Chapter 37: HIV/AIDS

In Category C HIV, CD4 is _______% and _______mcL

<14%, <200mcL

T/F: Category A HIV is asymptomatic

True - still contagious though!

Which microorganism is known to cause retinitis in people with HIV/AIDS? a. Cytomegalovirus b. Cryptococcus neoformans c. Mycobacterium avium d. Pneumocystis carinii

a. Cytomegalovirus

A client is suspected of having an immune system disorder. The physician wants to perform a diagnostic test to confirm the diagnosis. What test might the physician order? a. T-and C-cell assays b. Complete chemistry panel c. Enzyme-linked immunosorbent assay d. Plasmapherisis

c. Enzyme-linked immunosorbent assay

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS? a. Sharing the diagnosis with a support group b. Caring for a client who can kill other people c. Disclosure of the client's condition d. Caring for a client with an infectious terminal disease

c. Disclosure of the client's condition

the nurse is discussing sexual activity with a patient recently diagnosed with HIV. the patient states, "as long as I have sex with another person who is already infected, i will be okay". what is the best response by the nurse? a. "you should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner" b. "yes, since you are already infected, it won't make a difference if you have sex with a person who is HIV positive" c. "i am not sure why you would want to have sex with another person who is HIV positive. that person may have another sexually transmitted infection" d. "if you have sex with another person who is HIV positive, you will develop AIDS sooner"

a. "you should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner"

When assisting the client to interpret a negative HIV test result, the nurse informs the client that the results mean that a. the body has not produced antibodies to the AIDS virus. b. the client has not been infected with HIV. c. the client is immune to the AIDS virus. d. antibodies to the AIDS virus are in his blood.

a. the body has not produced antibodies to the AIDS virus.

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

b. Nutritional interventions may not necessarily resolve the patient's weight loss.

3 key diagnostic findings of AIDS

-CD4 < 200mcL -CD4 <14% -pt diagnosed with 1 or more AIDS related illnesses

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

a patient is on ART for the treatment of HIV. what does the nurse know would be an adequate CD4 count to determine the effectiveness of of treatment for a patient per year? a. 1 mm3 - 10 mm3 b. 10 mm3 - 20 mm3 c. 20 mm3 - 45 mm3 d. 50 mm3 - 150 mm3

d. 50 mm3 - 150 mm3

what precautions are used with HIV patients?

standard precautions

a patient is diagnosed with pneumocystis pneumonia. what medication does the nurse anticipate educating the patient about for treatment? a. TMP-SMZ (Bactrim) b. cephalexin (Keflex) c. Azithromycin (Zithromax) d. Garamycin (Gentamicin)

a. TMP-SMZ (Bactrim)

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? a. Western blot assay b. OraSure test c. p24 antigen capture assay d. Nucleic acid sequence-based amplification

a. Western blot assay

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.

A nurse is caring for a client with human immunodeficiency virus (HIV). To determine the effectiveness of treatment the nurse expects the physician to order: a. E-rosette immunofluorescence. b. quantification of T-lymphocytes. c. enzyme-linked immunosorbent assay (ELISA). d. ELISA with Western blot test.

b. quantification of T-lymphocytes.

An older adult widowed woman informs the nurse that she notices vaginal dryness now that she has become sexually active again. She is not using barrier protection because it makes the dryness worse. What education should the nurse provide to the patient? a. use a lamb skin condom instead of latex b. vaginal dryness is common in postmenopausal women, and there are creams that can be used, but she should still use a latex condom c. since the patient is older, it is not likely that she will acquire HIV d. she should abstain from sexual activity because she is at greatest risk for acquiring HIV

b. vaginal dryness is common in postmenopausal women, and there are creams that can be used, but she should still use a latex condom

A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? a. 1 mm3 to 10 mm3 b. 10 mm3 to 20 mm3 c. 20 mm3 to 45 mm3 d. 50 mm3 to 150 mm3

d. 50 mm3 to 150 mm3

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? a. Less than 200/mm3 b. Between 200 to 350/mm3 c. Between 350 to 499/mm3 d. Greater than 500/mm3

d. Greater than 500/mm3

the nurse receives a phone call at the clinic from the family of a patient with AIDS. the state that the patient started "acting funny" after complaining of headache, tiredness, and a stiff neck. checking the temperature resulted in a fever of 103.2 F. what should the nurse inform the family member? a. "the patient probably has a case of the flu and you should give them tylenol" b. "the patient may have cryptococcal meningitis and will need to be evaluated by the physician" c. "this is one of the side effects from antiretroviral therapy and will require changing the medication" d. "the patient probably has pneumocystis pneumonia and will need to be evaluated by the physician"

b. "the patient may have cryptococcal meningitis and will need to be evaluated by the physician"

A patient is infected with HIV after sharing needles with another IV drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection? a. 1-2 weeks b. 3-6 weeks c. 3-12 weeks d. 6-18 weeks

c. 3-12 weeks

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? a. Maintain the client in a supine or side-lying position. b. Encourage client to ambulate frequently in the halls. c. Assist with chest physiotherapy every 2 to 4 hours. d. Limit fluid intake to 1 1/2 to 2 liters per day.

c. Assist with chest physiotherapy every 2 to 4 hours.

Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________. a. 4 days; 7 days; 2 weeks b. 1 week; 3 weeks; 3 months c. 1 month; 2 months; 6 months d. 1 hour; 72 hours; 4 weeks

d. 1 hour; 72 hours; 4 weeks

A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? a. diarrhea b. hearing impairment c. fatigue d. blindness

d. blindness

a patient with AIDS informs the nurse of difficult eating and swallowing, and shows the nurse white patches in the mouth. what problem related to AIDS does the nurse understand the patient has developed? a. MAC b. wasting syndrome c. kaposi's sarcoma d. candidiasis

d. candidiasis

In Category B HIV, CD4 is _______% and greater than _______mcL

14-28%, 200-499mcL

In Category A HIV, CD4 is _______% and _______mcL

29%, > 500mcL

A patient is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the patient about for treatment? a. TMP-SMZ (Bactrim) b. Cephalexin (Keflex) c. Azithromycin (Zithromax) d. Garamycin (Gentamicin)

a. TMP-SMZ (Bactrim)

a patient with AIDS is having a recurrence of 10 to 12 loose stools a day, what medication may help this patient with controlling the chronic diarrhea? a. acetreotide (sandostatin) b. rifaximin (xifaxan) c. bismuth subsalicylate (pepto bismol) d. atropine diphenoxylate (lomotil)

a. acetreotide (sandostatin)

Which of the following are modes of transmission for HIV? Select all that apply. a. blood b. seminal fluid c. vaginal secretions d. casual contact e. amniotic fluid

a. blood b. seminal fluid c. vaginal secretions e. amniotic fluid

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

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 bodily 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

the patient develops GI bleeding from a gastric ulcer and requires blood transfusions. the patient states to the nurse, "i am not going to have a transfusion because i don't want to get AIDS" What is the best response by the nurse? a. "i understand what you mean, but you can never be sure if the blood is tainted" b. "i understand your concern. the blood is screened very carefully for different viruses as well as HIV" c. "if you don't have the blood transfusions, you may not make it through this episode of bleeding" d. "no one has gotten HIV from blood in a long time. you have to have the transfusion"

b. "i understand your concern. the blood is screened very carefully for different viruses as well as HIV"

A client who is HIV positive has been prescribed antiretroviral drugs. The nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration, including strong emphasis about rigidly adhering to the dosage, time and frequency of the administration of the drugs. Why is it important to adhere to the schedule of drug dosing developed for this client? a. To avoid overdosing on the drugs b. To avoid resistance to the drugs c. To maintain appropriate blood levels of the drugs d. To get the most benefit from the drugs

b. To avoid resistance to the drugs

What test will the nurse assess to determine the client's response to antiretroviral therapy? a. Western blotting b. Viral load c. Enzyme immunoassay d. Complete blood count

b. Viral load

a patient with HIV has been on antiretroviral therapy (ART) for 6 months. the patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. what does the nurse know about the factors associated with non-adherence to ART? (select all the apply) a. lives alone b. active substance abuse c. taking other medication d. depression e. lack of social support

b. active substance abuse d. depression e. lack of social support

a patient with HIV develops a nonproductive cough, shortness of breath, a fever of 101 F and an O2 sat of 92%. what infection caused by pneumocystis jiroveci does the nurse know could occur with this patient? a. myobacterium avium complex (MAC) b. pneumocystis pneumonia c. tuberculosis d. community-acquired pneumonia

b. pneumocystis pneumonia

The balance between the amount of HIV in the body and the immune response is the a. viral load test b. viral set point c. window period d. anergy

b. viral set point

When do most perinatal HIV infections occur? a. through breastfeeding b. in utero c. after exposure during delivery d. through physical contact

c. after exposure during delivery

while caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. what does the nurse suspect these lesions to indicate? a. molluscum contagiosum b. tuberculosis of the skin c. kaposi's sarcoma d. seborrheic dermatitis

c. kaposi's sarcoma