HIV Chap 22

CD4+ count is less than 200 cells/µL Esophageal candidiasis Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Toxoplasmosis correct. As the body weakens, the HIV virus will progress to AIDS. AIDS is defined by two things. The patient may have a CD4+ count is less than 200 cells/µL or present with an AIDS-defining illnesses or opportunistic infections. AIDS-defining illnesses include: Pneumocystis (carinii) jiroveci pneumonia, Mycobacterium avium complex, toxoplasmosis, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. The patient may also develop pain while swallowing due to esophageal candidiasis.

AIDS CD4+ count is less than 200 cells/µL Esophageal candidiasis Hodgkin's lymphoma Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Toxoplasmosis

Low-grade fever Generalized aches and pains Swollen lymph nodes Rapid viral load increase correct. During the acute viral infection and seroconversion, the CD4+ lymphocyte count rapidly decreases and the viral load rapidly increases as the HIV virus spreads. The individual may experience flu-like symptoms during this time including low-grade fever, generalized aches and pains, swollen lymph nodes, and generally feeling ill. After several weeks, the person's immune system develops antibodies to HIV, seroconversion occurs, and the person tests positive for HIV.

Acute Viral Infection and Seroconversion Low-grade fever Generalized aches and pains Cramps and diarrhea Swollen lymph nodes Rapid viral load increase Drop in blood pressure Rapid CD4+ count increase

Drop in viral load CD4+ count near normal correct. During the asymptomatic chronic infection stage, the body's immune system is able to maintain control over the invading virus by increasing the CD4+ count as the viral load drops to a set point. Total elimination of the virus is not possible, but the patient is asymptomatic. It is important to recognize that the virus can still be transmitted during the phase.

Asymptomatic Chronic Infection Vision changes Night sweats Weight loss Drop in viral load CD4+ count near normal Noncontagious

Acquired immune deficiency syndrome

At which stage will the client's immune system become symptomatic and unable to fight the progression of the virus? Seroconversion Asymptomatic chronic infection Symptomatic chronic infection Acquired immune deficiency syndrome

"The pneumocystis carinii pneumonia often causes shortness of breath with activity." Rationale: PCP is a possible reason for an HIV-infected client developing DOE, but not at rest. "It is probably from the aphthous ulcers you have in your throat." Rationale: Aphthous ulcers result in symptoms like pain when swallowing. "It's not uncommon for this to happen when there is a central nervous system infection." Rationale: A central nervous system infection results in symptoms like mental status changes. "Your mycobacterial infection can cause these symptoms." Rationale: A mycobacterial infection results in symptoms like night sweats. Test-Taking Tip Winded is a common term for short of breath. Question ID:MEDS2-HIVE-1 Course Topic:HIV and AIDS Concept:Infection, Nursing Roles Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Physiological Integrity Chapter:Chapter 22, Coordinating Care for Patients with HIV Page Reference:p. 429

Question 1 of 10 The nurse is caring for a client with HIV. During ambulation, the client says, "I don't understand why I get so winded when I walk." How should the nurse reply? "It is probably from the aphthous ulcers you have in your throat." "The pneumocystis carinii pneumonia often causes shortness of breath with activity." "It's not uncommon for this to happen when there is a central nervous system infection." "Your mycobacterial infection can cause these symptoms."

Room 448 Rationale: Appendicitis is not a communicable infection and would make an appropriate roommate. Room 445 Rationale: A teen with pelvic inflammatory disease has an infection and should not be paired with an immune compromised client. Room 446 Rationale: Pneumonia is infectious and should not be paired with an immune compromised client. Room 447 Rationale: A client with dementia will be confused and may require constant observation. This could be disruptive to another client. Test-Taking Tip Consider if the infection is contagious or not when making this decision. Question ID:MEDS2-HIVE-10 Course Topic:HIV and AIDS Concept:Infection, Nursing Roles, Immunity, Management Cognitive:Synthesis [Creating] Difficulty Level:Difficult Client Need:Safe and Effective Care Environment Chapter:Chapter 22, Coordinating Care for Patients With HIV Page Reference:p. 436

Question 10 of 10 The charge nurse is admitting a young-adult client with symptomatic chronic HIV infection. Which room should the client be assigned? Room 445 Room 446 Room 447 Room 448

Perform hand washing for a minimum of 15 to 30 seconds, and use personal protective equipment. Rationale: Perform hand washing for a minimum of 15 to 30 seconds, and use personal protective equipment. Ensure that antiretroviral drugs (ART) are administered within 1 to 2 hours of the scheduled time. Rationale: Ensure that antiretroviral drugs (ART) are administered within 1 to 2 hours of the scheduled time. Include small, frequent meals and snacks such as nuts or nutritional supplements as ordered. Rationale: Include small, frequent meals and snacks such as nuts or nutritional supplements as ordered. Try to be nonjudgmental when caring for a client with AIDS. Rationale: Try to be nonjudgmental when caring for a client with AIDS. Provide referrals to social services to assist in the high cost of medication maintenance. Rationale: Provide referrals to social services to assist in the high cost of medication maintenance. Test-Taking Tip Regardless of the stage of HIV infection, care is the same when planning care. Question ID:MEDS2-HIVE-2 Course Topic:HIV and AIDS Concept:Infection Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Safe and Effective Care Environment Chapter:Chapter 22, Coordinating Care for Patients with HIV Page Reference:p. 435

Question 2 of 10 The nurse is preparing to provide care for a client with symptomatic chronic infection of HIV. Which actions should the nurse take in planning care? Select all that apply. Perform hand washing for a minimum of 15 to 30 seconds, and use personal protective equipment. Ensure that antiretroviral drugs (ART) are administered within 1 to 2 hours of the scheduled time. Include small, frequent meals and snacks such as nuts or nutritional supplements as ordered. Try to be nonjudgmental when caring for a client with AIDS. Provide referrals to social services to assist in the high cost of medication maintenance.

"It is important to use condoms and avoid taking street drugs or alcohol." Rationale: With every sexual encounter, condoms must be used, and street drugs or alcohol should be avoided since they can impair judgment. These behaviors reduce the risk of infection transmission. "You should avoid eating raw or undercooked eggs, meat, poultry, or fish." Rationale: Raw or undercooked eggs, meat, poultry, or fish should be avoided to reduce the risk of diarrheal illnesses. "Signs and symptoms of the disease should immediately be reported to your primary health-care provider." Rationale: Early assessment and intervention can reduce the morbidity and mortality associated with opportunistic infections or side effects of medications; therefore, it is necessary to immediately report signs and symptoms of the disease to the primary health-care provider. "You should clean blood spills immediately with water." Rationale: To reduce the risk of infection transmission, blood spills should be cleaned with a bleach solution. "IT is important to take medications until the symptoms subside." Rationale: It is important to adhere to treatment regimens and to complete the dosage as prescribed by the primary health-care provider. This helps in reducing the risk of infection transmission and illness progression. Test-Taking Tip Serodiscordant means one partner is infected and the other is not. Question ID:MEDS2-HIVE-3 Course Topic:HIV and AIDS Concept:Infection, Safety, Nursing Roles Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Safe and Effective Care Environment Chapter:Chapter 22, Coordinating Care for Patients with HIV

Question 3 of 10 A nurse is teaching a serodiscordant couple about safe HIV practices for prevention of transmission and early intervention of progression. Which statements should the nurse include? Select all that apply. "It is important to use condoms and avoid taking street drugs or alcohol." "You should clean blood spills immediately with water." "You should avoid eating raw or undercooked eggs, meat, poultry, or fish." "Signs and symptoms of the disease should immediately be reported to your primary health-care provider." "IT is important to take medications until the symptoms subside."

Weight loss greater than 10% of previous recorded weight Rationale: Weight loss greater than 10% of previous recorded weight indicates that the HIV-positive client's health is deteriorating and needs immediate attention. Headache - 4 on 1 to 10 scale. Rationale: Headache is a common symptom in clients with HIV/AIDS. Low fever of 99.2ᵒ F Rationale: Fever is a common symptom that is observed in clients with HIV-AIDS. However, if the temperature is less than 36⁰C or greater than 39⁰C, it may indicate that the client's status is deteriorating and needs immediate attention. Cough - dry and non-productive Rationale: Cough is a common symptom that is observed in clients with HIV/AIDS. Test-Taking Tip It is necessary to differentiate between anticipated and worsening symptoms. Question ID:MEDS2-HIVE-4 Course Topic:HIV and AIDS Concept:Infection, Safety Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Physiological Integrity Chapter:Chapter 22, Coordinating Care for Patients with HIV Page Reference:p. 429

Question 4 of 10 The nurse is assessing a client coming to the clinic for a routine visit. Which clinical finding indicates that the status of an HIV-positive client is deteriorating and needs additional exploring? Headache - 4 on 1 to 10 scale. Weight loss greater than 10% of previous recorded weight Low fever of 99.2ᵒ F Cough - dry and non-productive

"They are done to quickly assess for the presence/absence of HIV antibodies." Rationale: Rapid tests using blood or oral fluids can be used in settings where a quick answer for the presence or absence of HIV antibodies is required, such as in health screening, occupational exposure, or labor and delivery. "Enzyme-linked immunosorbent assay (ELISA) is a type of rapid test." Rationale: An ELISA screening test using blood is not a rapid test. The specimen must be sent to a laboratory for testing. Results are available in 24 to 48 hours. "The rapid test results are available in 5 to 30 hours." Rationale: The results from the rapid tests are available in a very short time, usually 5 to 30 minutes. "A laboratory is required to perform rapid testing." Rationale: Rapid tests do not require a laboratory to perform them. Test-Taking Tip When answering questions as a professional, even when it's a friend or neighbor, HIPAA applies. Question ID:MEDS2-HIVE-5 Course Topic:HIV and AIDS Concept:Nursing Roles, Immunity Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Health Promotion and Maintenance Chapter:Chapter 22, Coordinating Care for Patients with HIV Page Reference:p. 430

Question 5 of 10 A neighbor approaches a nurse asking about a "quick test" for HIV diagnosis. What should the nurse explain about the Rapid Test? "They are done to quickly assess for the presence/absence of HIV antibodies." "Enzyme-linked immunosorbent assay (ELISA) is a type of rapid test." "The rapid test results are available in 5 to 30 hours." "A laboratory is required to perform rapid testing."

"An adherence rate of greater than or equal to 95% is essential to achieve viral suppression." Rationale: An adherence rate of greater than or equal to 95% is essential to achieve viral suppression and prevent the development of resistance to one or more ART drugs. If an HIV-positive client misses one dose of even one drug during a day, the adherence rate for that day is 0%. "To achieve a successful adherence rate, an HIV-positive client must take medications within 4 hours of the time it is due." Rationale: Taking medications on time is essential to maintain an adherence rate of greater than or equal to 95% for the ART to be properly effective. Administering doses more than 1 to 2 hours after the scheduled time can increase the risk of viral resistance developing. "To achieve a successful adherence rate, an HIV-positive client must take medication close to the completion of its course." Rationale: An HIV-positive client should intake all prescribed medications on time until the course is completed for the effectiveness of the ART. Stopping a medication midway interferes with the treatment. "Commitment to 50% adherence therapy for a lifetime may reduce the development of viral resistance." Rationale: Commitment to 100% adherence to ART for a lifetime may reduce the possibility of viral resistance developing to therapy. Test-Taking Tip Non-compliance of medication or treatments will never be an acceptable answer. Question ID: MEDS2-HIVE-6 Course Topic: HIV and AIDS Concept: Medication, Communication, Nursing Roles, Immunity Cognitive: Application [Applying] Difficulty Level: Moderate Client Need: Physiological Integrity Chapter: Chapter 22, Coordinating Care for Patients with HIV Page Reference: p. 430

Question 6 of 10 A client and his partner come to the clinic explaining that they are having a hard time remembering to take for all of the HIV medications that have been prescribed. They ask if they can eliminate one or two. What should the nurse explain about antiretroviral therapy? "An adherence rate of greater than or equal to 95% is essential to achieve viral suppression." "To achieve a successful adherence rate, an HIV-positive client must take medications within 4 hours of the time it is due." "To achieve a successful adherence rate, an HIV-positive client must take medication close to the completion of its course." "Commitment to 50% adherence therapy for a lifetime may reduce the development of viral resistance."

"Do not share his or her personal grooming items." Rationale: HIV spreads through blood and body fluids, so sharing any personal grooming equipment like a razor or epilator may expose the roommate to the risk of contracting HIV. "Do not share food with him or her." Rationale: Simply sharing food with a HIV-positive person does not contribute to the transmission of the infection. The viral load in tears and saliva is negligible for the spread of this infection. "Do not shake hands with him or her." Rationale: HIV does not spread through shaking hands with an infected person, although maintenance of proper hand hygiene in daily life is essential for all individuals. "Do not talk with him or her without covering your mouth and nose with a handkerchief." Rationale: HIV spreads through blood and body fluids in the reproductive tracts. Merely talking to an infected person does not expose a healthy person to such body fluids. HIV is not airborne. Test-Taking Tip The nurse may need to ask if the roommate is a sexual partner. Question ID:MEDS2-HIVE-7 Course Topic:HIV and AIDS Concept:Nursing Roles, Immunity Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Safe and Effective Care Environment Chapter:Chapter 22, Coordinating Care for Patients with HIV Page Reference:p. 433

Question 7 of 10 A young adult tells the nurse, "My roommate is HIV-positive. What precaution should I take so that I do not get the infection?" What should the nurse tell the client? "Do not share food with him or her." "Do not shake hands with him or her." "Do not talk with him or her without covering your mouth and nose with a handkerchief." "Do not share his or her personal grooming items."

Night sweats Rationale: Mycobacterial infection is clinically manifested through night sweats. Coughing Rationale: Coughing is a clinical manifestation of pneumonia and TB. Severe headache Rationale: A clinical manifestation of meningitis is severe headache. Fever Rationale: A clinical manifestation of infection is fever. Test-Taking Tip A clinical manifestation is a symptom. Question ID:MEDS2-HIVE-8 Course Topic:HIV and AIDS Concept:Assessment, Infection, Immunity Cognitive:Knowledge [Remembering] Difficulty Level:Easy Client Need:Safe and Effective Care Environment Chapter:Chapter 22, Coordinating Care for Patients With HIV Page Reference:p. 429

Question 8 of 10 Which is a clinical manifestation of mycobacterial infection in an HIV-positive client? Coughing Night sweats Severe headache Fever

Lesions of Kaposi's sarcoma on the left shoulder and upper chest. Rationale: This is a classic example of Kaposi's sarcoma. Multiple nickel-sized bruises on the left shoulder and clavicle area. Rationale: These are not bruising, but rather Kaposi's sarcoma and should be documented as such. Thrombocytopenia purpura lesions on the left shoulder and clavicle area. Rationale: These are not purpura lesions, but rather Kaposi's sarcoma and should be documented as such. Nickel-sized moles on the left shoulder and upper chest. Rationale: These are not moles, but rather Kaposi's sarcoma and should be documented as such. Test-Taking Tip When given an image, look at it closely. Question ID:MEDS2-HIVE-9 Course Topic:HIV and AIDS Concept:Assessment, Immunity Cognitive:Application [Applying] Difficulty Level:Moderate Client Need:Health Promotion and Maintenance Chapter:Chapter 22, Coordinating Care for Patients With HIV Page Reference:p. 429

Question 9 of 10 As the nurse performs an assessment on a client with AIDS, a rash is found (in the image). How should the nurse document the findings? Multiple nickel-sized bruises on the left shoulder and clavicle area. Lesions of Kaposi's sarcoma on the left shoulder and upper chest. Thrombocytopenia purpura lesions on the left shoulder and clavicle area. Nickel-sized moles on the left shoulder and upper chest.

Frequent respiratory infections Lymphadenopathy Skin problems Correct. The symptomatic chronic HIV infection phase is when the body begins to lose its fight against the virus. During this phase, the CD4+ count will fall and the viral load begins to take over, making it more difficult for the person to fight off infections. Symptoms begin to develop, such as frequent respiratory infections, enlarged lymph nodes, and skin rashes and disorders. Once a person with HIV becomes symptomatic, the average time to the development of AIDS is 2 years.

Symptomatic Chronic HIV Infection Frequent respiratory infections Chronic hyperthermia Increased CD4+ count Lymphadenopathy Skin problems Weight gain

Lymphadenopathy Fever Skin lesions Night sweats Cough Diarrhea correct. Common symptoms of an impaired immune systems include fever, cough, weakness, nausea/vomiting, diarrhea, dysphagia, forgetfulness, skin lesions, dyspnea, headache, vision changes, pain, night sweats, and lymphadenopathy.

Symptoms of impaired immune system Fever Constipation Cough Diarrhea Hypotension Night sweats Lymphadenopathy Skin lesions

Esophageal candidiasis Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Progressive multifocal leukoencephalopathy

The nurse is providing care to a patient whose CD4+ count is below 200 cells/µL. Which illnesses and opportunistic infections should the nurse assess for when providing patient care? Select all that apply. Esophageal candidiasis Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Progressive multifocal leukoencephalopathy Urinary tract infection

Early identification of infection

What is the key to prolonging life with HIV and AIDS? Select all that apply. Prevent of the spread of the virus to others Eradicate the virus in the body Slow the replication of the virus Early identification of infection

A few years to longer than a decade

What is the length of progression untreated HIV to acquired immune deficiency syndrome (AIDS)? A few days to a year A year to around 5 years A few years to longer than a decade Several decades

Flu-like symptoms

Which clinical manifestation may occur during the acute viral infection stage of human immunodeficiency virus infection? Weight loss Oral thrush Flu-like symptoms Night sweats and cough