Study Guide Ch. 17: Concepts of Care for Patients with HIV Disease

Which factor does the nurse consider most likely to be responsible for promoting infection development in an older adult client after an HIV exposure? A. Decline in the overall efficiency of the immune system B. Belief that HIV is not an issue for older people C. Reluctance to discuss sexual activity with a health care professional D. Mistaking signs/symptoms as normal part of aging

A A major part of susceptibility for developing HIV infection after an exposure is the efficiency of the client's immunity. All immunity decreases with age, placing the older adult client more at risk for infection after any type of infectious exposure, including HIV.

What is the nurse's best response to a client considering pre-exposure prophylaxis who asks why HIV testing must be performed every 3 months while on this therapy? A. "If you should become HIV positive while taking this therapy, your disease may become drug resistant." B. "Continued monitoring of your HIV status allows us to calculate the lowest effective dose you need." C. "The protection prophylaxis provides is effective against HIV but not against other infections." D. "If you are not monogamous, you could transmit the disease to your other partners."

A If pre-exposure prophylaxis is used in clients who become infected with HIV-I, the risk for developing drug resistance greatly increases. Thus, clients on this therapy must adherer to an every 3-month HIV testing schedule. The best dose for this therapy is generally established and is not modified individually. It is true that the therapy does not protect against other sexually transmitted infections, but that is not the reason HIV status must be monitored, nor is the fact that if the client becomes HIV positive, he or she could transmit the disease to another person.

Which precautions (in addition to Standard Precautions) will the nurse initiate for the newly admitted client who has HIV-III and symptoms that include cough, dyspnea, chest pain, fever, chills, night sweats, weight loss, and anorexia? A. Airborne Precautions B. Enteric Precautions C. Contact Precautions D. Droplet Precautions

A The client's symptoms are consistent with tuberculosis (TB), which is common in HIV-III and can be difficult to diagnose because standard TB skin testing may not be accurate and also takes 48 to 72 hours, during which time the client is contagious. Airborne precautions are most appropriate for TB because the organism is suspended in the air for long periods of time and does not form heavy droplets.

A nurse who is HIV positive and is now a client on a surgical unit the day after abdominal surgery asks a nurse colleague to keep her HIV status from the rest of the nursing staff. What is the unit nurse's best response? A. "Of course, there is no need for anyone else here to know." B. "Unless you require a blood transfusion, this should not be a problem." C. "I will only inform the person who is assigned to change your dressing." D. "I cannot promise that because I have an ethical obligation to protect everyone who works here."

A The consistent use of Standard Precautions is sufficient to prevent HIV transmission from an infected client to a health care worker. Standard Precautions are universally applied and, thus, the client's HIV status does not need to be disclosed regardless of whether a blood transfusion is needed or dressing changes are needed. Although the nurse does have an obligation to ensure safety for all personnel, there is no ethical, legal, or other reason to not comply with the client's wishes.

Which noninfection-related health promotion behavior is a priority for the nurse to teach a client with HIV disease at stage II? A. Exercise regularly and maintain a healthy weight. B. Avoid salt substitutes and foods high in potassium. C. Do not travel to countries outside of North America. D. Avoid using acetaminophen and any type of NSAID.

A With appropriate antiviral therapy, HIV stage II can last decades. However, the disease itself and many of the drugs used for its management increase the risk for diabetes and coronary artery disease, which are common causes of death for an HIV-positive client. A healthy weight and regular exercise help reduce the risks for these problems. Unless kidney impairment is present, potassium is not restricted. Infection risk is not great at this stage and there are no specific travel restrictions related to the client's health. There is no specific recommendation to avoid acetaminophen or NSAIDs during this stage of HIV disease.

Which conditions, all present in a female client, alert the nurse to the possibility of HIV infections? Select all that apply. A. Chronic vaginal candidiasis B. Pelvic inflammatory disease C. Spontaneous abortion D. Chronic sinus infection E. Mononucleosis F. Genital herpes

A, B, F Although any one of these conditions may occur in any client, when chronic vaginal candidiasis occurs in a woman who has genital herpes and a history of pelvic inflammatory disease (most often caused by a sexually transmitted infection), the client may have HIV disease. Spontaneous abortion, sinus infection, and mononucleosis are not associated with HIV disease either as a cluster of problems or as an individual problem.

Which type of focused assessment is a priority for the nurse to perform for an HIV-positive client who has toxoplasmosis encephalitis? Select all that apply. A. Performing a mental status examination B. Assessing heart rate and rhythm C. Asking about headache presence D. Palpating the abdomen for tenderness E. Listening for bowel sounds F. Assessing neck movement

A, C Infection with Toxoplasma gondii causes encephalitis with symptoms of headache and acute confusion. Neck stiffness is associated with meningitis, not encephalitis. Heart rhythm changes and GI disturbances are not part of the toxoplasmosis encephalitis.

Which items will the nurse tell family members living with a client who is HIV positive to avoid sharing to prevent the spread of HIV? Select all that apply. A. Safety razor B. Dishes C. Towels D. Toilet E. Shoes F. Toothbrushes

A, F Anyone living with a client who is HIV positive is taught to avoid sharing items that might have the client's blood on them, which include safety razors and toothbrushes. Dishes and eating utensils do not pose an HIV transmission risk to the family (although family infections could be transmitted to the client). Sharing of towels, toilets, and shoes pose no HIV transmission risk to anyone living with an HIV-positive client.

Which change in laboratory immune indicators does the nurse expect to find in a client whose HIV disease is at stage HIV-III (AIDS)? A. Leukocytosis B. Lymphocytopenia C. High plasma macrophage count D. Increased functional antibody production

B At stage HIV-III, the immune system is profoundly suppressed with decreased numbers of all immune system cell types, especially lymphocytes. Leukocytosis is an increase in the total white blood cell count, not a decrease. Macrophage do not circulate in the blood. Although antibody production may be increased, the antibodies produced are incomplete and nonfunctional.

Which part of the HIV infection process is disrupted by the antiretroviral drug class of CCR5 antagonists? A. Activating the viral enzyme "integrase" within the infected host's cells B. Binding of the virus's gp120 protein to one of the CD4+ co-receptors C. Clipping the newly generated viral proteins into smaller functional pieces D. Fusing of the newly created viral particle with the infected cell's membrane

B CCR5 antagonists work by binding to and blocking the CCR5 receptors on CD4+ T-cells, the main target of HIV. In order to successfully enter and infect a host cell, the virus must have its gp120 protein attach to the CD4 receptor and have its gp41 bind to the CD4+ T-cell's CCR5 receptor. Viral binding to both receptors is required for infection. By blocking the HIV's attachment to the CCR5 receptor, infection is inhibited.

What is the nurse's best response to an assistive personnel (AP) who is upset because "Some of the client's spit got on my arm when I was helping him with oral hygiene, and he is HIV positive?" A. "Don't worry about it. A little bit of saliva is no big deal." B. "Wash your arm; saliva is not infectious with HIV unless it is bloody." C. "Use alcohol-based handrub on your arm and go to employee health for HIV testing." D. "Next time, wear a gown and stand back during the swish and spit."

B Intact skin is not a portal of entry for HIV even if contaminated blood is in contact with it. The correct procedure is just to wash the area with soap and water. HIV testing is not necessary. Helping the AP to calm down is a nursing responsibility and the nurse does not just dismiss the AP's concern. A gown would not be needed according to the information provided in this question.

A young male client who has just been diagnosed as HIV positive suspects that he contracted the virus from a sex worker several weeks ago and is worried because he had sex with his girlfriend several days ago. What is the nurse's best response? A. "The virus needs time to replicate, so your girlfriend is not at risk unless you have symptoms." B. "Even in the early phase, it is possible to transmit the HIV virus and your girlfriend should be told and tested." C. "HIV always progresses to AIDS. You and your girlfriend need to start antiviral medication right away." D. "This is a reportable disease and you need to contact the health department so that both women can be informed."

B It is possible to transmit the disease even in the early stages of the disorder. Also, the client does not know for sure when he acquired the disorder. His girlfriend is at risk and should be told so that she has options for testing. HIV disease does not always progress to AIDS and only those who are found to be HIV positive should be taking life-long therapy. Although all states require that new cases of HIV-III (AIDS) be reported, not all states require reporting of HIV-positive status.

The client with HIV-III (AIDS) and pain is refusing to take the newly prescribed antidepressant amitriptyline, stating that depression is not a problem. What is the nurse's best response? A. "Depression is common in adults with AIDS and can make pain worse." B. "In addition to helping depression, this drug can reduce neuropathic pain." C. "Your primary health care provider knows all the latest drugs and would only have prescribed this one if it were needed." D. "I will notify your primary health care provider to check whether a drug with a similar sounding name is what should have been prescribed."

B The client has the right to refuse any drug but should only do so when adequately informed about the reason the therapy was prescribed and all of its side effects. Although amitriptyline is an antidepressant, it is effective in reducing neuropathic pain for many clients.

With which activities does the nurse teach assistive personnel (AP) caring for a client who is HIV positive to wear gloves to prevent disease transmission? Select all that apply. A. Applying lotion during a back rub B. Brushing the client's teeth C. Emptying a Foley catheter reservior D. Feeding the client E. Filing the client's fingernails F. Proving perineal care

B, C, F Standard Precautions for preventing the spread of any type of infection including HIV requires wearing gloves when coming into contact with mucous membranes, including oral and perineal membranes, as well as secretions and excretions. Although saliva has a low concentration of HIV unless frank blood is present, gloves are used for this task because of potential contact with the moist mucous membranes of the mouth. Standard Precautions require that gloves be worn when contact with urine is possible, including during such tasks as emptying a Foley catheter reservoir. Perspiration is not considered a body fluid with risk for transmission and neither is contact with transmissible fluids, nor should clipping finger nails.

Which factors or problems in an HIV-positive client does the nurse know increases the risk for HIV transmission? Select all that apply. A. Diarrhea B. High viral load C. Chronic confusion D. HIV positive partner E. Pneumocystis pneumonia F. Nonadherence to the drug regimen

B, C, F The higher the viral load, the greater the risk for transmission. Chronic confusion often reduces the client's adherence to drug therapy, which may cause inadequate suppression of viral replication and a higher viral load. Also, a confused client may not use other transmission prevention techniques. Diarrhea does not increase the transmission of HIV. Pneumocystis pneumonia is an opportunistic infection and does not increase HIV transmission risk. Having an HIV-positive partner does not increase the client's risk for transmitting the disease to anyone else.

Which client conditions experienced over the past year indicates to the nurse that the client's HIV status may have progressed to HIV-III (AIDS)? Select all that apply. A. Had influenza 2 months ago. B. Diagnosed with invasive cervical cancer C. Lost his long-term partner to heart disease 6 months ago. D. Had two episodes of bacterial pneumonia in the past year. E. Developed hepatitis A during a vacation to South America. F. Had an abscessed tooth that required treatment by root canal.

B, D Invasive cervical cancer and two or more episodes of bacterial pneumonia within a 12-month period are AIDS-defining illnesses. Anyone, even a person with a healthy immune system can get influenza, an abscessed tooth, or hepatitis A (when exposed to the virus). Having a partner who died from heart disease is not in itself an indicator that the partner had late-stage HIV disease.

Which assessment is a priority for the nurse caring for a client with HIV-III (AIDS) who has an exacerbation of cryptosporidiosis? A. Assess breath sounds and respiratory status. B. Assess neurologic status and presence of headache. C. Assess for signs of dehydration and electrolyte imbalance. D. Assess for difficulty in swallowing and pain behind the sternum.

C Cryptosporidiosis is an intestinal infection caused by Cryptosporidium organisms with problems ranging from a mild diarrhea to a severe wasting with electrolyte imbalance and dehydration. Oral and esophageal candidiasis causes difficulty swallowing and pain behind the sternum. Severe headache and neurologic changes are associated with Toxoplasma gondii infection. Respiratory problems are associated with Pneumocystis jiroveci infection.

Which factors increase the efficiency of infection by the human immune deficiency virus (HIV)? A. Is activated by contact with antibodies B. Is activated by normal human enzymes C. Contains the enzyme reverse transcriptase D. Has DNA similar to human DNA as its genetic material

C HIV is a type of retrovirus, which is a family of viruses that use RNA as their genetic material instead of DNA and have three special enzymes to ensure infection. These viruses can insert their RNA into a human cell's DNA with the enzyme reverse transcriptase to exert control over the human cell's actions. Thus, the HIV retrovirus is very efficient at infecting host cells.

When educating women clients about HIV prevention, which route does the nurse emphasize as the most common way women acquire the disease? A. Prenatal transmission during the birth process B. Sex with an infected female partner C. Sex with an infected male partner D. Injection drug use

C In North America and worldwide, the most common route of HIV transmission to women is by having sex with an infected male partner.

Which symptoms reported by a client who has HIV III (AIDS) indicates tot eh nurse possible infection with Pneumocystis jiroveci? A. Chronic diarrhea and weight loss B. Severe headache and neck stiffness C. Persistent dry cough and breathlessness D. Pain behind the sternum and difficulty swallowing

C Infection with Pneumocystis jiroveci causes a form of pneumonia resulting in persistent dry cough and breathlessness. Infection with Candida albicans causes pain behind the sternum and difficulty swallowing. Severe headache and neck stiffness is associated with Toxoplasma gondii infection. Chronic diarrhea and weight loss have many causes, some of which are infectious; however, Pneumocystis jiroveci does not cause these symptoms.

Which HIV-positive client does the nurse expect will progress to HIV-III (AIDS) the most quickly? A. Adult female who has one-time sex with an HIV-positive partner B. Older male who has vaginal sex with an HIV-positive female C. Adult male who is transfused with HIV-contaminated blood D. Older nurse who is stuck with an HIV-contaminated needle at work

C The development of HIV disease and its course of progression depends on transmission route and degree of viremia. A client who received HIV-contaminated blood has a much higher risk for development of HIV disease and more rapid progression to HIV-III than the other listed exposures. Even having sex once with an HIV-positive partner has only a 10% to 20% risk to result in infection. An uninfected male having sex with an infected female has a lower risk for successful infection. Even being stuck with an HIV-contaminated needle once is less likely to result in HIV disease than is receiving a blood transfusion with HIV-contaminated blood.

Which assessment findings in a client who is HIV positive and has new-onset acute confusion will the nurse report immediately to the immunity health care provider? Select all that apply. A. Alopecia B. Substernal pain C. Unequal pupil size D. Reduced grip strength E. Numbness of the fingers and toes F. Dry mouth with sticky tongue coating

C, D New-onset acute confusion is associated with several serious central nervous system problems that can increase intracranial pressure (ICP). Increased ICP requires immediate intervention to prevent brain impairment. Indicators include unequal pupil size or reactivity and reduced grip strength. Numbness of the fingers and toes is a peripheral nerve problem, not a CNS problem and is not associated with increased ICP. Alopecia, substernal pain, and dry mouth are not CNS problems indicating possible increased ICP.

Which personal protective equipment does the nurse assemble for use when giving oral and parenteral drugs care to an HIV-positive client who has amoebic diarrhea? Select all that apply. A. Air-purifying repirator B. Eye goggles C. Gloves D. Gown E. Hair cover F. Surgical mask

C, D When performing the action of giving either oral or parenteral drugs to any client with diarrhea, including those who are HIV positive, only Contact Precautions are needed.

The rate of new HIV infection in North America is highest among which groups people? A. White homosexual men and women B. Older non-monogamous heterosexual men and women C. Asian women who have sex with men D. Black and Hispanic men and women

D Although the prevalence of HIV infection in North America is highest among men who have sex with men, the incidence of new cases is highest among Black and Hispanic men and women. Another emerging population of HIV-positive individuals is transgender females.

What is the most common route by which nurses and other health care workers or providers are exposed to the HIV virus when caring for HIV-positive cleints? A. Getting blood on exposed skin on hands or arms B. Touching infected body fluids with bare hands C. Have urine splashed on mucous membranes D. Sharps injuries with contaminated needles

D Needlestick sharps injuries remain common in health care settings even though new equipment and action rules (i.e., do not recap needles) have reduced their incidence.

Based on the concept of "Treatment as Prevention," which outcome statement indicates to the nurse that the goal of combination antiretroviral therapy for an HIV-positive client is being met? A. Client states understanding of the prescribed medication regimen. B. Client's disease stage is classified as unknown. C. Opportunistic infections are not present. D. Viral load is at an undetectable level.

D Understanding the medication regimen is not sufficient. When it is followed and the client's viral load is undetectable, the goal of treatment as prevention has been met. An unknown disease stage is dangerous and does not help in prevention. Absence of opportunistic infection is a positive sign and may indicate the disease has not progressed, but does not indicate the goal of prevention has been met.

A client diagnosed with HIV-III (AIDS) who is receiving combination antiretroviral therapy (cART) now has a CD4+ T-cell count of 525 cells/mm3. How will the nurse interpret this result? A. The client can reduce the dosages of the prescribed drugs. B. The virus is resistant to the current combination of drugs. C. The client no longer has AIDS. D. The drug therapy is effective.

D When a client diagnosed with HIV-III (AIDS) has a CD4+ T-cell count increase as a result of therapy, the diagnosis of AIDS remains. The fact that the T-cell count has risen indicates the combination of drugs used for therapy are effective; however, the dosages are not decreased.

Which routes are the most common means of HIV transmission? Select all that apply. A. Airborne B. Enteral C. Oral D. Parenteral E. Perinatal F. Sexual

D, E, F Infected body fluids with highest HIV concentrations are semen, blood, breast milk, and vaginal secretions. HIV is transmitted most often by these routes: 1) sexual (genital, anal, or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretions), 2) parenteral (sharing of needles or equipment contaminated with infected blood or receiving contaminated blood products), and 3) perinatal (across the placenta, from contact with maternal blood and body fluids during birth, or through breast milk from an infected mother to child.

Which findings would the nurse expect when assessing a client with HIV disease at HIV-I classification? Select all that apply. A. Multiple Kaposi's sarcoma lesions B. One or more opportunistic infections C. Emaciation from AIDS wasting syndrome D. No indications of an AIDS-defining illness E. HIV antibody negative and undetectable viral load F. CD4+ T-cell count of greater than 500 cells/mm3.

D, F HIV-I classification is applied to clients who are HIV antibody positive, have no AIDS-defining illnesses, and have an immune profile in which the CD4+ T-cell count is greater than 500 cells/mm3. Their viral load may be undetectable but their antibody test is positive. The immune function to prevent any opportunistic infection or AIDS-defining illness.

Which actions does the nurse recommend for a night shift co-worker, who just experienced a sharps injury from a known HIV-positive source client, to take immediately? Select all that apply. A. Go to the emergency department immediately for a tetanus booster vaccination. B. Immediately use an alcohol-based handrub on the injured area. C. Notify employee health tomorrow morning when it opens. D. Ask your sex partner to have HIV testing as soon as possible. E. Wash the injured area immediately for at least 1 minute with soap and water. F. Make an appointment with the nursing department and request a transfer to an area where direct physical contact with a client is not expected.

E The first step with a sharps injury from a known HIV-positive source is to wash the hands thoroughly with soap and water for at least 1 minute. Using an alcohol-based handrub is not sufficient for this purpose. Although the co-worder should go immediately to the emergency department, the purpose is to initiate postexposure prophylaxis and begin documentation, not to get a tetanus booster (irrelevant to this situation). Notifying employee health to continue documentation and prophylaxis is important but cannot be done immediately. The co-worker's sex partner should have HIV testing relatively soon, but not immediately, to determine his or her current status. There is no legal, ethical, or medical reason for the co-worker to avoid direct physical contact with clients.