Immunity 3 - HIV
A woman infected with human immunodeficiency virus (HIV) delivers a baby with congenital anomalies. The patient was put on Atripla (tenofovir DF+emtricitabine+efavirenz) during pregnancy to control her infection. The nurse recognizes that what is the probable cause for the fetal malformations? 1 Adverse effects of efavirenz 2 Adverse effects of tenofovir DF 3 Adverse effects of emtricitabine 4 Immune deficiency due to HIV
1 The use of efavirenz in large doses in pregnant women may cause fetal anomalies. Tenofovir and emtricitabine are usually not associated with fetal malformations. Tenofovir and emtricitabine are used for preexposure prophylaxis. Immune deficiency due to HIV rarely causes fetal malformation. Text Reference - p. 238
A nurse is counseling a patient diagnosed with human immunodeficiency virus (HIV). The nurse understands that patients with HIV need vaccines to protect them from other infectious diseases. Which vaccines should the nurse advise the patient to take to comply with the recommended immunization schedule for a patient with HIV? Select all that apply. 1 Tetanus 2 Hepatitis B 3 Influenza 4 Pneumococcal vaccines 5 Measles-mumps-rubella (MMR) 6 Hepatitis C
1, 2, 3, 4 Patients with HIV should receive vaccination to avoid contracting other infectious diseases. They should get vaccinated against tetanus, influenza, hepatitis B, and pneumococcal infection. Vaccines with live pathogens such as MMR should be avoided, because these are contraindicated in people with a compromised immune system. Currently, there is no vaccine for preventing hepatitis C. Text Reference - p. 238
A patient has human immunodeficiency virus (HIV) infection and wants to know about the measures which can help delay the progression of HIV disease. What should the attending nurse tell the patient? Select all that apply. 1 Encourage adequate rest. 2 Encourage a nutritious diet. 3 Inform the patient not to exercise. 4 Encourage adherence to the vaccination schedule. 5 Inform the patient that taking antiretroviral therapy (ART) alone is sufficient.
1, 2, 4 Useful interventions for HIV-infected patients that help delay the progression of disease include adequate rest, getting nutritional support, and keeping up to date with recommended vaccines. Exercising should be encouraged based on tolerance. Taking ART alone may not be sufficient, and treatment for other opportunistic infections may be required. HIV disease progression may be delayed by promoting a healthy immune system whether the patient chooses to use ART or not. Text Reference - p. 242
During a follow-up appointment, the patient was notified by the health care provider that he or she has human immunodeficiency virus (HIV). The patient is extremely upset and does not understand how he or she could have gotten HIV. The nurse explains to the patient that HIV can be transmitted via which of the following? Select all that apply. 1 Blood 2 Emesis 3 Breast milk 4 Sharing utensils 5 Sexual intercourse
1, 3, 5 HIV can be transmitted as a result of contact with infected blood, semen, vaginal secretions, or breast milk. Therefore, it occurs through sexual intercourse, exposure to blood or blood products, and during pregnancy, delivery, or breastfeeding. HIV is not spread casually. Therefore, it cannot be spread just by sharing utensils or through emesis, as well as sweat, tears, saliva, or insect bites. Text Reference - p. 231
A patient with AIDS has been put on antiretroviral therapy and has been taking the medications for four weeks. During the one-month follow-up visit, what findings will help the nurse identify whether the patient is responding to the treatment? Select all that apply. 1 80% drop in viral load 2 90% drop in viral load 3 CD4 T cell count above 14% 4 CD4 T cell count above 400 cells /µL 5 3-unit drop in viral load on a log scale
2, 3, 5 Lab findings may help assess the response of the patient to treatment. A 90% or more drop in viral load and CD4 T cell count above 14% indicate good response to treatment. A 3-unit drop in viral load, which corresponds to a 99% reduction in viral load, also indicates that the patient is responding well to the treatment. A drop in viral load of less than 90% does not indicate a significant response to antiretroviral therapy after four of therapy. A CD4 T cell count above 500 to 600 cells/µL is considered a favorable response to antiretroviral therapy. Text Reference - p. 241
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? 1 A new onset of polycythemia 2 Presence of mononucleosis-like symptoms 3 A sharp decrease in the patient's CD4+ count 4 A sudden increase in the patient's white blood cell (WBC) count
3 A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. Mononucleosis-like symptoms, such as malaise, headache, and fatigue, are typical of early HIV infection and seroconversion. A patient's WBC count is very unlikely to increase suddenly, with decreases being typical. Text Reference - p. 234
A woman who is three months pregnant finds out that she is human immunodeficiency virus (HIV)-positive on routine HIV testing. She wishes to continue her pregnancy. What information should be given to this patient? Select all that apply. 1 Inform her that the infant will not be infected. 2 Advise her to consider abortion. 3 Advise her to consider tubectomy after delivery. 4 Advise her that antiretroviral therapy (ART) can decrease the risk of transmission. 5 Advise her to follow a healthy lifestyle with nutritious food and regular exercise.
3, 4, 5
A woman who is three months pregnant finds out that she is human immunodeficiency virus (HIV)-positive on routine HIV testing. She wishes to continue her pregnancy. What information should be given to this patient? Select all that apply. 1 Inform her that the infant will not be infected. 2 Advise her to consider abortion. 3 Advise her to consider tubectomy after delivery. 4 Advise her that antiretroviral therapy (ART) can decrease the risk of transmission. 5 Advise her to follow a healthy lifestyle with nutritious food and regular exercise.
3, 4, 5 Women who are already infected with HIV should be asked about their reproductive desires. Those who choose not to have children should undergo family planning methods like tubectomy. The current standard of care is for all women who are pregnant or contemplating pregnancy to be counseled about HIV, routinely offered access to voluntary HIV-antibody testing, and, if infected, offered optimal ART. In this case, the possibility of maintaining the pregnancy and using ART to decrease the risk of transmission should be discussed. Abortion is not mandatory in such cases. If HIV-infected pregnant women are appropriately treated during pregnancy, the rate of perinatal transmission can be decreased from 25% to less than 2%, but it cannot be guaranteed that the infant will not be infected. The patient should eat a healthy and nutritious diet and do regular exercise to remain active and delay the progression of disease. Text Reference - p. 240
A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? 1 Shaking hands 2 Sharing a toilet seat 3 Eating from the same utensils 4 Having unprotected sex
4 AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes. Text Reference - p. 231
A patient receiving long-term antiretroviral therapy (ART) for HIV has developed lipodystrophy, hyperlipidemia, insulin resistance, and bone disease. Which should be the first intervention? 1 Suggest dietary changes to lower lipid levels. 2 Promote weight loss through exercise. 3 Advocate use of calcium supplements. 4 Change antiretroviral medications.
4 Long-term therapy with antiretroviral drugs may lead to development of certain metabolic disorders, including lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, renal disease, and cardiovascular disease. Therefore, the first intervention should be to change the antiretroviral drug and start medications that have fewer side effects. Other interventions like dietary changes, weight loss through exercise, and taking calcium supplements are general measures and may not contribute directly to the reduction of side effects.
The nurse assesses a patient who tests positive for HIV. Which finding would the nurse identify as the highest priority for follow-up? 1 Anorexia 2 Insomnia 3 Mood swings 4 Nonproductive cough
4 The patient who tests positive for HIV should be observed for the first sign of Pneumocystis jiroveci pneumonia, which is a dry, nonproductive cough. After evaluation of the nonproductive cough, follow-up care for anorexia, insomnia, and mood swings is secondary. Text Reference - p. 236
The nurse should assess a patient with acquired immunodeficiency syndrome (AIDS) for which most common symptoms? 1 Tremors and bradykinesia 2 Hematuria and abdominal pain 3 Persistent vomiting and headache 4 Low-grade fever and persistent diarrhea
4 The symptoms of acquired immunodeficiency syndrome (AIDS) are variable, but low-grade fever and persistent diarrhea are common. The symptoms listed in the other answer options are not specifically associated with AIDS. Text Reference - p. 235
A human immunodeficiency virus (HIV)-infected patient tells the nurse that he or she is worried that he or she might have acquired immunodeficiency syndrome (AIDS). When is a diagnosis of AIDS in an HIV-infected patient confirmed? 1 The patient's CD4+ T cell count is below 200/μL. 2 The patient has flu-like symptoms. 3 Lipodystrophy with metabolic abnormalities is present. 4 Elevated platelet and white blood cell (WBC) counts are present.
1 AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/μL. Flu-like symptoms can be indicative of other diseases. Changes in WBC or platelet counts are not diagnostic criteria for AIDS (and WBC and platelet levels decrease, not increase). Changes in body shape because of lipodystrophy are not definitive diagnoses for AIDS. Text Reference - p. 235
When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? 1 "I will need to isolate any tissues I use so as not to infect my family." 2 "I will notify all of my sexual partners so they can get tested for HIV." 3 "Unprotected sexual contact is the most common mode of transmission." 4 "I do not need to worry about spreading this virus to others by sweating at the gym."
1 HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching.
During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidiodes immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans
1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus, and the presence of thrush indicate Candida albicans. Infection by Coccidiodes immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans. Text Reference - p. 236
A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: 1 Hyperthermia 2 Social isolation 3 Impaired memory 4 Sexual dysfunction
1 Temperature increase is the highest priority for the nurse because Pneumocystis jiroveci pneumonia (PCP) is an indication of AIDS (acquired immunodeficiency syndrome). Early detection and treatment of PCP is directly related to a positive outcome. Temperature increase in an immunosuppressed patient is always a concern. Social isolation is a secondary risk of all persons who test positive for human immunodeficiency virus (HIV). Impaired memory and sexual dysfunction may develop as complications in patients with HIV disease, but these issues are not always present. Text Reference - p. 236
A human immunodeficiency virus (HIV) patient on antiretroviral therapy comes into the clinic complaining that he or she is starting to feel like he or she did before starting the therapy. What should the nurse plan for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test
1 The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection. Text Reference - p. 235
The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities
1 These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities. Text Reference - p. 242
In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? Select all that apply. 1 T lymphocytes 2 B lymphocytes 3 Platelets 4 Immunoglobulins 5 Red blood cells
1, 2 In the early stages of HIV infection, B cells and T cells protect the body from infections. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T-cells. Platelets do not take part in providing immunity to the human body. They are required for clotting mechanism. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 233
The nurse is discussing human immunodeficiency virus (HIV) infection with a patient and his or her family. Which statements accurately describe HIV infection? Select all that apply. 1 Untreated HIV infection has a predictable pattern of progression. 2 Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). 3 Untreated HIV infection usually remains in the early chronic stage for one year or less. 4 The interval between untreated HIV infection and a diagnosis of AIDS is about five years. 5 Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection.
1, 2, 5 The typical course of untreated HIV infection follows a predictable pattern. Late chronic HIV infection is known as AIDS. The most common infection associated with the symptomatic phase of HIV infection is oropharyngeal candidiasis. The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years. Untreated HIV infection usually remains in the early chronic stage for about eight years. Text Reference - p. 233
One month after delivering a baby, a mother was infected with human immunodeficiency virus (HIV) due to intercourse with a stranger. She came to the hospital to seek medical advice and HIV testing. Enzyme immunoassay (EIA) and Western blot tests revealed that she was HIV-positive. What should be advised to the mother? Select all that apply. 1 Avoid breastfeeding. 2 Extract breast milk with a breast pump. 3 Have the baby immunized. 4 Get Bacille Calmette Guerin (BCG) vaccination (mother). 5 Baby will need antiretroviral drugs.
1, 3 Perinatal transmission from an HIV-infected mother to her infant can occur during pregnancy, delivery, or breastfeeding. In this case, the baby was born to a healthy mother, and, therefore, there are chances of baby getting infected through breast milk. Hence, breast milk should be avoided in this case. The baby needs regular immunization to protect against other infectious diseases. The baby does not need any antiretroviral drugs, because the mother got HIV infection after delivering the baby. Breast milk, even after extracting through a breast pump, should not be fed to the baby, because it can spread infection. The mother needs vaccines, but not live vaccines like BCG or measles-mumps-rubella (MMR). BCG and MMR should be avoided in people with HIV infection, because these patients have a compromised immune system. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. Text Reference - p. 231
A homosexual who was diagnosed with acquired immunodeficiency syndrome (AIDS) has come to a nurse to find out which tests would determine the prognosis of the syndrome. What should the nurse provide? Select all that apply. 1 Prognosis can be assessed by viral load. 2 Prognosis can be assessed by red blood cell count. 3 Prognosis can be assessed by CD4+ T-cell count. 4 Prognosis can be assessed by testing for hepatitis B virus (HBV) or hepatitis C virus (HCV). 5 Prognosis can be assessed by immunoglobulin M (IgM) antibody levels
1, 3 The progression of HIV infection is monitored by two important laboratory assessments: CD4+ T-cell counts and viral load. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4+ T-cell count is done to monitor the progression of HIV infection and response to treatment. The normal range for CD4+ T cells is 800 to 1200 cells/μL. The red blood cell count indicates presence or absence of anemia. The tests for HBV and HCV indicate the infection with respective hepatitis virus. IgM antibody levels are nonspecific and do not indicate the progress of AIDS. Text Reference - p. 233
As part of an awareness program for high school students on acquired immunodeficiency syndrome (AIDS), a public nurse is giving information about routes of transmission. What information should the nurse provide to students regarding the routes of transmission? Select all that apply. 1 A person can be infected by having intercourse with one stable partner. 2 A person can be infected by donating a pint of whole blood. 3 A person can be infected even if a condom is used each time there is sexual intercourse. 4 A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies. 5 A person can get infected while hugging or shaking hands with a person infected with HIV.
1, 3, 4 The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. Equipment used in donation is disposable, and the donor does not come into contact with anyone else's blood. Hence, transmission cannot occur by donating blood. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 231
A patient with acquired immunodeficiency syndrome (AIDS) has come to the hospital without any improvement in condition in spite of antiretroviral therapy. On assessment, the nurse learns that the patient was noncompliant with the therapy. What are the next appropriate nursing actions? Select all that apply. 1 Assess the need for a change in the medication regimen. 2 Avoid discussing the patient's status with other people. 3 Instruct the patient to avoid adjusting dosages, even if the medications interfere with the patient's work schedule. 4 Determine if the patient experienced any adverse effects of the medications. 5 Determine whether the patient understands the need for treatment compliance.
1, 4, 5 Noncompliance to the treatment regimen is common in patients with HIV; therefore, the nurse should evaluate the factors that may lead to the noncompliance. If the noncompliance is caused by side effects, the side effects should be treated or the regimen should be changed. The nurse should determine if the patient experienced any adverse effects to the drugs. Sometimes patients will not comprehend the need for compliance to the antiretroviral therapy. Therefore, the nurse should educate the patient about the importance of compliance. The nurse should engage the patient's family and friends when teaching about the medications and the need for compliance. Sometimes compliance can be improved if the patient adjusts the medication according to a work schedule. Text Reference - p. 242
A human immunodeficiency virus (HIV) patient recently is started on antiretroviral therapy, but does not fully understand the purpose of the medication. The nurse would explain to the patient that the goals of the antiretroviral therapy are which of the following? Select all that apply. 1 To decrease the viral load 2 To cure the HIV disease 3 To stop the HIV disease from progressing 4 To prevent transmission of the HIV disease 5 To maintain or increase the CD4 cell counts 6 To prevent HIV-related opportunistic infections
1, 4, 5, 6 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or increase CD4 T cell counts, prevent HIV-related symptoms and opportunistic infections, delay disease progression, and prevent HIV transmission. Curing the HIV disease is incorrect, because there is currently no cure for the HIV disease. Stopping the HIV disease from progressing is incorrect, because it cannot stop the progression of the HIV disease, but only delay the HIV disease progression. Text Reference - p. 237
A patient is enzyme immunoassay (EIA)-antibody negative for HIV. The patient informs the nurse about recent sexual contact with multiple partners. What is the most appropriate nursing action? 1 Reassure the patient that HIV infection is unlikely. 2 Suggest HIV retesting at three weeks, six weeks, and three months. 3 Advise a more specific test, such as the Western blot. 4 Suggest getting a genotype and phenotype assay done.
2 If the patient is EIA-antibody negative for HIV and has a history of risky behavior, such as sexual contact with multiple partners, the nurse should advise the patient to get retested at three weeks, six weeks, and three months. In the initial stages of infection, the viral antibody may not be detectable; therefore repeated testing may be required. The nurse should inform the patient that absence of antibody does not indicate absence of HIV infection, and to confirm, further testing may be required. If the repeated tests are positive, then a more specific and confirmatory test like Western blot may be done. Genotype and phenotype assays are done not to detect presence of infection, but to determine whether a patient's HIV is resistant to drugs used for antiretroviral therapy. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 236
The nurse understands that a patient with human immunodeficiency virus (HIV) starts to develop immune problems when his or her CD4 count: 1 drops below 200 2 drops below 500 3 is greater than 500 4 falls to between 800 to 1200
2 Immune problems start to occur when the count drops below 500 CD4 T cells. When it drops below 200 CD4 T cells, severe immune problems will develop and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 to 1200 CD4 T cells is normal for adults who do not have any immune dysfunction. Text Reference - p. 233
The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? 1 Personal protective equipment 2 Combination antiretroviral therapy 3 Counseling to report blood exposures 4 A negative evaluation by the manager
2 Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first. Text Reference - p. 240
A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the nurse reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."
2 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4+ T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle. Text Reference - p. 237
A 25-year-old male patient has been diagnosed with human immunodeficiency virus (HIV). The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs
2 The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs. Text Reference - p. 236
A patient was given 500 mL of O-negative blood after proper cross-matching. Later, it was found that the blood donor was human immunodeficiency virus-(HIV) positive. After two weeks, the patient complained of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and diffuse rash. What could be the possible reason for these symptoms? Select all that apply. 1 Flu 2 Seroconversion 3 Mononucleosis 4 Acute HIV infection 5 Guillain-Barré syndrome
2, 4 In this case, the patient would have acquired HIV infection from the donor. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompanies seroconversion (when HIV-specific antibodies develop). These symptoms, called acute HIV infection, generally occur within two to four weeks after the initial infection and last for one to three weeks, although some symptoms may persist for several months. Many people, including health care providers, mistake acute HIV symptoms for a bad case of the flu. Some people also develop neurologic complications, such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome. This patient has not yet developed neurologic symptoms. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 234
A patient is admitted to the emergency department with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations? Select all that apply. 1 Assessment of lung sounds 2 Assessment of sexual behavior 3 Assessment of living conditions 4 Assessment of drug and syringe use 5 Assessment of exposure to an ill person
2, 4 With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the human immunodeficiency virus (HIV) should be made or if the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for tuberculosis). The symptoms listed are not indicative of the person being around an acutely ill individual.
A nurse is asked to teach a human immunodeficiency virus (HIV)-positive patient about the measures to be taken to prevent resistance to antibiotics and infections. What information should the nurse give? Select all that apply. 1 Advise patient to only take antibiotics until the patient feels better. 2 Advise patient to avoid requesting an antibiotic for flu or colds. 3 Advise patient to save unfinished antibiotics for later use. 4 Advise patient to wash hands properly and regularly. 5 Advise patient to avoid skipping antibiotic doses.
2, 4, 5 Antibiotics are effective against bacterial infections but not viruses, which cause colds and flu. Therefore, antibiotics should not be requested for flu or colds. Hand washing is the single most important thing to do to prevent infection. The patient should not skip antibiotic doses, because doing so can lead to development of resistance. A person should never stop taking antibiotics when feeling better. If an antibiotic is stopped early, the hardiest bacteria survive and multiply. Eventually, the patient could develop an infection resistant to many antibiotics. It is also important to never have leftover antibiotics. Text Reference - p. 230
A patient with HIV infection has been diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse be watchful for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex
2, 4, 5 Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS, because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with HIV due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence. Text Reference - p. 235
A nurse is caring for a patient diagnosed with acquired immunodeficiency syndrome (AIDS) who wants to know about the opportunistic carcinomas that are included in the diagnostic criteria of AIDS. Which opportunistic cancers should the nurse discuss with the patient? Select all that apply. 1 Melanoma 2 Kaposi sarcoma 3 Hodgkin's lymphoma 4 Burkitt's lymphoma 5 Invasive cervical cancer
2, 4, 5 Opportunistic cancers are cancers that develop due to a dysfunctional immune system and are otherwise not found in healthy people. The opportunistic cancers in AIDS patients are invasive cervical cancer, Kaposi sarcoma (KS), Burkitt's lymphoma, immunoblastic lymphoma, and primary lymphoma of the brain. Kaposi sarcoma is caused by human herpesvirus 8. Burkitt's lymphoma is cancer of the lymphatic system. Melanoma is a skin cancer not associated with AIDS. Hodgkin's lymphoma represents one of the most common non-AIDS-defining cancers with an increasing incidence. Text Reference - p. 235
The nurse assesses a patient with recently diagnosed human immunodeficiency virus disease who has been admitted to the hospital with a new diagnosis of acquired immunodeficiency syndrome (AIDS). What assessment finding is most diagnostic of AIDS? 1 Sleeping six to eight hours per night 2 Feelings of fatigue in the evening 3 Steady weight loss over the past several months 4 Feelings of profound helplessness and hopelessness
3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss. Text Reference - p. 234
A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false-negative report. 3 The test should be repeated at three weeks, six weeks, and three months. 4 The patient is HIV positive, but the viral load is not detectable.
3 An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at three weeks, six weeks, and three months. The test is unlikely to give a false-negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he or she is HIV positive.
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1 "The baby probably will be infected with HIV." 2 "Only an abortion will keep your baby from having HIV." 3 "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4 "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
3 On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism are two variables that influence whether transmission of HIV occurs. Volume, virulence, and concentration of the organism, as well as host immune status, are variables related to transmission via blood, semen, vaginal secretions, or breast milk. Text Reference - p. 240
The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching? 1 "I can't contract HIV unless there's an opportunistic infection present." 2 "Using a condom with a spermicide will give 100% protection from HIV." 3 "Using a condom with a spermicide will reduce my risk of contracting HIV." 4 "Kaposi sarcoma is one of the first opportunistic infections to show up in someone with HIV."
3 Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse. An opportunistic infection does not have to be present, a condom with spermicide does not provide 100% protection, and Kapos sarcoma is not one of the first opportunistic infections to appear in someone infected with HIV. Text Reference - p. 240
The nurse is assessing a human immunodeficiency virus (HIV)-nfected patient who has been on antiretroviral therapy (ART) for eight months. Which statement about metabolic side effects of ART is true? Select all that apply. 1 Glucose levels often decrease because of insulin resistance. 2 These are a bothersome set of symptoms that are ultimately harmless. 3 ART-related body changes include central fat accumulation and peripheral wasting. 4 Lipid abnormalities include elevated triglyceride levels and decreases in high-density lipoproteins. 5 Bone disease may be improved with exercise, dietary changes, and calcium and vitamin D supplements
3, 4, 5 Some HIV-infected patients, especially those who have been infected and on ART for a long time, develop a set of metabolic disorders that include changes in body shape (i.e., fat deposits in the abdomen, upper back, and breasts, along with fat loss in the arms, legs, and face) caused by lipodystrophy, hyperlipidemia (i.e., elevated triglycerides and decreases in high-density lipoproteins), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease. These disorders are treated early to prevent complications. It is important to recognize and treat these problems early, especially because cardiovascular disease and lactic acidosis are potentially fatal complications. Text Reference - p. 23
A woman is afraid she may get human immunodeficiency virus (HIV) from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis? Select all that apply. 1 Take fluconazole 2 Take amphotericin B 3 Use condoms for risk-reducing sexual relations 4 Take emtricitabine and tenofovir regularly 5 Have regular HIV testing for herself and her husband
3, 4, 5 Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly have been shown to decrease the infection rate of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associated with HIV infection. Text Reference - p. 237
When reviewing the assessment data of a human immunodeficiency virus (HIV) patient, the nurse notes that the patient's CD4 cell count is below 200, and that the patient has lost more than 10% of his or her ideal body weight. The nurse suspects that the patient is experiencing: 1 Kaposi sarcoma 2 Cytomegalovirus (CMV) 3 Pneumocystis jiroveci pneumonia (PCP) 4 Acquired immunodeficiency syndrome (AIDS
4 A patient with HIV is diagnosed with AIDS when the CD4 T cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS. Text Reference - p. 235
A human immunodeficiency virus (HIV) patient comes into the clinic for a follow-up appointment with a temperature of 102o F. Which statement would the nurse report immediately? 1 "I woke up this morning with a mild headache." 2 "I vomited once this morning." 3 "I started coughing up some clear mucous when I woke up this morning." 4 "I have a rash that appeared on my stomach this morning."
4 Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 242
The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? 1 "I need to keep my appointments for follow-up laboratory work." 2 "I will call my health care provider if I am too sick to take these drugs." 3 "I won't take any new drugs or herbal products without checking with my health care provider first." 4 "Once my tests show that the virus has decreased, I cannot give HIV to another person."
4 Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first. Text Reference - p. 235 Topics
A patient has an undetectable level of plasma human immunodeficiency virus (HIV) RNA after six months of antiretroviral therapy. The patient exclaims, "I'm so glad to be cured!" Which response by the nurse is most therapeutic and accurate? 1 "Oh,that is wonderful. I'm glad everything worked out so well for you." 2 "No, you're wrong. You're never going to be cured—this is a lifelong illness." 3 "You should be very pleased, and I think you should celebrate the good news." 4 "An undetectable level means that your therapy was successful but not that you were cured."
4 Human immunodeficiency virus antiretroviral therapy can reduce viral load, resulting in an undetectable serum level. This does not indicate a cure; rather, it indicates that the therapy is working and that the patient must continue to take the medication. Congratulating the patient, or telling him or her to celebrate, is inaccurate and incorrect; telling the patient that he or she is wrong and will never be cured is nontherapeutic. Text Reference - p. 243
