Chapter 35: Caring for Clients with HIV/AIDS

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? CD4+ counts HIV RNA Western blotting assay ELISA

CD4+ counts

Which of the following indicates that a client with HIV has developed AIDS? Severe fatigue at night Pain on standing and walking Weight loss of 10 lb over 3 months Herpes simplex ulcer persisting for 2 months

Herpes simplex ulcer persisting for 2 months

Which condition is an early manifestation of HIV encephalopathy? Hyperreflexia Headache Vacant stare Hallucinations

Headache

A nurse is working with a client who was diagnosed with HIV several months earlier. This client will be considered to have AIDS when the CD4+ T-lymphocyte cell count drops below what threshold? 75 cells/mm3 of blood 200 cells/mm3 of blood 325 cells/mm3 of blood 450 cells/mm3 of blood

200 cells/mm3 of blood

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? distal sensory polyneuropathy (DSP) candidiasis AIDS dementia complex (ADC) cytomegalovirus (CMV)

AIDS dementia complex (ADC)

The nurse is performing an admission assessment on a patient with AIDS. When assessing the patient's gastrointestinal (GI) system what is most likely to be the priority nursing diagnosis? Imbalanced nutrition: more than body requirements Diarrhea Bowel incontinence Constipation

Diarrhea

Which of the following is the first barrier method that can be controlled by the woman? Female condom IUD Diaphragm Birth control pills

Female condom

Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. At present, members of what group are most affected by new cases of HIV? Gay, bisexual, and other men who have sex with men Recreational drug users Blood transfusion recipients Health care providers

Gay, bisexual, and other men who have sex with men

A clinic nurse is caring for a client admitted with AIDS. The nurse has assessed that the client is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? HIV encephalopathy B-cell lymphoma Kaposi's sarcoma Wasting syndrome

HIV encephalopathy

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient? Test for HIV without informing the patient. Test for HIV, requiring the patient to sign a permit. Inform the patient that it would be beneficial to test for HIV. Administer treatment for the STI and discharge the patient.

Inform the patient that it would be beneficial to test for HIV

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Liquids Gluten Sucrose Iron and zinc

Liquids

A male client is having sexual relations with another male as well as using methamphetamine, and has contracted HIV. The nurse is concerned that this client: is a drug addict and needs to stop using. may infect other people because of his drug use. may develop AIDS in a shorter period of time. will remain HIV positive for a longer period of time.

May develop AIDS in a shorter period of time

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? Active substance abuse Depression Past substance abuse Lack of social support

Past substance abuse

A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in? Primary infection Secondary infection Tertiary infection Latent infection

Primary infection

The period from infection with HIV to the development of antibodies to HIV is known as which of the following? Primary infection Viral load Viral set point Anergy

Primary infection

A client asks a nurse, "What can I use to decrease my risk of exposure to HIV?" What will the nurse include as effective in reducing the risk of HIV exposure? Select all that apply. Lambskin condoms Sexual abstinence Latex male condoms Polyurethane female condoms Dental dams

Sexual abstinence Latex male condoms Polyurethane female condoms Dental dams

A nurse is assessing a client with HIV who has been admitted with pneumonia. In assessing the client, which of the following observations takes immediate priority? Oral temperature of 37.2°C (99°F) Tachypnea and restlessness Frequent loose stools Weight loss of 0.45 kg (1 lb) since yesterday

Tachypnea and restlessness

A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? Teach the client guided imagery. Give the client more control of her antiretroviral regimen. Increase the client's activity level. Collaborate with the client's physician to obtain an order for hydromorphone.

Teach the client guided imagery

The lower the client's viral load, the shorter the time to AIDS diagnosis. the longer the survival time. the shorter the survival time. the longer the time immunity.

The longer the survival time

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior? The nurse wears face protection, gloves, and a gown when irrigating a wound. The nurse performs hand hygiene with a waterless antiseptic agent after removing a pair of soiled gloves. The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.

The nurse puts on a second pair of gloves over soiled gloves while performing a bloody precedure

A client who is HIV/AIDS positive has orders for laboratory tests to be performed. What precautions should the nurse observe whenever there is a risk of exposure to the blood and body fluids of an infected client? Avoid any physical contact with the client. Avoid cleaning up spilled urine and feces. Wear barrier garments for as long as possible after leaving a client's room. Transport the specimens of body fluids in leak-proof containers.

Transport the specimens of body fluids in leak-proof containers.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? Urine Semen Blood Breast milk

Urine

A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? The client will be required to stop medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. Viral load and T4-cell counts will be performed every 2 to 3 months. More antiretroviral medication will be added every 2 to 3 months. The Western blot test will be monitored every 6 months to see if the virus is still present.

Viral load T4-cell counts will be performed every 2 to 3 months

A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? Another EIA test Viral load test Western blot test CD4/CD8 ratio

Western blot test

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? diarrhea and abdominal pain numbness in the extremities and decreased cognition alterations in renal function pancreatitis

diarrhea and abdominal pain

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "You should take the drug with an antacid." "It doesn't matter if you take this drug with or without food." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "When you take this drug, eat a high-fat meal immediately afterwards."

"Be sure to take this drug about 1/2 our before or 2 hours after you eat."

An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? "There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV." "Your physician is likely the best one to ask that question." "If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now." "It's possible that your baby could contract HIV, either before, during, or after delivery."

"It's possible that your baby could contract IV, either before, during, or after delivery."

A nurse is preparing to administer saquinavir, which is prescribed for a client who is HIV positive. What type of drug does the nurse identify saquinavir as? Fusion inhibitor Protease inhibitor (PI) Non-nucleoside reverse transcriptase inhibitor (NNRTI) Nucleoside reverse transcriptase inhibitor (NRTI)

Protease inhibitor (PI)

A client was tested for HIV as part of a screening process and has just been told that the results were positive. What anticipatory guidance should the nurse provide to the client? The client will be retested for HIV in 6 weeks and in 3 months Antiretroviral therapy will begin within 3 months A follow-up test will be promptly performed to confirm the result The client will be monitored for signs and symptoms of HIV infection to determine if treatment is necessary

A follow-up test will be promptly preformed to confirm the result

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? Antibodies to HIV are not present in his blood. He has not been infected with HIV. He is immune to HIV. Antibodies to HIV are present in his blood.

Antibodies to HIV are not present in his blood

The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick? Have the patient placed in restraints. Ask for assistance. Refuse to start the IV. Give the client a sedative prior to starting the IV.

Ask for assistance

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? Sign a refusal of blood transfusion form so the client will not receive the transfusion. Bank autologous blood. Ask people to donate blood. Using volume expanders in case blood is needed.

Bank autologous blood

A client with a history of IV drug use is HIV-positive. The client has been following an antiretroviral medication regimen faithfully and is doing well, attending college to get a social work degree, and focused on a bright future. In regular CD counts, what factor will indicate that this client has progressed from HIV to AIDS? CD count <200/mm CD count >200/mm CD count <100/mm CD count >100/mm

CD count <200/mm

A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? Severe joint pain Lymphedema of the lower extremities Deep purple cutaneous lesions Venous stasis and phlebitis formation

Deep purple cutaneous lesions

A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention? Lifestyle actions that improve immune function Educational programs that focus on control and prevention Appropriate use of standard precautions Screening programs for youth and young adults

Educational programs that focus on control and prevention

A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's: Electrolyte levels Oral mucus membranes Abdominal girth White blood cell (WBC) count

Electrolyte levels

Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) p24 antigen Reverse transcriptase Enzyme immunoassay (EIA)

Enzyme immunoassay (EIA)

A nurse is teaching a health education class to a group of young adults and perceives that misinformation exists about the signs, symptoms, and trajectory of HIV infection. The nurse should inform participants that the first symptoms of HIV exposure include: Fever, headache, and malaise Pneumonia-like symptoms and increased sputum production Rapid weight loss and anorexia Painful lesions on the vulva or the shaft of the penis

Fever, headache, and malaise

The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? Apply the condom prior to erection. A condom may be reused with the same partner if ejaculation has not occurred. Use skin lotion as a lubricant if alternatives are unavailable. Grasp the condom by the cuff after withdrawal.

Grasp the condom by the cuff after withdrawal

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? means of transmission HIV-1 is more prevalent than HIV-2 subtypes the fact that it is a mutated virus originally thought to be bovine in nature cure rate

HIV-1 is more prevalent than HIV-2 subtypes

A client who has AIDS has been admitted for the treatment of Kaposi sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? Risk for Disuse Syndrome Related to Kaposi Sarcoma Impaired Skin Integrity Related to Kaposi Sarcoma Diarrhea Related to Kaposi Sarcoma Impaired Swallowing Related to Kaposi Sarcoma

Impaired skin integrity related to Kaposi Sacroma

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? Molluscum contagiosum Tuberculosis of the skin Kaposi's sarcoma Seborrheic dermatitis

Kaposi's sarcoma

The nurse care plan for a client with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? Maximize the client's fluid intake. Provide total parenteral nutrition (TPN). Keep the client's bed linens free of wrinkles. Provide the client with snug clothing at all times.

Keep the client's bed linens free of wrinkles

The nurse teaches the client that reducing the viral load will have what effect? Shorter time to AIDS diagnosis Longer survival Shorter survival Longer immunity

Longer survival

A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effects should the nurse closely monitor in the client? numbness in extremities hypotension emboli dyspnea

Numbness in exremities

A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate? Position the client in the high Fowler position whenever possible. Temporarily eliminate animal protein from the client's diet. Make sure the client eats at least two servings of raw fruit each day. Obtain a stool culture to identify possible pathogens.

Obtain a stool culture to identify possible pathogens

Which nursing actions essential before an ELISA test is performed? Obtain a written consent from the client. Perform a Western blot test. Perform a polymerase chain reaction test. Provide the client with plenty of fluids.

Obtain a written consent from the client.

A client with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this client should expect the health care provider to prescribe what medication for the management of the client's diarrhea? Azithromycin Octreotide acetate Levofloxacin Clarithromycin

Octreotide acetate

A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? Perianal region and oral mucosa Sacral region and lower abdomen Scalp and skin over the scapulae Axillae and upper thorax

Perianal region and oral mcosa

A client with human immunodeficiency virus (HIV) develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this client? Mycobacterium avium complex (MAC) Pneumocystis pneumonia Tuberculosis Community-acquired pneumonia

Pneumocystis pneumonia

The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? Cytomegalovirus Legionnaire's disease Mycobacterium tuberculosis Pneumocystis pneumonia

Pneumocystis pneumonia

As a result of a needlestick injury, a hospital nurse has experienced percutaneous exposure to the blood of a client who is HIV-positive. The nurse has informed the supervisor and identified the client. What action should the nurse take next? Flush the wound site with chlorhexidine. Report to the emergency department or employee health department. Apply a hydrocolloid dressing to the wound site. Follow up with the nurse's primary care provider.

Report to the emrgency department or employee health department

Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? Deoxyribonucleic acid (DNA) Ribonucleic acid (RNA) Viral core Glycoprotein envelope

Ribonucleic acid (RNA)

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? Bathing or hygiene self-care deficit Ineffective cerebral tissue perfusion Complicated grieving Risk for injury

Risk for injury

The nurse knows to follow the CDC's guidelines for Standard Precautions while caring for patients regardless of known or unknown infectious status. The nurse is aware that barrier protection is not necessary for which body fluid? Pleural Sweat Amniotic Synovial

Sweat

A client is in the primary infection stage of HIV. What is true of this client's current health status? The client's HIV antibodies are successfully, but temporarily, killing the virus. The client is infected with HIV but lacks HIV-specific antibodies. The client's risk for opportunistic infections is at its peak. The client may or may not develop long-standing HIV infection.

The client is infected with HIV but lacks HIV-specific antibodies

A client will be having a hysterectomy and wants her daughter to provide directed donor blood. What factor would eliminate her daughter from donating the blood? The daughter is 15 years of age. The daughter weighs 124 lb. The daughter is negative for HIV. The physician has been notified of the procedure.

The daughter is 15 years of age.

A client has discussed therapy for HIV-positive status. The goal of antiretroviral therapy is to: reverse the HIV+ status to a negative status. treat mycobacterium avium complex. eliminate the risk of AIDS. keep the CD4 cell count above 350/mm3 and viral load undetectable.

keep the CD4 cell count above 350/mm3 and viral load undetecable

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? trimethoprim-sulfamethoxazole nystatin amphotericin B fluconazole

timethoprim-sulfamethoxazole

A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse? "A man should wear a latex condom during intimate sexual contact." "I've heard about people who got AIDS from blood transfusions." "I won't donate blood because I don't want to get AIDS." "I.V. drug users can get HIV from sharing needles."

"I won't donate blood because I don't want to get AIDS."

A client requires a blood transfusion for anemia and is concerned about the risk of contracting acquired immune deficiency syndrome (AIDS). What is the best response by the nurse? "It is always a possibility." "You don't want to die, do you?" "The blood is screened very carefully; the risk is 1 in 2,000,000." "If you don't have the transfusion, you are taking a greater risk."

"The blood is screened very carefully; the risk is 1 in 2,000,000."

A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? Administer antidiarrheal medications on a scheduled basis, as prescribed. Encourage the client to eat three balanced meals and a snack at bedtime. Increase the client's oral fluid intake. Encourage the client to increase his or her activity level.

Administer andtidiarrheal medications on a scheduled basis, as prescribed

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: Anorexia. Chronic diarrhea. Nausea and vomiting. Oral candida.

Chronic diarrhea

A client with acquired immune deficiency syndrome (AIDS) comes to the clinic reporting difficulty swallowing. The client says, "It hurts so much when I swallow." Inspection reveals creamy white patches in the client's mouth. What will the nurse suspect? Candidiasis Wasting syndrome Cryptococcus neoformans Clostridium difficile diarrhea

Candidiasis

A male patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows antibodies to the AIDS virus are present in the blood, this indicates what? The patient is immune to HIV. AIDS is inactive in the body. The patient may have unprotected intercourse because he is not infected with HIV. The patient has been infected with HIV.

The patient has been infected with HIV

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client probably has a case of the flu and you should give acetaminophen." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider."

"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."

When do most perinatal HIV infections occur? Through breastfeeding In utero After exposure during delivery Through casual contact

After exposure during delivery

An HIV-infected client presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the client's increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug? Azithromycin Vancomycin Levofloxacin Fluconazole

Azithromycin

A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? Appropriate use of prophylactic antibiotics Importance of personal hygiene Signs and symptoms of wasting syndrome Strategies for adjusting antiretroviral dosages

Importance of personal hygiene