ch37: HIV

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "It doesn't matter if you take this drug with or without food." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "You should take the drug with an antacid." "When you take this drug, eat a high-fat meal immediately afterwards."

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 3 mL/min 1.5 mL/min 6 mL/min 10 mL/min

3 mL/min The nurse should administer the IV infusion at a slow rate, not to exceed 3 mL/min, usually at 100-200 mL/h.

A patient is on highly active antiretroviral therapy (HAART) 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? 10 mm3 to 20 mm3 20 mm3 to 45 mm3 50 mm3 to 150 mm3 1 mm3 to 10 mm3

50 mm3 to 150 mm3 An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

When do most perinatal HIV infections occur? Through casual contact Through breastfeeding After exposure during delivery In utero

After exposure during delivery Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery. if viral load high, c/s recommended

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? CD4+ counts Western blotting assay ELISA HIV RNA

CD4+ counts The most important consideration in decisions to initiate antiretroviral therapy is CD4+ counts.

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: Oral candida. Nausea and vomiting. Anorexia. Chronic diarrhea.

Chronic diarrhea. Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

More than 50% of individuals with this disease develop pernicious anemia: Nezelof syndrome DiGeorge syndrome Bruton disease Common variable immunodeficiency (CVID)

Common variable immunodeficiency (CVID) More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.

Which condition is an early manifestation of HIV encephalopathy? Hyperreflexia Hallucinations Headache Vacant stare

Headache Early manifestations of HIV encephalopathy include headache, memory deficits, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. Later stages include hyperreflexia, a vacant stare, and hallucinations.

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? Urine specific gravity of 1.010 Hypernatremia Hypokalemia Proteinuria

Hypokalemia Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse? The client has another infection present that is causing a decrease in the T4-cell count. The client has advanced HIV infection. The client has converted from HIV infection to AIDS. The client's T4-cell count has decreased due to the Pneumocystis pneumonia.

The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/mm3 and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next? Western Blot T4/T8 ratio Polymerase chain reaction ELISA

Western Blot The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. A positive result on Western blot confirms the diagnosis; however, false-positive and false-negative results on both tests are possible. A polymerase chain reaction gives the viral load of the client. The T4/T8 ratio determines the status of T lymphocytes.

A patient is being tested for HIV using enzyme immunoassay (EIA). The EIA shows antibodies. The nurse expects the health care provider to order what test to confirm the EIA test results? Viral load test Western blot test Another EIA test CD4:CD8 ratio

Western blot test The Western blot test detects antibodies to HIV and is used to confirm EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4:CD8 ratio test evaluates the ratio of CD4 to CD8 cells. HIV kills CD4 cells, which results in an impaired immune system, and this test is used to assess the immune system.

A hospice nurse has been providing care for a patient with AIDS. Among the manifestations of the disease has been a profound weight loss over the past several weeks. Consequently, the nurse is adjusting the patient's plan of care to reprioritize this problem. When planning interventions for the patient's weight loss, the nurse should be aware of which fact? The patient's weight loss is a sign of the progression of AIDS but is not a direct threat to his health. Nutritional interventions may not necessarily resolve the patient's weight loss. The patient's weight loss is attributable to psychological factors rather than pathophysiological factors. The patient should simultaneously receive total parenteral nutrition (TPN) and oral nutritional supplements.

Nutritional interventions may not necessarily resolve the patient's weight loss. In some AIDS-associated illnesses, patients experience a hypermetabolic state in which excessive calories are burned and lean body mass is lost. As a result, nutritional interventions (including TPN) may not necessarily be effective. This weight loss has profound implications for the patient's overall health and prognosis.

A nurse is collecting objective data for a client with AIDS. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does this finding indicate? Kaposi's sarcoma candidiasis hairy leukoplakia coccidioidomycosis

candidiasis Candidiasis is a yeast infection caused by the Candida albicans microorganisms. It may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in folds of the skin. It is often called thrush when located in the mouth. Inspection of the mouth, throat, or vagina reveals areas of white plaque that may bleed when mobilized with a cotton-tipped swab. Kaposi's sarcoma is a purple lesion and is an opportunistic cancer. Hairy leukoplakia is also an indication of oral cancer. Coccidioidomycosis causes diarrhea in the immunosuppressed client.

A nurse is caring for a client who is HIV positive and is taking zidovudine. Which side effects should the nurse expect in this client? kidney/bladder stones diarrhea and abdominal pain decreased cognition and memory loss renal dysfunction

diarrhea and abdominal pain Common side effects associated with the administration of zidovudine and other NRTIs include headache, nausea, rash, vomiting, peripheral neuropathy, abdominal pain, and diarrhea. The nurse should also monitor for pancreatitis and liver dysfunction (not renal dysfunction). The drug does not cause decreased cognition, memory loss, or kidney/bladder stones.

The term used to define the amount of virus in the body after the initial immune response subsides is viral clearance rate. primary infection stage. window period. viral set point.

viral set point. The amount of virus in the body after the initial immune response subsides is referred to as the viral set point, which results in an equilibrium between HIV levels and the immune response that may be elicited. During the primary infection period, the window period occurs because a person is infected with HIV but negative on the HIV antibody blood test. The period from infection with HIV to the development of antibodies to HIV is known as the primary infection stage. The amount of virus in circulation and the number of infected cells equals the rate of viral clearance.