medsurg 3: exam 3 (HIV)
A person with HIV could be asymptomatic for ___ years
8
What is the normal range of CD4 cells in the body?
800-1200
When should therapy be started for HIV considering the CD4 cell level?
< 500 cells
What is the CD4 cell level in the body when someone develops AIDS?
<200
What category do Acyclovir and Ganciclovir fall under?
antiviral medications
Why should anti-viral therapy not be started until CD4 is trending down?
because if it is given too early, it could create a supervirus or immunity to the anti-virals
Why is HIV uncurable?
because it makes its own DNA
Why is HIV considered to be a retrovirus?
because it replicates backwards
What effect on cervical cancers does HIV have?
causes cervical cancers to be 10 times more likely
HIV infection in the brain cells can cause what?
encephalopathy
____ involves using three to four HIV medications in combination with other antiretroviral medications to reduce medication resistance, adverse effects, and dosages. -This is an aggressive treatment method using three or more different medications to reduce the amount of virus and increase CD4 cell count
highly active antiretroviral therapy (HAART)
HIV is an _____
immunodeficiency
As a nurse what is a priority with HIV patients?
interprofessional care
____ condoms are the only ones that prevent transmisson
latex
What plays a major role in determining the type of treatment that a patient receives for HIV?
liver functioning/damage
an infection that causes disease when the immune system is compromised for other reasons
opportunistic infection
A method of producing thousands of copies of DNA segment using the enzyme DNA polymerase
polymerase chain reaction (PCR)
What condoms can be used if a patient is allergic to latex and trying to prevent HIV transmission?
polyurethane
What is the major symptom associated with cytomegalovirus?
retinitis
The window period occurs before what?
seroconversion
When HIV antibodies start developing
seroconversion
How long is a CD4 cells life? What does HIV do to it?
-100 days normally; -HIV makes the cell life about 2 days
____ in ____ people are unaware that they carry HIV
1 in 8
What are the two main antiviral medications?
1. acyclovir (oral, topical, IV) 2. ganciclovir (oral, IV)
What are the main medications for antiretrovirals: NNRTIs?
1. delavirdine 2. Efavirenz (both oral) others: nevirapine, etravirine, and rilpivirine
Medication complications: -rash (stevens-johnsons syndrome possible) -flu-like manifestations, headache, fatigue -CNS manifestations (dizziness, drowsiness, insomnia, nightmares (especially with efavirenz) -nausea/diarrhea
1. delavirdine 2. Efavirenz NNRTI's
Medications: NNRTIs act directly on reverse transcriptase to stop HIV replication
1. delavirdine 2. Efavirenz NNRTI's
What are the types of HIV?
1. primary 2. secondary
If HIV is untreated, how long until it develops into AIDS?
10 years
What is a normal pre-albumin level?
15-36 mg/dL
What is a normal platelet count?
150,000-400,000/mm3
During the event of an accidental needle stick, prophylaxis medications should be started within ____ hours after exposure. Post-exposure prophylaxis must be initiated within ____ hours of exposure to be effective.
2 72 *monitor for toxicity *practice safer sex *continue medications for 4 weeks *testing at 1 month, 3 months, and 6 months
____% of babies are HIV positive when a HIV positive mother goes untreated while pregnant
25%
What is a normal albumin level?
3.5-5 g/dL
How long is the window period with HIV?
4 weeks
What is the normal range for WBC?
4,500-10,500
Without treatment, AIDS can cause death within ____
5 years
A nurse is caring for a client who is suspected of having HIV. The nurse should identify that which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (select all that apply) A. Western blot B. indirect immunofluorescence assay C. CD4 and T-lymphocyte count D. HIV RNA quantification test E. cerebrospinal fluid (CSF) analysis
A. Western blot B. indirect immunofluorescence assay
The nurse is caring for a patient who is receiving antiretroviaral therapy (ART) for treatment of AIDS. Which assessment best indicates that the patient's condition is improving? A. decreased viral load B. increased drug resistance C. decreased CD4 and T-cell count D. increased aminotransferase levels
A. decreased viral load
A nurse is caring for a client who takes several antiretroviral medications, including the NRTI zidovudine, to treat HIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? (select all that apply) A. fatigue B. blurred vision C. ataxia D. hyperventilation E. vomiting
A. fatigue D. hyperventilation E. vomiting
A nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. The client reports having a cough along with nausea and diarrhea. The client is concerned about the possibility of having HIV. Which of the following actions should the nurse take? (Select all that apply) A. perform a physical assessment B. determine when manifestations began C. teach the client about HIV transmission D. draw blood for HIV testing E. obtain a sexual history
A. perform a physical assessment B. determine when manifestations began E. obtain a sexual history
A nurse is assessing a client for HIV. The nurse should identify that which of the following are risk factors associated with this virus? (select all that apply) A. perinatal exposure B. pregnancy C. monogamous sex partner D. older adult women E. occupational exposure
A. perinatal exposure D. older adult women E. occupational exposure
A 12-month-old child just received the first measles, mumps, and rubella (MMR) vaccine. For which of the following findings should the nurse instruct the family to monitor for as adverse effects of the MMR vaccine? (select all that apply) A. rash B. swollen glands C. bruising D. headache E. inconsolable crying
A. rash B. swollen glands C. bruising
The CDC classifies HIV into what three categories?
A: asymptomatic B: symptomatic C: AIDS
This stage is characterized by life-threatening opportunistic infections
AIDS
All people with ___ have ____, but not all people with ____ have ___
AIDS have HIV HIV have AIDS
Test: -These are markers found on lymphocytes, HIV kills CD4 cells, which results in a significantly impaired immune system. Used in decision to initiate ART and use of prophylactic medications
CD4/CD8 ratio
Medication complications: -phlebitis and inflammation at the site of infusion -nephrotoxicity -mild discomfort associated with oral therapy (N/headache/diarrhea)
Acyclovir antiviral medications
Medication: prevents the reproduction of viral DNA and thus interrupts cell replication
Acyclovir and ganciclovir antiviral medications
Where did HIV come from?
African man got it from animals in 1959
absence of the normal immune response to a particular antigen or allergen
Anergy
Pseudomembranous colitis is what?
Clostridium difficile
Symptoms: <200 CD4 cells, malignancies, wasting, HIV-related and cognitive changes. These could indicate what?
Any one symptom could indicate the bridge from HIV to AIDS in a patient
Primary HIV involves ____
B-lymphocytes
A nurse is caring for several clients who came to the clinic for a seasonal influenza immunization. The nurse should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection? A. 1-year-old who has no health problems B. 17-year-old who has a hypersensitivity to penicillin C. 25-year-old who is pregnant D. 52-year-old who takes a multivitamin supplement
B. 17-year-old who has a hypersensitivity to penicillin
A nurse at a provider's office is preparing to administer RV, DTaP, Hib, PCV13, and IPV immunizations to a 4-month-old infant. Which of the following actions should the nurse plan to take? (select all that apply) A. administer IPV orally B. administer subcutaneous injections in the anterolateral thigh C. administer IM injections in the deltoid muscle D. give the infant a pacifier during vaccine injections E. teach caregivers to give aspirin on a schedule for 24 hours after immunization
B. administer subcutaneous injections in the anterolateral thigh D. give the infant a pacifier during vaccine injections
The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is: A. antibiotics should have been used to prevent pneumonia B. all of the supplied antibiotics should be taken even when symptoms have resolved C. enough antibiotics for 2 days' treatment should be reserved in case symptoms recur D. patients should request antibiotics for upper respiratory infections to prevent development of streptococcal-related diseases
B. all of the supplied antibiotics should be taken even when symptoms have resolved
A nurse is reviewing strategies to promote comfort with a client who received an immunization. Which of the following information should the nurse include? (select all that apply) A. massage the injection site B. apply a cool compress to the injection site C. take acetaminophen or ibuprofen D. use the affected extremity E. apply an antimicrobial ointment to the injection site
B. apply a cool compress to the injection site C. take acetaminophen or ibuprofen D. use the affected extremity
A nurse is preparing to administer a scratch test to a client who has possible food and environmental allergies. which of the following actions should the nurse perform prior to the procedure? (Select all that apply) A. cleanse the skin with povidone-iodine B. ask the client about previous reactions to allergens C. ask the client about medications taken over the past several days D. inform the client to expect itching at one site E. obtain emergency resuscitation equipment
B. ask the client about previous reactions to allergens C. ask the client about medications taken over the past several days E. obtain emergency resuscitation equipment
A nurse is caring for a client who has a WBC count of 20,000/mm3. The nurse should conclude that the client has which of the following? A. neutropenia B. leukocytosis C. left shift D. leukopenia
B. leukocytosis
A nurse is preparing to document administration of a meningococcal vaccine to a client. Which of the following information should the nurse include in the documentation? (select all that apply) A. age of client receiving the vaccine B. name of vaccine manufacturer C. vaccine expiration date D. date of administration E. serial number of the vaccine
B. name of vaccine manufacturer C. vaccine expiration date D. date of administration
A nurse is caring for a client who has a new prescription for enfuvirtide to treat HIV infection. The nurse should monitor the client for which of the following adverse reactions of this medication? (select all that apply.) A. bleeding B. pneumonia C. cerebral edema D. localized erythema E. hypotension
B. pneumonia D. localized erythema E. hypotension
Why do gerontologic patients have a higher rate of HIV? (18%)
Because they see condoms as birth control rather than STD prevention. They also are at the age where they may be widowed, divorced, etc.
A nurse is preparing to administer a varicella immunization to a client. Which of the following questions by the nurse is appropriate? A. "Are you allergic to eggs?" B. "Are you allergic to baker's yeast?" C. "Are you pregnant?" D. "Do you have a history of Guillian Barre syndrome?"
C. "Are you pregnant?"
A nurse is teaching a client who has a new prescription for combination oral NRTIs (abacavir, lamivudine, and dolutegravir) for treatment of HIV. Which of the following statements should the nurse include? A. "These medications work by blocking HIV entry into cells." B. "These medications work by weakening the cell wall of the HIV virus." C. "These medications work by inhibiting enzymes to prevent HIV replication." D. "These medications work by preventing protein synthesis within the HIV cell."
C. "These medications work by inhibiting enzymes to prevent HIV replication."
A nurse is preparing to administer an IM injection of immune globulin to a client who has been exposed to hepatitis A. Which of the following statements by the nurse is appropriate? A. "This medication offers permanent immunity to hepatitis A." B. "This medication involves three injections over several months." C. "This medication provides you with an immune response more quickly than your body can produce it." D. "This medication contains an attenuated virus to help your body create antibodies."
C. "This medication provides you with an immune response more quickly than your body can produce it."
A nurse is administering IV acyclovir to a client who has varicella. Which of the following actions should the nurse take? A. administer a stool softener B. decrease fluid intake following infusion C. infuse acyclovir over 1 hr. D. monitor for hypotension
C. infuse acyclovir over 1 hr.
A nurse is reviewing the laboratory findings of a client who has measles. The nurse should expect to find an increase in which of the following types of WBCs? A. neutrophils B. basophils C. lymphocytes D. eosinophils
C. lymphocytes
A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following information should the nurse teach the client about resistance? A. taking low dosages of antiretroviral medication minimizes resistance B. taking one antiretroviral medication at a time minimizes resistance C. taking medication at the same times daily without missing doses minimizes resistance D. changing the medication regimen when adverse effects occur minimizes resistance
C. taking medication at the same times daily without missing doses minimizes resistance
A nurse is providing teaching for a client who has stage 2 HIV disease and is having difficulty maintaining a normal weight. Which of the following statements by the client should indicate to the nurse an understanding of the teaching? A. "I will choose a diet high in fat to help gain weight." B. "I will be sure to eat three large meals daily." C. "I will drink up to 1 liter of liquid each day." D. "I will add high-protein foods to my diet."
D. "I will add high-protein foods to my diet."
A nurse is providing teaching for a client who has stage 3 HIV disease. which of the following statements by the client should indicate to the nurse an understanding of the teaching? A. "I will wear gloves while changing the pet litter box." B. "I will rinse raw fruits with water before eating them." C. "I will wear a mask when around family members who are ill." D. "I will cook vegetables before eating them."
D. "I will cook vegetables before eating them."
A nurse is teaching a newly diagnosed 34-year-old male about his HIV infection. which statement by the patient would indicate the patient needs additional education? A. "I will need to take my HIV medication daily for the rest of my life." B. "Although I only take one pill, it has multiple medications combined into a single tablet." C. "I should notify my HIV provider if I get fevers that do not go away with Tylenol or aspirin." D. "Once my viral load is undetectable I don't have to worry about taking my medication every day."
D. "Once my viral load is undetectable I don't have to worry about taking my medication every day."
A nurse in a clinic is caring for a client who is to receive an immunization. The client asks about contraindications to immunizations. Which of the following responses should the nurse make? A. "The use of insulin is a contraindication." B. "An anaphylactic reaction is a contraindication for administration of any type of immunization." C. "The common cold is a contraindication for receiving an immunization." D. "Your provider will weigh the risks if you have experienced any adverse effects."
D. "Your provider will weigh the risks if you have experienced any adverse effects."
A nurse is caring for a group of clients who are not protected against varicella. The nurse should prepare to administer the varicella vaccine at this time to which of the following clients? A. 24-year-old client in the third trimester of pregnancy B. 12-year-old child who has a severe allergy to neomycin C. 2-month-old infant who has no health problems D. 32-year-old client who has essential hypertension
D. 32-year-old client who has essential hypertension
A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this medication? A. increased TSH level B. decreased ALT level C. hypoglycemia D. hyperlipidemia
D. hyperlipidemia
A diagnosis of AIDS can be made for a patient with HIV with: A. a CD4 and T-cell count <500/uL B. a WBC count < 3000/ul (3 X 10^3/L) C. development of oral candidiasis (thrush) D. onset of Pneumocystis jiroveci pneumonia
D. onset of Pneumocystis jiroveci pneumonia
A nurse is teaching a group of new guardians about immunizations. The nurse should instruct the guardians that the series for which of the following vaccines is completed prior to the first birthday? A. pneumococcal conjugate vaccine B. meningococcal conjugate vaccine C. varicella vaccine D. roavirus vaccine
D. roavirus vaccine
Medication complications: -localized reaction at injection site -bacterial pneumonia -fever, chills, rash, hypotension
Enfuvirtide fusion/entry inhibitor
Medication: decreases and limits the spread of HIV by blocking HIV from attaching to and entering CD4 and T cells
Enfuvirtide fusion/entry inhibitor
What is the main medication for antiretrovirals: fusion/entry inhibitors?
Enfuvirtide (subcutaneous)
Test: -Antibodies are detected, resulting in positive results. May have false-negative results within the window period
Enzyme immunoassay (EIA)
Medication complications: -suppressed bone marrow -Fever, nausea, headache, diarrhea (administer with food)
Ganciclovir antiviral medications
Medication complications: -Cough and upper respiratory tract infections -CNS effects (dizziness, paresthesias, orthostatic hypotension) -Hepatotoxicity -pseudomembranous colitis
Maraviroc CCR5
What is the main medication for antiretrovirals: CCR5 antagonists?
Maraviroc (oral)
Medication: -Prevents HIV from entering lymphocytes by binding to CCR5 on cell membranes
Maraviroc (oral) CCR5
acute infection that causes the initial illness
Primary infection
Medication complications: -headache and difficulty sleeping -skin rash (could lead to Stevens-Johnson syndrome) -Liver injury -renal failure, hematuria -suicidal ideation
Raltegravir Integrase inhibitors (INSTIs)
Medication: -Interferes with the enzyme integrase to prevent HIV replication within the cell
Raltegravir Integrase inhibitors (INSTIs)
What is the main medication for antiretrovirals: Integrase inhibitors (INSTIs)?
Raltegravir (oral)
Medication complications: -bone loss/osteoporosis -diabetes mellitus/hyperglycemia -hypersensitivity reaction -N/V Elevated blood lipids -altered fat distribution
Ritonavir (Protease inhibitor)
Medication: protease inhibitors act against HIV-1 and HIV-2 to alter and inactivate the virus by inhibiting enzymes needed for HIV replication
Ritonavir (Protease inhibitor)
What is the main medication for antiretrovirals: protease inhibitors?
Ritonavir (oral) others: saquinavir, indinavir, fosamprenavir, nelfinavir, lopinavir/ritoniavir combination
What precautions are used with HIV positive patients?
Standard; gown for dressing changes, procedures, etc.
Secondary HIV involves ___
T-lymphocytes
What category does Enfuvirtide fall under?
antiretrovirals: fusion/entry inhibitors
What category does Ritonavir fall under?
antiretrovirals: protease inhibitors
Test: -Quantifies HIV RNA in the plasma. Monitors efficacy of ART through virologic suppression. Goal is undetectable
Viral load
the number of virus particles circulating in the body; the amount of HIV present in an infected person's blood
Viral load
Medication complications: -suppressed bone marrow -lactic acidosis -N/V/diarrhea -hepatomegaly/fatty liver
Zidovudine (oral, IV) NRTI
Medication: -reduces HIV manifestations by inhibiting DNA synthesis and thus viral replication
Zidovudine (oral, IV) NRTI
What is the main medication for antiretrovirals: NRTIs?
Zidovudine (oral, IV) Others: didanosine, stavudine, lamivudine, abacavir
Symptoms: fever, night sweats, chills, headaches, muscle aches, sore throat, and rash
acute HIV infection
If you wait to test for tuberculosis during HIV infection, it will show negative due to the body not making antibodies anymore, even though they still have TB
anergy
a substance produced by the body that destroys or inactivates an antigen that has entered the body
antibody
A protein that, when introduced in the blood, triggers the production of an antibody
antigen
Test: -Detects HIV antibodies and p24 antigen; detects early acute infection.
antigen/antibody
What is the category of medication used for HIV?
antiretroviral agents
____ act by preventing the virus from entering the cells (fusion/entry inhibitors and CCR5 antagonists). Others act by inhibiting enzymes needed for HIV replication (nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and an integrase inhibitor (NSTI))
antiretroviral agents
What category does Maraviroc fall under?
antiretrovirals: CCR5 antagonists
What category does Raltegravir fall under?
antiretrovirals: Integrase inhibitors (INSTIs)
What category does delavirdine and efavirenz fall under?
antiretrovirals: NNRTIs
What category does Zidovudine fall under?
antiretrovirals: NRTIs
AIDS cannot be ____
undiagnosed
balance between amount of HIV and the immune response
viral set point