breaths per minute), resulting from opioid binding to μ-receptors in the brainstem's respiratory centers. Naloxone rapidly reverses this central nervous system depression, stimulating the patient's drive to breathe, which is critical for restoring adequate oxygenation and ventilation.
Correct Answer is A
Explanation
Choice A rationale
The standard clinical definition of chronic bronchitis is a respiratory disorder characterized by a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years. This persistent cough is due to hypertrophy of the mucous glands in the large airways and inflammation, leading to excessive mucus production and airflow obstruction.
Choice B rationale
This description relates to the frequency of respiratory infections, not the specific characteristic cough or duration required for a chronic bronchitis diagnosis. While individuals with chronic bronchitis are more susceptible to infections due to impaired mucociliary clearance, the diagnostic criteria are based on the chronic productive cough for a defined duration.
Choice C rationale
This describes a diagnosis related to tuberculosis, where a tubercle bacillus (Mycobacterium tuberculosis) forms lesions called tubercles, often seen on chest x-ray. Chronic bronchitis is characterized by inflammation and mucus hypersecretion in the bronchi, not by the presence of a tubercle bacillus in the lungs.
Choice D rationale
Hospitalization for shortness of breath is a general sign of severe respiratory distress from various causes, including severe COPD exacerbation or heart failure. It is not a specific diagnostic criterion for chronic bronchitis, which relies on the historical pattern of a chronic productive cough.
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