HIV and AIDS Prep U

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? A. Anxiety related to an inherited disorder B. Grieving related to the poor prognosis of the condition C. Risk for infection related to altered immune cell function D. Impaired skin integrity related to persistent deep skin abscesses

C. Risk for infection related to altered immune cell function Although anxiety and impaired skin integrity may be appropriate, the priority nursing diagnosis for any immunodeficiency is the risk for infection. Although primary immunodeficiencies can be serious, they are rarely fatal. Therefore, the nursing diagnosis of grieving would be inappropriate.

The period from infection with HIV to the development of antibodies to HIV is known as which of the following? A. Primary infection B. Viral load C. Viral set point D. Anergy

A. Primary infection Primary infection is the period from the infection with HIV to the development of antibodies to HIV. The viral load test measures plasma HIV RNA levels. Viral set point is the balance between the amount of HIV in the body and the immune response. Anergy is the absence of an immune response.

A nurse works in an employee health department of a hospital. She was asked to treat a staff nurse who was exposed to blood from a patient with an HIV infection. The nurse practitioner instituted a PEP protocol that includes which of the following actions? Select all that apply. A. Start prophylaxis medications between 3 to 6 hours after exposure. B. Continue HIV medications for 4 weeks postexposure. C. Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level). D. Initiate postexposure testing after 4 weeks. E. Finish postexposure testing at 6 months.

B. Continue HIV medications for 4 weeks postexposure. D. Initiate postexposure testing after 4 weeks. E. Finish postexposure testing at 6 months. Refer to Box 37-4 in the text

A client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wart-like lesions on my vagina. This is happening quite often." Which nursing action is the priority for this client? A. Recommend abstinence or safer-sex practices. B. Offer information on human immunodeficiency virus (HIV) testing. C. Provide a prescribed topical antifungal agent to treat the client's vaginal infection. D. Refer the client to a support group with others experiencing the same symptoms.

B. Offer information on human immunodeficiency virus (HIV) testing. In women, gynecologic problems may be the focus of the chief complaint for clients who are HIV positive but not yet diagnosed. Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may also correlate with HIV infection. Based on this information, the priority nursing action is to offer information on HIV testing to the client. Although recommending abstinence or safer-sex practices, providing a prescribed topical antifungal agent to treat the client's vaginal infection, and referring to a support group may be appropriate, the priority is to determine the source of the client's symptoms.

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse? A. "A latex condom should be used during intimate sexual contact." B. "I've heard about people who got AIDS from blood transfusions." C. "I won't donate blood because I don't want to get AIDS." D. "I.V. drug users can get HIV from sharing needles."

C. "I won't donate blood because I don't want to get AIDS." HIV is transmitted through infected blood, semen, and certain other body fluids. Although a transfusion with infected blood may cause HIV infection in the recipient, a person can't become infected by donating blood. The other options reflect accurate understanding of HIV transmission.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? A. Antibodies to HIV are not present in his blood. B. He has not been infected with HIV. C. He is immune to HIV. D. Antibodies to HIV are present in his blood.

A. Antibodies to HIV are not present in his blood. A negative test result indicates that antibodies to HIV are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that if infected, the body has not produced antibodies (which take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to HIV are detected in the blood, the test is interpreted as positive.

The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about their medications. What is essential for the nurse to include in the teaching of this client regarding medications? A. The use of condoms B. What vaccinations to have C. Side effects of drug therapy D. The action of each antiretroviral drug

C. Side effects of drug therapy Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

The nurse is preparing a teaching plan for a client with an immunodeficiency. What aspect would the nurse emphasize as most important? A. Frequent and thorough handwashing B. Identifying the signs and symptoms of infection C. Adherence to prophylactic medication administration D. Incorporation of treatment regimens into daily patterns

A. Frequent and thorough handwashing Although identifying the signs and symptoms of infection, adherence to medication prophylaxis, and incorporation of treatment regimens into daily patterns are important, the most important aspect is frequent and thorough handwashing to prevent infection. If infection is prevented, signs and symptoms will not develop and medications would not necessarily be needed.

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? A. The client has converted from HIV infection to AIDS. B. The client has advanced HIV infection. C. The client's T4-cell count has decreased due to the Pneumocystis pneumonia. D. The client has another infection present that is causing a decrease in the T4-cell count.

A. 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 has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? A. Reverse the HIV+ status to a negative status. B. Treat mycobacterium avium complex. C. Eliminate the risk of AIDS. D. Bring the viral load to a virtually undetectable level

D. Bring the viral load to a virtually undetectable level The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.

The lower the client's viral load, A. the shorter the time to AIDS diagnosis. B. the longer the survival time. C. the shorter the survival time. D. the longer the time immunity.

B. the longer the survival time. The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretroviral therapy is to achieve and maintain durable viral suppression.

The nurse is teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed? A. "I will wash my hands whenever I get home from work." B. "I will make sure to have my own toothbrush and tube of toothpaste at home." C. "I will avoid contact with people who are sick or who have recently been vaccinated." D. "I will be sure to eat lots of fresh fruits and vegetables every day."

D. "I will be sure to eat lots of fresh fruits and vegetables every day." The client should avoid eating raw fruits and vegetables. All foods should be cooked thoroughly and all leftover food should be refrigerated immediately to prevent infection.

The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? A. Obtain counseling. B. Call the lab to draw the nurse's blood. C. Fill out a risk management report. D. Report the incident to the supervisor.

D. Report the incident to the supervisor. Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.

The nurse has four clients that come to the clinic for healthcare. Which client has the highest risk factor for HIV infection? A. a 46-year-old who has been in a monogamous relationship for 9 years B. a 22-year-old who has had one relationship for 2 years C. a 34-year-old who has donated blood on several occasions D. a 26-year-old inmate who receives tattoos in prison

D. a 26-year-old inmate who receives tattoos in prison Contact with infected blood on body piercing, tattoo, and dental equipment places the inmate at great risk because there is not an approved method for sterilization of the equipment. The other answers do not eliminate the risk for HIV but are less likely.

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? A. Primary infection B. Secondary infection C. Tertiary infection D. Latent infection

A. Primary infection The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection, or stage 1. Initially, there is a period during which those who are HIV positive test negative on the HIV antibody blood test, although they are infected and highly infectious, because their viral loads are very high.

Which client is more at risk of becoming infected with human immunodeficiency virus (HIV)? A. A client who has never had intercourse B. A person having casual intercourse with multiple partners C. A client who has delivered a baby after the age of 40 D. A client who uses sildenafil before having intercourse

B. A person having casual intercourse with multiple partners People who have casual intercourse with multiple partners are at a greater risk of acquiring HIV. Women who have never had intercourse are at the least risk because HIV spreads through body fluids, such as semen, vaginal secretions, and blood. The risks of women who have had deliveries after the age of 40 or men who use sildenafil (Viagra) before having intercourse are yet to be established.

A home care nurse is visiting a client with acquired immune deficiency syndrome (AIDS) at home. During the visit, the nurse observes the caregiver providing care. What action by the caregiver would alert the nurse to the need for additional teaching? A. Caregiver washes hands before and after providing care to the client. B. Caregiver cleans the client's anal area without wearing gloves C. Caregiver disposes of syringe and needle in a metal coffee can with lid. D. Caregiver uses a dilute bleach solution to clean up a urine spill.

B. Caregiver cleans the client's anal area without wearing gloves To prevent the risk of HIV transmission, standard precautions should be used. Cleaning the client's anal area without wearing gloves indicates that the nurse needs to reinstruct the caregiver in measures related to standard precautions. Handwashing before and after client care, disposing of sharps in a puncture-resistant container, and cleaning up spills with a dilute bleach solution are appropriate measures.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses, including the steps in the process of HIV entering the host cell. What would the nurse describe as the first step? A. Cleavage B. Budding c D. Uncoating

C. Attachment Once HIV enters the host cell, attachment occurs in which the glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors. This is followed by uncoating, in which HIV's viral core is emptied into the CD4+ T cell. Cleavage and budding occur as the last steps.

A client being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the best action by the nurse? A. Talk to the client about his unwillingness to eat. B. Ask the dietician to prepare the client's favorite meals. C. Ask the client's family to bring in food the client enjoys. D. Administer megestrol acetate.

D. Administer megestrol acetate. Appetite stimulants are successfully used in clients with AIDS-related anorexia. The anorexia is compounded by medications that cause nausea and vomiting. The anorexia has a physiologic cause, and this must be addressed. Bringing in favorite foods or making favorite foods may have little or no effect on the client's appetite; it is physiological rather than psychological.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? A. Anorexia B. Chronic diarrhea C. Nausea and vomiting D. Oral candida

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

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? A. Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens. B. Standard precautions should only be used with patients who are HIV positive to reduce the risk of transmission of the HIV virus. C. It is only necessary to use gloves when you are emptying reservoirs that have body fluids in them. D. If you are careful and do not expose yourself to blood or body fluids, it is not necessary to use gloves all of the time.

A. Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens. Standard precautions are designed to reduce the risk of transmission of bloodborne pathogens and of pathogens from moist body substances. Standard precautions are used when working with all patients in all health care settings, regardless of their diagnosis or presumed infectious status (Siegel, Rhinehart, Jackson, et al., 2007).

A nurse is preparing a presentation about human immunodeficiency virus (HIV) for a local community group. What would the nurse include in the presentation about HIV transmission? Select all that apply. A. The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. B. HIV transmission from mother-to child occurs primarily during pregnancy while the fetus is in utero. C. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. D. HIV can be found in seminal fluid, vaginal secretions, and breast milk. E. Sharing of infected equipment used to inject drugs increases the risk for infection.

A. The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. C. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. D. HIV can be found in seminal fluid, vaginal secretions, and breast milk. E. Sharing of infected equipment used to inject drugs increases the risk for infection. HIV-1 is transmitted in body fluids that contain free virions and infected CD+4 T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. The amount of HIV and infected cells in the body fluid is associated with the probability that the exposure will result in infection. Blood and blood products can transmit HIV to recipients; however, the risk associated with transfusions have been virtually eliminated as the result of intensive donor screening. Mother-to-child transmission may occur in utero, at the time of delivery, or through breastfeeding. Most perinatal infections are thought to occur during delivery. Sharing infected equipment during drug injections increases a person's risk for acquiring HIV.

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. A. semen B. urine C. breast milk D. blood E. vaginal secretions

A. semen C. breast milk D. blood E. vaginal secretions There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? A. "I won't go to see my sister while she has a cold." B. "I can eat whatever I want as long as it's low in fat." C. "I stopped smoking last year; this year I'll quit drinking alcohol." D. "I won't go to see my nephew right after he gets his vaccines."

B. "I can eat whatever I want as long as it's low in fat." The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

A client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate? A. If the client and her sexual partners are HIV-positive, unprotected sex is permitted. B. A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. C. Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended to prevent HIV transmission. D. The intrauterine device is recommended for a client with HIV.

B. A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. The nurse should caution the client not to have unprotected sex because continued exposure to HIV in a seropositive client may hasten the course of the disease or result in infection with another strain of HIV. Hormonal contraceptives, implants, and injections offer no protection against HIV transmission. The intrauterine device isn't recommended for a client with HIV because it may increase her susceptibility to pelvic inflammatory disease.

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 the form of the genetic viral material? A. Deoxyribonucleic acid (DNA) B. Ribonucleic acid (RNA) C. Viral core D. Glycoprotein envelope

B. Ribonucleic acid (RNA) HIV is a retrovirus that carries its genetic material in the form of RNA rather than DNA. HIV consists of a viral core containing the viral RNA, surrounded by an envelope consisting of protruding glycoproteins.

A nurse is working in a health clinic at a retirement community. What is the nurse's primary rationale for recommending HIV testing for older adults? A. Older adults, who are sexually active don't use condoms. B. Older gay men, feeling less inhibited by social mores, tend to have multiple sex partners. C. Age-related immune system changes increase the risks of infections for older adults. D. Older adults may have received HIV-infected blood transfusions before 1985.

C. Age-related immune system changes increase the risks of infections for older adults. Normal aging decreases the immune system's response to infection and puts the older adult at greater risk for HIV. Since 2006, more than 10% of new HIV cases occurred in those older than 50. Choices A and B are assumptions; choice D would only be relevant for those who did receive a blood transfusion. The rationale would not be generalized for all adults over age 55.

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? A. Deficient knowledge related to the effects of the disease B. Risk for infection related to the immune system dysfunction C. Disturbed body image related to loss of fat in the face and arms D. Risk for impaired liver function related to drug therapy effects

C. Disturbed body image related to loss of fat in the face and arms The client is experiencing lipoatrophy, which results in a localized loss of subcutaneous fat in the face (manifested as sinking of the cheeks, eyes, and temples), arms, legs, and buttocks. These changes as well as his statement about the side effects of the drug being worse than the disease indicate that he is concerned about how he appears to others. Therefore, the nursing diagnosis of disturbed body image would be the priority. Deficient knowledge, risk for infection, and risk for impaired liver function may be applicable; however, they are not concerns at this time.

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? A. Test for HIV without informing the patient. B. Test for HIV, requiring the patient to sign a permit. C. Inform the patient that it would be beneficial to test for HIV. D. Administer treatment for the STI and discharge the patient.

C. Inform the patient that it would be beneficial to test for HIV. HIV screening is recommended for all persons who seek evaluation and treatment for STIs. HIV testing must be voluntary and free of coercion. Patients must not be tested without their knowledge. HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health care settings. Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient.

An adolescent client tells the nurse during a clinic visit that they are sexually active and concerned about prevention of HIV. Which would be the best response by the nurse? Select all that apply. A. "There's no way to be sure you won't get HIV except to use condoms." B. "Only the correct use of a female condom protects against the transmission of HIV." C. "There are new ways of protecting yourself from HIV that are being discovered every day." D. "Abstinence is the most effective means of preventing HIV." E. "Consistent and correct use of condoms will help minimize the risk of contracting HIV."

D. "Abstinence is the most effective means of preventing HIV." E. "Consistent and correct use of condoms will help minimize the risk of contracting HIV." Abstinence is the most effective method of preventing sexual transmission of HIV. After abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of transmission. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.