Pathophysiology chp 15 Immunodeficiency
The nurse teaches about HIV transmission. Which patient response describes why HIV is less commonly transmitted during sexual intercourse by infected women than by infected men? "The concentration of HIV in cervicovaginal secretions is lower." "The concentration of HIV in cervicovaginal secretions is higher." "The concentration of HIV in seminal fluid is lower." "HIV doesn't live in cervicovaginal secretions."
"The concentration of HIV in cervicovaginal secretions is lower."
The nurse is teaching a class about HIV. Which response about the frequency of HIV diagnosis indicates that teaching was effective? Black men who have sex with men Black heterosexual men White heterosexual women Hispanic men who have sex with men
Black men who have sex with men Black men who have sex with men accounted for 11,201 newly diagnosed cases in 2014. Cases involving white heterosexual women numbered 1,115; black heterosexual men numbered 2,108, and Hispanic men who have sex with men numbered 7,252.
The nursing instructor is teaching about the lifecycle of HIV. Which is the transcription and translation phase of the HIV lifecycle? Creation of new HIV released from the CD4 cell Binding to the surface of the CD4 cell Fusion of the HIV envelope and cell membrane Creation of HIV proteins used to build more HIV
Creation of HIV proteins used to build more HIV The transcription and translation phase is the creation of HIV proteins used to build more HIV. Fusion of the HIV envelope and the cell membrane is fusion. Release of new HIV from the CD4 cell is budding. Binding to the surface of the CD4 cell is binding.
The nurse teaches a patient with newly diagnosed HIV infection about CD4+ lymphocytes and how it progresses to a chronic period of the disease. Which topic should the nurse include in this teaching? How CD4+ decreases and HIV replicates How CD4+ decreases and HIV does not replicate How CD4+ is unaffected and HIV replicates How CD4+ increases and HIV replicates
How CD4+ decreases and HIV replicates Once the acute infection subsides, most individuals show no clinical manifestations of HIV infection for several years, even in the absence of treatment. However, during this prolonged asymptomatic period, HIV actively replicates, and there is an intense reduction in the half-life of circulating CD4+ T-lymphocytes.
The nurse notes that a fewer number of female patients who are HIV positive have spouses that are also HIV positive. Which explanation should the nurse consider as the reason for this difference in frequency of HIV positive between the genders? Higher concentration of HIV in cervicovaginal secretions Lower concentration of HIV in seminal fluid Absence of HIV in cervicovaginal secretions Lower concentration of HIV in cervicovaginal secretions
Lower concentration of HIV in cervicovaginal secretions HIGHER concentration of HIV in seminal fluid Cervicovaginal secretions contain low, not high, levels of HIV; hence, transmission of HIV from infected women to uninfected men is less likely. Seminal fluid has a higher concentration of HIV than cervicovaginal secretions do. HIV does live in both cervicovaginal and seminal secretions.
The nurse teaches a patient at risk for HIV infection about the symptoms of primary versus symptomatic disease. Which symptoms should the nurse encourage the patient to report as a manifestation of symptomatic disease? Headache Fatigue Kaposi sarcoma Night sweats
Night sweats Night sweats are a manifestation of symptomatic disease. Headache and fatigue are symptoms of both primary infection and symptomatic disease and are also symptoms associated with several non-HIV-related illnesses. Kaposi sarcoma is an AIDS-defining illness.
The nurse reviews the modes of transmission for HIV prior to caring for a patient with the illness. Which mode of transmission should cause the nurse the least concern when providing care? Blood products Saliva and tears Seminal fluid Transplacental
Saliva and tears HIV is not known to be transmitted in tears. It can be transmitted by way of sexual intercourse, in blood products, and from mother to fetus (vertically). HIV has been isolated in the following: Blood Semen Cervicovaginal secretions Cerebrospinal fluid Saliva Tears Breast milk
In which phase of the HIV lifecycle is there creation of HIV proteins that contribute to the building of new HIV virus? Budding Fusion Transcription and translation Binding
Transcription and translation The transcription and translation phase is the creation of HIV proteins used to build more HIV. Fusion of the HIV envelope and the cell membrane is fusion. Release of new HIV from the CD4 cell is budding. Binding to the surface of the CD4 cell is binding.
The nurse is teaching a pregnant patient about the use of antiretroviral medications. Which statement by the patient indicates to the nurse that teaching was successful? "My baby could have multiple birth defects as a result of the antiretroviral medications." "I can't take the antiretroviral medications until the third trimester." "Following the medication regimen can reduce the risk of transmission of HIV to my baby by 90%." "My baby will get HIV even if I take the medications as recommended."
"Following the medication regimen can reduce the risk of transmission of HIV to my baby by 90%." Adherence to current recommendations—including administration of antiretroviral medications to HIV-positive mothers during pregnancy, during delivery, and during breastfeeding—can reduce the risk of vertical transmission by 90%. The risk to the baby is much lower, and therefore the baby will not necessarily be infected. Birth defects are uncommon with the use of antiretroviral medications. The medication regimen is recommended for use throughout the entire pregnancy.
The nurse teaches a patient with HIV infection about the benefits of early highly active antiretroviral therapy (HAART). Which statement by the patient indicates that the teaching has been effective? "HAART causes a decrease in the CD4+ lymphocyte count." "HAART promotes transcription of HIV." "HAART causes an eradication of HIV from the body." "HAART causes suppression of HIV RNA to an undetectable level."
"HAART causes suppression of HIV RNA to an undetectable level." Current treatment guidelines recommend that HAART be offered to all individuals infected with HIV. In patients with early-stage HIV infection, primary treatment goals include suppression of plasma HIV RNA to undetectable levels. The goal is not to decrease the CD4+ count. HIV cannot be eradicated once it is in the body. HAART decreases the probability of replication and therefore does not promote transcription. Risks of early therapy include: Drug toxicities. Development of drug-resistant mutants that will limit treatment options in symptomatic disease. Transmission of drug-resistant mutants to uninfected individuals, thus limiting their treatment options.
The nurse teaches a patient with primary immunodeficiency disease about the risk of tuberculosis.Which statement by the patient indicates that the teaching has been effective? "HIV infection increases the risk of primary tuberculosis." "HIV infection and tuberculosis infections are unrelated." "HIV infection can increase the risk of latent tuberculosis." "HIV infection doesn't increase the risk of latent tuberculosis."
"HIV infection can increase the risk of latent tuberculosis." Although HIV infection does not increase the risk of acquiring tuberculosis (TB) infection, it does increase the risk of activation of latent disease and subsequent dissemination. Among individuals who are infected with HIV, TB is the leading cause of death; therefore, all HIV-infected individuals should undergo annual tuberculin testing.
The nurse reviews the role of body fluids in the transmission of HIV with a group of new nurses. Which statement by a new nurse reflects accurate understanding of HIV transmission? "HIV is transmitted through tears and saliva." "HIV is not known to be transmitted through tears and saliva." "HIV is only transmitted through blood products." "HIV is only transmitted through sexual intercourse and blood products."
"HIV is not known to be transmitted through tears and saliva." HIV is not known to be transmitted in tears or saliva. HIV can be transmitted by way of sexual intercourse, blood products, and maternal-fetal contact (vertical transmission).
The nurse teaches a patient who has just been given a diagnosis of HIV about antiretroviral treatment. Which statement should the nurse make that best describes the goal of antiretroviral treatment? "It prevents the development of drug-resistant strains of HIV." "It kills the HIV in the plasma." "It increases the viral load of HIV in the plasma." "It suppresses plasma HIV RNA to an undetectable level."
"It suppresses plasma HIV RNA to an undetectable level." The purpose of antiretroviral treatment is to suppress the plasma HIV level. Although drug-resistant forms of HIV are becoming more prevalent, the goal of treatment is to suppress the plasma HIV level. HIV cannot be killed. The viral load of HIV should be undetectable in a patient on antiretroviral treatment; it should not increase.
The nurse teaches a patient with primary immunodeficiency disease. Which statement by the patient indicates that teaching has been effective? "Primary immunodeficiency disease causes no change in susceptibility to infection." "Primary immunodeficiency disease causes a decrease in only the natural killer cells." "Primary immunodeficiency disease causes increased susceptibility to infection." "Primary immunodeficiency disease causes decreased susceptibility to infection."
"Primary immunodeficiency disease causes increased susceptibility to infection." Primary immunodeficiency disease increases, not decreases, susceptibility to infection. It affects not only natural killer cells but also B- and T-lymphocytes. The most common manifestations of primary immunodeficiency disease are recurrent, severe, and/or persistent/unresponsive bacterial and viral infections involving both common and opportunistic pathogens and infections with unexpected or severe complications that most often occur in the: Sinuses. Middle ear. Bronchi. Lungs. Gastrointestinal tract.
The nurse teaches a community education class about risk factors for HIV infection. Which statement describes how the presence of genital ulcers increases the risk of HIV infection? "The ulcers represent a fomite in the transmission of illness." "The ulcers provide a portal of entry for HIV." "HIV needs the herpes virus to replicate." "The ulcers are a vector for the transmission of HIV."
"The ulcers provide a portal of entry for HIV." Genital ulcers serve as a portal of entry for the virus. HIV does not need the herpes virus to replicate. Fomites are inanimate objects that transmit illness or disease. Vectors are living organisms that transmit illness and disease. previous
The nursing instructor is teaching about the CD4+ lymphocyte count. Which reason should the nurse explain why the CD4+ T-lymphocyte count exhibits a marked decrease right after the initial infection with HIV? "There is decreased erythropoietin release from the kidneys." "There are low concentrations of HIV." "There are high concentrations of HIV." "There is decreased lymphadenopathy in the lymph system."
"There are high concentrations of HIV." The high level of HIV contributes to a marked decreased in the CD4+ T-lymphocyte count as the body is acutely fighting the infection. The viral count is high, not reduced, during the primary infection. Erythropoietin is not affected during the initial infection. Lymphadenopathy worsens during the primary infection.
The nurse teaches patients about transmission of HIV through blood transfusions. Which statement should the nurse make that is the most accurate regarding the transmission of HIV through a blood transfusion? "Transmission of HIV through blood transfusion has been eradicated." "Transmission of HIV has been reduced by nucleic acid testing of blood products." "Transmission of HIV only occurs through sexual contact." "Transmission of HIV is increased through blood products and blood transfusion."
"Transmission of HIV has been reduced by nucleic acid testing of blood products." Since the introduction of nucleic acid testing of all donated blood products in the 1990s, the risk of transfusion-related infection has been reduced to 1 in 1 million to 1.5 million units transfused. Transmission is not increased by way of blood products. Transmission has not been eradicated, but it has decreased. HIV is transmitted through sexual intercourse, in blood products, and vertically (from mother to fetus).
The nursing instructor is teaching about needlestick transmission of HIV. Which value is the most accurate description of the rate of HIV needlestick transmission? 3% 0.3% 30% 7%
0.3% The risk of needlestick HIV transmission has been shown to be approximately 0.3%. Needlestick transmission is most likely to occur if the wound is deep, if there is visible blood on the instrument, and if the person in whom the contaminated needle was first used has a high viral titer. The 30%, 3%, and 7% values are all incorrect.
A nurse is teaching a patient with HIV infection about the average time frame for the progression to chronic disease. Which time frame given by the patient indicates that the nurse's teaching was effective? 1 year 20 years 2 years 10 years
10 years
Which is the average time frame for the progression of HIV infection to chronic disease? 1 year 2 years 20 years 10 years
10 years Once acute infection subsides, most individuals show no clinical manifestations of HIV infection for several years, even in the absence of treatment. However, during this prolonged asymptomatic period, HIV actively replicates, and there is an intense reduction in the half-life of circulating CD4+ T-lymphocytes. The average duration of this asymptomatic period is 10 years (although it varies considerably), not as little as 1 to 2 years or as long as 20 years. Several host factors can influence the duration of the asymptomatic period: Increased age is associated with accelerated progression to AIDS; heterozygotes for the CCR5 32-bp deletion show delayed progression. Behavioral factors such as smoking, poor nutrition, depression, and unprotected anal intercourse have been correlated with more rapid progression to AIDS. Genetic variations in CD8+ T-lymphocytes, which are involved in the immune response to HIV, are also believed to affect the rate of progression from acute HIV infection to AIDS.
Which is the window of time during which a patient may have a false-negative result on HIV testing? 1 to 2 weeks 12 to 18 months 2 to 6 days 2 weeks to 3 months
2 weeks to 3 months Seroconversion occurs when neutralizing antibodies appear, generally within weeks to months of infection. The interval between infection and the appearance of neutralizing antibodies is called the window period. During this time, HIV testing will detect only HIV antibodies; therefore, individuals with early acute HIV infection may test falsely negative for the infection. As a means of documenting seroconversion when acute HIV infection is suspected, the individual should undergo repeat serologic testing over the next 3 to 6 months.
The nurse teaches about testing required for patients with HIV infection. Which blood test should the nurse emphasize that predicts the classification of HIV disease in an individual? CD4+ lymphocyte count Complete metabolic panel Complete blood count Platelet count
CD4+ lymphocyte count The CD4+ lymphocyte is the cell targeted by HIV, and the percentage is used to classify the stage of illness. Complete blood count, complete metabolic panel, and platelet count may be important in identifying complications arising from HIV infection, but they are not used to stage HIV infection.
Which type of cell does HIV target? Red blood cells CD4+ lymphocytes Natural killer cells Platelets
CD4+ lymphocytes HIV targets CD4+ lymphocyte cells. Natural killer cells, red blood cells, and platelets are not cells targeted by HIV. Characteristics of HIV and how it targets cells: HIV differs in its tropism, or capacity to infect target cells. The major target cells of HIV are CD4-expressing T-helper lymphocytes and macrophages. Although all HIV isolates are capable of infecting CD4+ T-lymphocytes, some also infect macrophages; they are known as macrophage tropic strains (M-tropic). Other viral isolates are capable of infecting only T-lymphocytes and are known as T-cell-tropic strains (T-tropic). Although multiple viral isolates can be transmitted in a single exposure to infected body fluids, M-tropic strains nearly always establish the initial infection.
The nurse is teaching a patient with HIV about illnesses that define AIDS. Which illness identified by the patient indicates that the nurse's teaching was effective? Rhinosinusitis Urinary tract infection Atopic asthma Cytomegalovirus infection
Cytomegalovirus infection Opportunistic infections such as tuberculosis, Kaposi sarcoma, cytomegalovirus, and lymphoma are considered AIDS-defining illnesses. Urinary tract infections, rhinosinusitis, and asthma are illnesses that commonly affect patients without HIV infection. Older adults are among the populations in whom diagnosis of HIV infection tends to be delayed. Many HIV-positive older adults contract AIDS-defining illnesses within 1 year of the initial diagnosis of HIV infection. As a means of ensuring prompt recognition and treatment of HIV infection, measures to promote early identification and treatment of HIV infection, including adherence to recommended screening protocols and education, are essential.
The nurse teaches about primary immunodeficiency disease. Which condition should the nurse emphasize as the result of a primary immunodeficiency disease? A decrease only in natural killer cells No change in susceptibility to infection Decreased susceptibility to infection Increased susceptibility to infection
Increased susceptibility to infection
The nurse assesses a patient with HIV infection. Which term should the nurse use to document this patient's manifestation? Image of most common AIDS-associated malignancy on the leg of an individual with AIDS. Malignant melanoma HIV lymphoma Kaposi sarcoma HIV scleroderma
Kaposi sarcoma The picture depicts Kaposi sarcoma (KS), not malignant melanoma, lymphoma, or scleroderma. Malignant melanoma is a form of skin cancer. Lymphoma is a type of blood cancer that is not seen on the skin. Scleroderma is a hardening of the skin and organs, which is not depicted in this picture. Kaposi sarcoma (KS) is the most common AIDS-associated malignancy: The etiologic agent, human herpes virus 8, has been isolated in all forms of KS. The cell of origin is unknown, although mesenchymal cells, smooth muscle cells, and fibroblasts may be the sites of tumor initiation. Although tumors generally appear in the skin, they may also develop in the oral cavity, gut, lymph nodes, brain, and visceral organs. Histologically, all forms of KS are characterized by interwoven bands of spindle cells and vascular structures contained within a network of collagen and reticular fibers. Dermatological lesions may present as localized or disseminated plaques; brown, red, or purple nodules; or both.
The nurse notes that a patient with an HIV infection is prescribed more than one medication. Which purpose correctly explains the use of a combination of highly active antiretroviral therapy (HAART) medications in this patient? Promote transcription of HIV Kill HIV in the body Prevent viral resistance to the medications Decrease the CD4+ lymphocyte count
Prevent viral resistance to the medications Antiretroviral therapy (ART) is the cornerstone of treatment of HIV infection. Typically, treatment of HIV consists of at least three medications that diminish viral replication. Use of a combination of antiretroviral drugs, sometimes referred to as highly active antiretroviral therapy (HAART), helps decrease viral resistance to the medications. HIV is not killed by HAART, and the goal is to increase, not decrease, the CD4+ count and to decrease replication of the virus.
The nurse is teaching about opportunistic infections. Which part of the human body should the nurse emphasize as being the most often affected by cytomegalovirus (CMV) infection? Brain Retinas Intestines Lungs
Retinas CMV retinitis is the most common CMV infection, accounting for 80% to 90% of all CMV infections among AIDS patients. CMV can also affect the lungs, brain, and intestines, but the retina is most often affected CMV is a double-stranded DNA virus that is carried by 60% of the U.S. population. It can be found in blood, saliva, semen, cervical secretions, and urine. Normally, the immune system inhibits CMV replication, but in individuals with severe immunosuppression (typically when the CD4 T-lymphocyte count drops below 50 cells/mm3), active viral replication can occur, with dissemination to target tissues such as the retina, gut, lungs, and central nervous system.
Which reason correctly explains how antiretroviral medications reduce the risk of HIV transmission? Suppresses plasma HIV RNA to an undetectable level Kills HIV in the plasma Prevents development of drug-resistant strains of HIV Increases the load of HIV in the plasma
Suppresses plasma HIV RNA to an undetectable level The purpose of antiretroviral treatment is to suppress HIV in plasma. Although drug-resistant forms of HIV are becoming more prevalent, the goal of treatment is to suppress the plasma HIV level. HIV virus cannot be killed. The viral load of HIV should be undetectable in a patient undergoing antiretroviral treatment; it should not increase. There are five requirements for HIV to be transmitted to an uninfected individual: There must be an infected host. There must be infectious viral particles in a body fluid. There must be a bolus of infectious particles. Infectious particles must encounter target cells in an uninfected individual. Infected cells must escape clearance from the immune system.
Which benefits should the nurse recognize as the result of early highly active antiretroviral therapy (HAART)? Promotion of transcription of HIV Suppression of HIV RNA to an undetectable level Decrease in the CD4+ T-lymphocyte count Eradication of HIV in the body
Suppression of HIV RNA to an undetectable level Current treatment guidelines recommend that HAART be offered to all individuals infected with HIV. In patients with early-stage HIV infection, primary treatment goals include suppression of plasma HIV RNA to an undetectable level. The goal is not to decrease the CD4+ count. HIV cannot be eradicated once it is in the body. HAART decreases the probability of replication and therefore does not promote transcription. Risks of early therapy include: Drug toxicities. Development of drug-resistant mutants that will limit treatment options in symptomatic disease. Transmission of drug-resistant mutants to uninfected individuals, thus limiting their treatment options.
Which is the resultant effect of seroconversion in HIV infection? The development of neutralizing antigens The development of neutralizing antibodies The development of a viral load count An increase in the CD4+ count
The development of neutralizing antibodies Seroconversion occurs when neutralizing antibodies appear, generally within weeks to months of infection. The period between infection and the appearance of neutralizing antibodies is called the window period. During this time, HIV testing will detect only HIV antibodies; therefore, individuals with early acute HIV infection may test falsely negative for the infection. As a means of documenting seroconversion when acute HIV infection is suspected, the individual should undergo repeat serologic testing over the next 3 to 6 months. The antigen is the HIV virus that initiates an antibody response. The viral load doesn't increase before seroconversion. CD4+ count decreases, not increases, at the time of infection.
