HIV/AIDS, Lewis Medsurg Chapt 15 - HIV

Chapter 15: Infection and Human Immunodeficiency Virus Infection Chapter 15: Infection and Human Immunodeficiency Virus Infection Test Bank MULTIPLE CHOICE 1. A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS. DIF: Cognitive Level: Apply (application) REF: 236 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

6. Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus. DIF: Cognitive Level: Apply (application) REF: 232 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

11. Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

ANS: A The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range. DIF: Cognitive Level: Apply (application) REF: 241 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

17. To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART. DIF: Cognitive Level: Apply (application) REF: 241 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment 21. An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease. DIF: Cognitive Level: Apply (application) REF: 237 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE 1. The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred. DIF: Cognitive Level: Apply (application) REF: 238 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

3. The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.

ANS: A, B, E All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza. DIF: Cognitive Level: Apply (application) REF: 230 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

22. The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.

ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice. DIF: Cognitive Level: Apply (application) REF: 230-231 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

16. The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

ANS: B It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day. DIF: Cognitive Level: Apply (application) REF: 237 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided. DIF: Cognitive Level: Understand (comprehension) REF: 232 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

12. A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

ANS: B Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs. DIF: Cognitive Level: Apply (application) REF: 240 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

19. Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART. DIF: Cognitive Level: Apply (application) REF: 234 | 242 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

ANS: B, C Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines. DIF: Cognitive Level: Apply (application) REF: 230 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

15. A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

ANS: C A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem. DIF: Cognitive Level: Apply (application) REF: 243 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

3. A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is mostimportant at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals. DIF: Cognitive Level: Apply (application) REF: 235-236 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection. DIF: Cognitive Level: Understand (comprehension) REF: 235 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

ANS: C Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams. DIF: Cognitive Level: Apply (application) REF: 238 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

10. The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu. DIF: Cognitive Level: Apply (application) REF: 234 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

23. The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower. DIF: Cognitive Level: Apply (application) REF: 232 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

20. Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock. DIF: Cognitive Level: Analyze (analysis) REF: 242 OBJ: Special Questions: Prioritization; Multiple Patients

18. The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT. DIF: Cognitive Level: Apply (application) REF: 242 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

9. The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

ANS: D CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count. DIF: Cognitive Level: Apply (application) REF: 235 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

8. A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART. DIF: Cognitive Level: Apply (application) REF: 242 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

4. A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

ANS: D More assessment of the patient's psychosocial status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings. DIF: Cognitive Level: Apply (application) REF: 241 | 244

13. Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule. DIF: Cognitive Level: Apply (application) REF: 242 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

14. A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.

ANS: D The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection. DIF: Cognitive Level: Apply (application) REF: 236 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A diagnosis of AIDS is made when an HIV infected patient has a. a CD+4 T cell count below 200/uL b. an increasing amount of HIV in the blood c.. lipodystrophy with metabolic abnormalities d. oral hairy leukoplakakia, an infection caused by Epstein Barr virus

a

A patient with advanced AIDS has a nursing diagnosis of impaired memory r/t neurologic changes. In planning care for the patient, the nurse sets the highest priority on a. maintaining a safe patient environment b. providing a quiet, nonstressful environment to avoid overstimulation c. using memory cues such as calendars and clock to promote orientation d. providing written instructions of directions to promote understanding and orientation

a

A primary reason that the normal immune response fails to contain HIV infection is that a. CD4+ T cells drawn to the viruses become infected and are destroyed b. the virus inactivates B lymphocytes, preventing the production of HIV antibodies c. natural killer cells are destroyed by the virus before the immune system can be activated d. monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues

a

Saquinavir (Invirase) is prescribed for the client who is seropositive for HIV. The nurse provides medication instructions and tell the client to A avoid sun exposure b eat low calorie foods c eat foods that are low in fat d take the medication on an empty stomach

a

The client who is HIV seropositive has been taking Stavudine (Zerit). The nurse monitors which of the following most closely while the client is taking this medication? A gait b appetite c LOC d gastrointestinal function

a

which of the following strategies can the nurse teach the patient to eliminate the risk of HIV transmission a. using sterile equipment to inject drugs b. cleaning equipment used to inject drugs c. taking AZT, ZDV, Retrovir, during prergnancy d. using latex or polyurethane barriers to cover genitals durng sexual contact.

a

Which of the following statements accurately describes HIV infections Select all that apply a. HIV infection has inevitable and predictable course of progression b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS) c. Untreated HIV infection can remain in the early chronic stage for a decade or more d. Untreated HIV infection usually remains in the early chronic stage for `1 year or less e. Opportunistic diseases occur more often when the CD4+ T cell count is low and viral load is low.

a,b,c

When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education? a. "I will need to isolate any tissues I use so as not to infect my family." b. "I will notify all of my sexual partners so they can get tested for HIV." c."Unprotected sexual contact is the most common mode of transmission." d. "I do not need to worry about spreading this virus to others by sweating at the gym."

a. 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.

A man is admitted to the hospital with a diagnosis of AIDS. He is being treated for Pneumocystis jiroveci pneumonia. The nurse evaluates the care provided to this client by other members of the health care team. The nurse should intervene in which of the following situations? a. a housekeeper cleans up spilled blood with a bleach solution b. a nursing student takes his blood pressure wearing a mask and gloves c. a technician wears gloves to perform a venipuncture d. a nurse attendant allows visitors to enter his room without masks

b

A patient comes to the clinic and requests testing for HIV infection. Before administering testing, it is most important that the nurse a. ask the patient to identify all sexual partners b. determine when the patient thinks exposure to HIV occurred c. explain that all test results must be repeated at least twice to be valid d. discuss prevention practices to prevent transmission of the HIV to others

b

After teaching a patient with HIV infection about using antiretroviral drugs, the nurse recognizes that further teaching is needed when the patient says a. I should never skip doses of my medication, even if I develop side effects b. if my viral load becomes undetectable,I will no longer be able to transmit HIV to others c. i should not use any over the counter drugs without checking with my physician d. if i develop a constant headache that is not relieved with aspirin or acetaminophen, I should report it within 24 hours

b

Antiretoviral drugs are used to a. cure acute HIV infection b. decrease viral RNA levels c. treat opportunistic diseases d. decrease pain and symptoms in terminal disease

b

The clinic nurse is instructing the mother of a child with HIV infection regarding immunizations. The nurse tells the mother that A. the hepatitis b vaccine will not be given to the child b. the inactivated influenza vaccine will be given yearly c. the varicella vaccine will be given before 6 months of age d. the western blot test needs to be performed and the results evaluated before immunizations

b

The nurse in an outpatient clinic evaluates the Mantoux test of a client whose history indicates that she has been treated during the past year for AIDS related infection. The nurse should document that there was a positive reaction if there is an area of induration measuring which of the following a. 3mm b. 7mm c. 11mm d. 15mm

b

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that which of the following is a diagnostic criterion for AIDS? a. Presence of HIV antibodies b. CD4+ T cell count <200/µl c. White blood cell count <5000/µl d. Presence of oral hairy leukoplakia

b. Diagnostic criteria for AIDS include a CD4+ T-cell count <200/µl and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease, but do not define the advancement of the disease to AIDS.

The nurse is providing care for a patient who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease? a. A new onset of polycythemia b. Presence of mononucleosis-like symptoms c. A sharp decrease in the patient's CD4+ count d. A sudden increase in the patient's WBC count

c. A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

Following infection with HIV a. the virus replicates mainly B lymphocytes before spreading to CD4+T cells b. infection of monocytes may occur, but antibodies quickly destroy the cells c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

c

One of the most significant factors in determining when to start antiretroviral therapy in a patient with HIV infection is a. whether the patient has high levels of HIV antibodies b. the confirmation that the patient has contracted HIV infection c. the patients readiness to commit to a complex, life long, uncomfortable drug regimen d. whether the patient has a support system to help manage the costs and side effects of the drugs

c

Opportunistic diseases in HIV infection a. are usually benign b. are generally slow to develop and progress c. occur in the presence of immunosupression d. are curable with appropriate drug intervention

c

Screen for HIV infection generally involves a. laboratory analysis of blood to detect HIV antigens b. electrophoretic analysis for HIV antigen in plasma c. laboratory analysis of blood to detect HIV antibodies d. analysis of lymph tissue for the presence of HIV RNA

c

The "rapid" HIV antibody testing is performed on a patient at high risk for HIV infection. The nurse explains that a. the test measures the activity of the HIV and reports viral loads as real numbers b. this test is highly reliable, and in 20 minutes the patient will know if HIV infection is present c. if the results are positive, another blood test and a return appointment for results will be necessary d. this test detects drug resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs

c

The client with AIDS has begun therapy with zidovudine (RETROVIR, AZT, ZDV). The nurse carefully monitors which of the following lab results during the treatment with this medication A blood culture b blood glucose level c CBC d BUN

c

The nurse is reviewing the results of lab studies drawn on a client with AIDS who is receiving Videx. The nurse interprets that the client may have the medication discontinued by the physician if which of the following significantly elevated results is noted A. serum protein level b blood glucose level c serum amylase level d serum creatinine level

c

Opportunistic diseases develop in AIDS because these disorders are a.side effects of drug treatment of AIDS b. sexually transmitted to individuals during exposure of HIV c. characteristic in individuals with stimulated B and T lymphocytes d. infections or tumors that rarely occur with a competent immune system

d

A patient identified as HIV antibody positive 1 year ago manifests early HIV infection but does not want to start antiretroviral therapy at this time. An appropriate nursing intervention for this patient at this stage of illness is to a. assist with end of life issues b. provide caring during acute exacerbations c. provide physical care for chronic diseases d. educate the patient regarding immune enhancement

d

A patient with advanced AIDS has diarrhea and wasting syndrome. An appropriate nursing diagnosis for the patient is a. diarrhea r/t opportunistic infection b. risk for fluid deficit r/t diarrhea c. risk for infection r/t immunosuppression d. risk for impaired skin integrity r/t altered nutritional status and frequent stools

d

An infant of a mother infected with HIV is seen in the clinic each month and is being monitored for symptoms indicative of HIV infection. The nurse assesses the infant, knowing that the most common opportunistic infection of children infected with HIV is A. meningitis b gastroenteritis c cytomegalovirus infection d. pneumocystis jiroveci pneumonia

d

The client with AIDS and Pneumocystis jiroveci infection has been receiving pentamidine. The client develops a temp of 101. The nurse does further monitoring of the client, knowing that this sign would most likely indicate A. that the dose of the medication is too low b that the client is experiencing toxic effects of the medication c that the client has developed inadequacy of thermoregulation d that the client has developed another infection caused by leukopenic effects of the medication

d

The nurse provides home care instruction to the parent of a child with AIDS. Which statement by the patient indicates the need for further teaching? A. I will wash my hands frequently b I will keep my Childs immunizations up to date c I will avoid direct unprotected contact with my Childs body fluids d I can send my child to daycare if he has a fever, as long as it a low grade fever

d

Transmission of HIV from an infected individual to another most commonly occurs as a result of a perinatal transmission b. sharing drug using equipment c. low levels of virus in the blood d. anal or vaginal sexual intercourse

d

of the following, which is the most appropriate nursing intervention to help an HIV infected patient adhere to a treatment regimen a. set up a drug pillbox for the patient every week b. give the patient a videotape and a brochure to view and read at home c. tell the patient that the side effects of the drugs are bad but that they go away after a while d. assess the patients routines and find adherence cues that fit into the patients lilfe and circumstances

d