Ch. 37: Management of Patients With HIV Infection and AIDS
A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in?
Primary infection
The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care?
Assist with chest physiotherapy every 2 to 4 hours.
Diagnosis of Kaposi's sarcoma (KS) is made by which of the following?
Biopsy
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection?
Follow the same sexual precautions as someone who has been diagnosed with AIDS.
A client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care?
TMP-SMZ
A patient taking amprenavir (APV, Agenerase) complains of "getting fat." What is the nurse's best action?
Teach the patient about medication side effects.
The balance between the amount of HIV in the body and the immune response is the:
Viral set point
A patient is on ART for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year?
50 mm3 to 150 mm3
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?
Antibodies to HIV are not present in his blood.
During assessment of a patient with Kaposi's sarcoma, the nurse knows to look for the initial sign of:
Deep purple cutaneous lesions.
Which of the following is an early manifestation of HIV encephalopathy?
Headache
The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:
Chronic diarrhea.
The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply.
-Semen -Breast milk -Blood -Vaginal secretions
A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when he schedules a return visit for viral load testing at which time?
6 weeks
A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. Which of the following would the nurse describe as the first step?
Attachment
Which blood test confirms the presence of antibodies to HIV?
Enzyme-linked immunosorbent assay (ELISA)
Which of the following nursing actions is essential before an EIA test is performed?
Obtaining a general consent for medical care from the patient
A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about?
Reverse transcriptase inhibitors
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis?
Stool specimen for ova and parasites
A client on antiretroviral drug therapy is discussing with the nurse that sometimes he "forgets to take his meds for a few days." What should the nurse inform the client can occur when the medications are not taken as prescribed?
The client is risking the development of drug resistance and drug failure.
The client comes to the clinic to obtain the results from the test to determine if he is infected with HIV. The physician informs the client that he has a CD4 cell count of 300 cells/mm3 and a high viral load. What does the nurse anticipate the physician will discuss with the client?
The initiation of antiretroviral therapy
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material?
Ribonucleic acid (RNA)
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean that:
his body has not produced antibodies to the AIDS virus.
A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action?
Call the health care provider to report.
The nurse is collecting objective data for a client with AIDS at the clinic. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does the nurse understand this finding indicates?
Candidiasis
A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient?
Inform the patient that it would be beneficial to test for HIV.
Which of the following is the most common HIV-related malignancy?
Kaposi's sarcoma
Which of the following options should the nurse encourage to replace fluid and electrolyte losses in a patient with AIDS?
Liquids
HIV is harbored within which type of cell?
Lymphocyte
The nurse completes a history and physical assessment on a patient with AIDS who was admitted to the hospital with respiratory complications. The nurse knows to assess for the most common infection in persons with AIDS (80% occurrence). This is:
Pneumocystis pneumonia.
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
Risk for injury
A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions?
Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens.
The nurse receives a phone call at the clinic from the family of a patient with AIDS. They state that the patient started "acting funny" after complaining of headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?
"The patient may have cryptococcal meningitis and will need to be evaluated by the physician."
Which of the following are modes of transmission for HIV? Select all that apply.
-Blood -Seminal fluid -Vaginal secretions -Amniotic fluid
A client with AIDS is brought to the clinic by his family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?
AIDS dementia complex (ADC)
A home care nurse is visiting a client with AIDS at home. During the visit, the nurse observes the caregiver providing care. Which of the following would alert the nurse to the need for additional teaching for the caregiver?
Caregiver cleans the client's anal area without wearing gloves
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by ____.
HIV-1 is more prevalent than HIV-2 subtypes
Which of the following indicates that a client with HIV has developed AIDS?
Herpes simplex ulcer persisting for 2 months
A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?
Hypokalemia
A client with AIDS is exhibiting shortness of breath, cough, and fever. The nurse most likely would suspect infection with which of the following?
Pneumocystis jiroveci
A patient with HIV develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this patient?
Pneumocystis pneumonia
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection?
Trimethoprim-sulfamethoxazole (Bactrim, Septra)
The balance between the amount of HIV in the body and the immune response is the:
viral set point.
A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.)
-Active substance abuse -Depression -Lack of social support
A patient receiving antiretroviral therapy is complaining of "not urinating enough." What is the nurse's best action?
Assess BUN and creatinine.
A client visits the nurse complaining of diarrhea every time he eats. The client has AIDS and wants to know what he can do to stop having diarrhea. What should the nurse advise?
Avoid fibrous foods, lactose, fat, and caffeine.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
Bank autologous blood.
Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy?
CD4 counts
A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority?
Disturbed body image related to loss of fat in the face and arms
A client suspected of having HIV has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?
ELISA
Which blood test confirms the presence of antibodies to HIV?
Enzyme-linked immunoabsorbent assay (ELISA)
The period from infection with HIV to the development of antibodies to HIV is known as which of the following?
Primary infection
A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often."What should the nurse consult with the physician regarding?
Testing the client for the presence of HIV
Which of the following statements reflects the treatment of HIV infection?
Treatment of HIV infection for an individual patient is based on the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load).
