Human Immunodeficiency Virus Infection
Which new findings by the nurse may indicate a patient's human immunodeficiency virus (HIV) infection is no longer in the incubation stage and is progressing? Select all that apply. a) Rash b) Fatigue c) Muscle aches d) Photophobia e) Nausea and vomiting
A, B, C, D Rationale: Rash- When a patient develops a rash, it is a sign that the HIV infection has progressed to the early stage. Fatigue- Fatigue is an indication that the patient's HIV infection has progressed beyond the incubation stage. Muscle aches- If a patient who was in the incubation stage reports muscle aches, this indicates disease progression. Photophobia- New-onset photophobia in an HIV-positive patient indicates disease progression. Nausea and vomiting- Nausea and vomiting in an HIV-positive patient are not indicative of disease progression.
The nurse is talking with an HIV+ patient about managing the disease. The patient admits to being depressed about the diagnosis and does not feel like going out because of the medication side effects. What is the nurse's best response? a) "Do people talk about your HIV status or avoid being around you?" b) "Have you discussed these side effects with your health care provider? c) "Do you want to talk to the health care provider about an antidepressant?" d) "Do you have any hobbies or interests that would get you out of the house?"
B Rationale: "Do people talk about your HIV status or avoid being around you?" The patient is depressed about the diagnosis and side effects, but did not mention depression related to others' reactions to the diagnosis. "Have you discussed these side effects with your health care provider? This is the best response because it addresses the patient's concerns about the medication side effects. "Do you want to talk to the health care provider about an antidepressant?" An antidepressant may be beneficial for the patient; however, this questions does not address the patient's concerns about the treatment regimen. "Do you have any hobbies or interests that would get you out of the house?" It is important to determine a patient's interests and hobbies, but it does not address the patient's issues with the antiretroviral medications.
The health care provider prescribes a combination drug for a patient with human immunodeficiency virus (HIV) infection who has had a progressive increase in viral load. The patient asks the nurse why there is a change to the medication regimen. What is the nurse's best response? a) "Sometimes the health care provider has to find the one drug that is most effective by trial and error." b) "Combination antiretroviral drugs are more effective because each drug attacks HIV in different stages." c) "When the manufacturer combines two or more antiretroviral agents in one pill, the side effects are more manageable." d) "It increases the patient's compliance in taking antiretroviral medications when they are given in the form of one pill."
B Rationale: "Sometimes the health care provider has to find the one drug that is most effective by trial and error." The health care provider prescribes antiretroviral medications based on which would be most effective for specific clinical manifestations, not by trial and error. "Combination antiretroviral drugs are more effective because each drug attacks HIV in different stages." Each class of antiviral drugs works in a different way to kill HIV. Using more than one antiretroviral drug kills the virus in different ways. "When the manufacturer combines two or more antiretroviral agents in one pill, the side effects are more manageable." Combination antiretroviral therapy does not make the side effects more manageable. The side effects actually increase with each antiretroviral medication being administered. "It increases the patient's compliance in taking antiretroviral medications when they are given in the form of one pill." Although giving the patient only one pill to take could increase patient compliance, this is not the primary reason that combination drugs are prescribed.
The nurse is teaching a patient with human immunodeficiency virus (HIV) infection ways to decrease the risk of infecting other people. Which statement made by the patient indicates effective teaching? a) "I should not receive any vaccinations." b) "It is important that I stay away from crowds." c) "I should refrain from sharing needles with anyone else." d) "I should wash my hands frequently throughout the day."
C Rationale: "I should not receive any vaccinations." The nurse will instruct the patient to receive vaccinations to prevent illnesses that could occur because of the patients immunocompromised status, but this will not prevent transmission of the virus. "It is important that I stay away from crowds." The nurse will instruct the patient with HIV infection to stay away from crowds to prevent the patient from getting sick, but this does not prevent HIV transmission. "I should refrain from sharing needles with anyone else." The nurse will instruct the patient with HIV to refrain from sharing needles with others because this exposes people to the virus. "I should wash my hands frequently throughout the day." The nurse will instruct the patient to wash his or her hands frequently to decrease the patient's risk of infection. This does not prevent HIV transmission.
The nurse is caring for a patient who has been receiving antiretroviral treatment for human immunodeficiency virus (HIV) infection. Which finding in the medical record indicates the treatment has been effective? a) A positive Western Blot test b) A viral load of 2000 copies/µL c) A CD4 T-cell count of 900 cells/µL d) A white blood cell (WBC) count of 3.0 cells/µL e) A positive Western Blot test
C Rationale: A positive Western Blot test- The Western Blot test is a diagnostic test to determine whether a patient has HIV infection. It is not used to determine efficacy of treatment. A viral load of 2000 copies/µL- A viral load of 2000 copies/µL indicates that the treatment is not effective. The treatment is considered effective when the viral load is not detectable. A CD4 T-cell count of 900 cells/µL- The normal CD4 T-cell count is between 800 and 1200 cells/µL. A CD4 T-cell count of 900 cells/µL indicates the patient has a normal count and the treatment is effective. A white blood cell (WBC) count of 3.0 cells/µL- A WBC of 3.0 cells/µL is decreased. A normal WBC is between 4.0 and 11.0 cells/µL. A decreased WBC count does not indicate effective treatment.
A patient presents to the clinic and asks the nurse about human immunodeficiency virus (HIV) infection to determine her risk for contracting the disease. What should the nurse ask the patient? a) "When was your last menstrual period?" b) "Are you currently breastfeeding an infant?" c) "Have you ever had unprotected sexual contact?" d) "Do you use intravenous drugs and share needles?" e) "How many sexual partners do you currently have?"
C, D, E Rationale: "When was your last menstrual period?" The nurse need not ask the patient when her last menstrual period was because this is not a risk factor for contracting HIV infection. "Are you currently breastfeeding an infant?" The nurse would ask the patient about breastfeeding if she were HIV positive, but breastfeeding is not a risk factor for contracting HIV infection. "Have you ever had unprotected sexual contact?" Unprotected sexual contact is a risk factor for contracting HIV infection. "Do you use intravenous drugs and share needles?" Sharing needles during use of intravenous drugs is a risk factor for contracting HIV infection. "How many sexual partners do you currently have?" Having multiple sexual partners places an individual at higher risk for contracting HIV infection.
A patient with a negative rapid antibody human immunodeficiency virus (HIV) test result asks the nurse why the health care provider scheduled another HIV test in 2 months. What is the nurse's best response? a) "To obtain baseline data before beginning prophylactic antiretroviral therapy." b) "The diagnosis of HIV is confirmed after two consecutive test results are positive." c) "The rapid antibody HIV test can produce a false-positive result, so it will be repeated." d) "There is a period during which the virus is present in the body but not detected in blood tests."
D Rationale: "To obtain baseline data before beginning prophylactic antiretroviral therapy." The HIV test is done to determine a diagnosis of HIV infection. It is not done to obtain baseline data. "The diagnosis of HIV is confirmed after two consecutive test results are positive." HIV is diagnosed after three, not two, consecutive positive test results. "The rapid antibody HIV test can produce a false-positive result, so it will be repeated." The rapid antibody HIV test does not produce a false-positive result. "There is a period during which the virus is present in the body but not detected in blood tests." The window period is a time frame between infection and seroconversion. The patient has HIV infection, but antibodies are not detectable by diagnostic tests. Therefore the health care provider will repeat the HIV test in 2 months.
Which dietary choice made by a patient with human immunodeficiency virus (HIV) infection indicates a need for further education? a) Baked fish b) Scrambled eggs c) Mashed potatoes d) Raw cookie dough
D Rationale: Baked fish is an acceptable food choice for a patient with HIV infection because it is high in protein. Scrambled eggs are high in protein and are appropriate for a patient with HIV infection. Mashed potatoes are safe to eat and do not increase the risk of infection. Mashed potatoes are a soft food that may be easier to eat when a patient has mouth sores. Raw cookie dough contains raw eggs, and this can increase the patient's risk for food poisoning or infection.
Which statement best describes the transmission of the human immunodeficiency virus (HIV)? a) HIV is spread by social contact. b) HIV is transmitted by sexual contact. c) HIV is a highly contagious virus that is airborne. d) HIV is transmitted through blood and bodily fluids.
D Rationale: HIV is spread by social contact. HIV is not spread by social contact. Other viruses such as the common cold and influenza are spread by social contact. HIV is transmitted by sexual contact. HIV is transmitted through sexual contact; however, it is not the only means of transmission. HIV is a highly contagious virus that is airborne. HIV is not an airborne virus. HIV is transmitted through blood and bodily fluids. HIV is transmitted through blood and body fluids.
The nurse is reviewing the laboratory test results for a patient who is HIV+. The results show no viral load. Which information should the nurse include in patient education? a) "Use barrier contraception during sexual contact." b) "You can discontinue your antiretroviral drugs." c) "You are no longer considered to be HIV positive." d) "It is safe to breastfeed if you become pregnant."
a) "Use barrier contraception during sexual contact." Even though the patient has no detectable HIV cells in the blood, the patient is still HIV+ and can transmit the disease to other people. Therefore the nurse should instruct the patient to use barrier contraception during sexual contact. The patient should not discontinue their antiretroviral medications because these medications are keeping the virus from replicating. The patient will still be HIV+ even with no detectable viral load. It is not safe for a patient who is HIV+ to breastfeed because the virus can still be transmitted through breast milk.
Which intervention would be most appropriate for the nurse to include in the plan of care for a patient having side effects from the antiretroviral drugs? a) Administer antiemetics b) Provide warm goat's milk c) Tell the patient to stay away from sick people d) Instruct the patient to obtain an annual flu shot
a) Administer antiemetics Rationale: The main side effects of antiretroviral therapy are nausea and vomiting. Therefore the nurse would administer antiemetics. Warm goat's milk is not pasteurized and could make the patient sick. Refraining from being around people who are sick will decrease the patient's risk for infection, but it will not decrease side effects from antiretroviral medications. The patient who is HIV+ should obtain immunizations, but this will not alleviate the side effects of the antiretroviral medications.
Which manifestation would the nurse expect to find when assessing the gastrointestinal tract of an HIV+ patient in the crisis stage? a) Diarrhea b) Constipation c) Abdominal distention d) Hypoactive bowel sounds
a) Diarrhea Rationale: The nurse would expect the patient in the crisis stage of HIV infection to have diarrhea. Constipation is not a clinical manifestation of HIV infection in any stage. The patient in the crisis stage of HIV infection would not have abdominal distention. Clinical manifestations in the crisis stage of HIV infection would not include hypoactive bowel sounds.
The school nurse is preparing to discuss HIV and AIDS with a group of teenagers. Which aspects of disease prevention would be best suited for this age group? Select all that apply. a) Modes of transmission b) Maintaining healthy relationships c) Avoiding exposure to sexually transmitted diseases d) The importance of prophylactic antiretroviral therapy e) Not assuming that HIV affects only certain groups
a) Modes of transmission c) Avoiding exposure to sexually transmitted diseases e) Not assuming that HIV affects only certain groups Rationale: Teenagers need to be educated about how HIV is spread and ways to prevent transmission because the virus is spread by sexual contact and intravenous drug use. Teenagers are likely to take part in these risky behaviors because of their developmental stage. HIV prevention does not include information about maintaining healthy relationships because this is not related to preventing the disease. The nurse will instruct the teenagers about barrier protection methods to decrease the risk of HIV transmission. Antiretroviral therapy is not administered to prevent the disease; it is administered to treat HIV infection after a patient has received the diagnosis. Not assuming that HIV affects only certain groups The nurse should point out that HIV is not just a disease that affects the homosexual community; it affects heterosexual people as well.
A patient with HIV comes to the health care provider's office for a check-up, and the nurse notices the patient has lost 10 pounds since the last visit. Which factors should the nurse assess next? Select all that apply. a) Oral cavity b) CD4 T-cell count c) Nutritional status d) Medication compliance e) Gastrointestinal (GI) function
a) Oral cavity b) CD4 T-cell count c) Nutritional status e) Gastrointestinal (GI) function Rationale: It is common for a patient who has HIV infection or AIDS to have oral lesions or thrush. If the patient is losing weight, the nurse will assess the oral cavity for lesions that may interfere with maintaining optimal nutrition. A change in the CD4 T-cell count indicates disease progression, which may lead to weight loss in a person with HIV infection. The nurse should assess the patient's nutritional status because of the 10-pound weight loss. The nurse would not assess medication compliance to determine the cause of a patient's weight loss. The nurse would assess medication compliance if the patient's viral load had increased. Patients with HIV infection often have GI issues which can cause changes in weight, so this factor should be assessed.
The nurse is caring for a patient who is HIV+ and has been admitted to the hospital for treatment of community-acquired pneumonia. Which intervention will prevent complications related to the patient's HIV infection? a) Assign the patient to a private room b) Administer antiretroviral drugs on time c) Instruct the patient to cough up secretions d) Provide three full meals a day plus snacks
b) Administer antiretroviral drugs on time Rationale: The patient should be in a private room to prevent transmitting the community-acquired pneumonia to others. However, this will not prevent complications related to the patient's HIV infection. Antiretroviral medications should be given on time to decrease viral load and improve immune function. The nurse should instruct the patient to cough up pulmonary secretions, but this will not prevent complications related to the patient's HIV infection. It is important for the patient to have good nutrition, but this will not prevent complications related to the HIV infection.
Which finding in the patient's medical record indicates that the patient with human immunodeficiency virus (HIV) infection has developed acquired immunodeficiency syndrome (AIDS)? a) Fever of 101° F and chills b) Onset of wasting syndrome c) CD4 T-cell count of 1000 cells/µL d) Persistent generalized lymphadenopathy
b) Onset of wasting syndrome Rationale A patient having a fever of 101° F is not a determining factor of AIDS. The onset of wasting syndrome indicates that the patient now has AIDS. A CD4 T-cell count of <200 cells/µL confirms a diagnosis of AIDS. Generalized lymphadenopathy is a clinical manifestation of the latent phase of HIV infection.
A patient with a new diagnosis of human immunodeficiency virus (HIV) infection begins receiving antiretroviral therapy. Which finding indicates the patient is having complications related to the treatment regimen? a) Headaches b) Weight loss c) Shortness of breath d) Peripheral neuropathy
b) Weight loss Rationale: Headaches are not a complication of antiretroviral therapy. Headaches are a complication of some opportunistic infections. Nausea, vomiting, and diarrhea are major side effects of antiretroviral therapy. These side effects can lead to wasting syndrome. Shortness of breath may be related to Pneumocystis jiroveci pneumonia, but it is not related to antiretroviral therapy. Peripheral neuropathy is not a side effect of antiretroviral therapy.
The nurse is caring for an HIV+ patient whose laboratory reports indicate a normal CD4 T-cell count and no physical symptoms. What should the nurse infer from this finding? a) The patient is in the early stage of HIV infection. b) The patient is in the crisis stage of HIV infection. c) The patient is in the latent stage of HIV infection. d) The patient is in the incubation stage of HIV infection.
d) The patient is in the incubation stage of HIV infection. Rationale: The patient in the early stage of HIV infection would have a normal CD4 T-cell count but would also have physical symptoms such as myalgias and photophobia. A patient in the crisis stage of HIV infection would have a CD4 T-cell count <500 cells/µL and clinical manifestations such as fever, fatigue, weight loss, and diarrhea. A patient in the latent stage of HIV infection would have a normal CD4 T-cell count but might also have generalized lymphadenopathy. A patient in the incubation stage of HIV infection is free of symptoms and has a normal CD4 T-cell count.