HIV EAQ quiz

A patient with human immunodeficiency virus (HIV) is hospitalized. The patient's assessment findings include a CD4 + T-cell count of 150 cells/μL and a 12% loss of ideal body mass. Which diagnosis does the nurse suspect?

Acquired immunodeficiency syndrome (AIDS) Rationale: A patient with HIV is diagnosed with AIDS when the CD4 + T-cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS.

When teaching a patient infected with human immunodeficiency virus (HIV) about transmission of the virus to others, which statement made by the patient indicates understanding?

"I will notify all of my sexual partners so they can get tested for HIV." Rationale: The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. HIV is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. "Unprotected contact is the most common mode of transmission" and "I need to worry about spreading this virus to others by sweating at the gym" show a need for further teaching. The most common mode is unprotected sexual contact, and HIV is not spread via sweat. Transmission occurs through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or through breastfeeding.

The nurse provides education for a recent transplant recipient related to immunosuppressive therapy. Which statement made by the patient indicates effective teaching?

"The lower doses of the medications can still prevent rejection while minimizing side effects." Rationale: The medications are designed to prevent rejection, but rejection may occur even if the patient is compliant with the prescribed therapy.

Which information about a baby's risk of being born with human immunodeficiency virus (HIV) infection would the nurse share with a pregnant woman who voluntarily tested and was diagnosed positive with HIV?

"Treatment with antiretroviral therapy decreases the baby's chance of developing the HIV infection." Rationale: On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy.

A patient with O-positive blood is transfused with AB-positive blood. Which hypersensitivity reaction does the nurse anticipate the patient will experience?

Cytotoxic reaction Rationale: One type of a cytotoxic reaction is a hemolytic transfusion reaction. It is a classic type II reaction that occurs when a recipient receives ABO-incompatible blood from a donor.

A patient has tested positive for syphilis. For which other condition would the nurse expect to test the patient?

Human immunodeficiency virus (HIV) Rationale: People who have syphilis are predisposed to infection with HIV. Syphilitic lesions on the genitalia enhance HIV transmission, so the patient should be tested for HIV.

In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections?

T cells Rationale: In the early stages of HIV infection, T cells protect the body from infections. T cells play a key role in the immune system's ability to recognize and defend against pathogens.

When interpreting laboratory diagnostics, which statement would the nurse identify as pathophysiology for the human immunodeficiency virus (HIV) infection?

The immune system is impaired from CD4 + T-cell destruction. Rationale: Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells (also known as T helper cells or CD4 + T lymphocytes). HIV cannot replicate unless it is inside a living cell.

The patient with human immunodeficiency virus (HIV) does not want to take more than one prescribed antiretroviral medication at a time. Which explanation would the nurse provide the patient regarding combination antiretroviral therapy?

Viral replication will be inhibited through use of the combinations. Rationale: The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4 + T-cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

When teaching a patient with human immunodeficiency virus (HIV) about CD4 T cells, which statement would the nurse include?

"HIV destroys your CD4 T cells and depletes your immune system." Rationale: HIV depletes the immune system by destroying CD4 T cells, which are an important part of the body's natural defense against infection. The human body produces CD4 T cells to fight the HIV virus; however, opportunistic infections will develop when CD4 T-cell counts diminish.

When assessing for a patient's human immunodeficiency virus (HIV) risk, which questions would the nurse ask? Select all that apply.

- "Have you ever had a blood transfusion?" - "Have you ever had unprotected sexual intercourse?" - "Have you ever had a sexually transmitted infection?" Rationale: To help a patient assess risk of HIV, the nurse should ask questions regarding history of blood transfusion, unprotected sexual intercourse, and sexually transmitted disease. These questions provide the minimum information needed to initiate a risk assessment. A positive response to any of these questions should be followed by an in-depth exploration of issues related to the identified risk.

A newly diagnosed patient with human immunodeficiency virus (HIV) inquires as to the requirements for development of acquired immunodeficiency syndrome (AIDS). Which diagnostic criterion for AIDS would the nurse share with the patient? Select all that apply.

- A CD4 + T-cell count below 200/µL - The presence of an opportunistic infection - Presence of an opportunistic cancer - Loss of 10% or more of ideal body mass Rationale: Diagnostic criteria for AIDS include a CD4 + T-cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia.

Which purpose statements would the nurse use to fully explain antiretroviral therapy (ART) recently prescribed for a patient with human immunodeficiency virus (HIV)? Select all that apply.

- ART will decrease the viral load in the blood. - The medications prevent transmission of the HIV disease. - Prescribed medications maintain or increase the CD4 cell counts. - Therapy includes prevention of HIV-related opportunistic infections. Rationale: The goals of drug therapy in HIV infection are to decrease the viral load, maintain or increase CD4 T-cell counts, prevent HIV-related symptoms and opportunistic infections, delay disease progression, and prevent HIV transmission. Curing the HIV disease is incorrect because there is currently no cure for the HIV disease. Stopping the HIV disease from progressing is incorrect because it cannot stop the progression of the HIV disease, but only delay the HIV disease progression.

Two weeks after exposure to human immunodeficiency virus (HIV) during unprotected intercourse, the patient reports fever, swollen lymph nodes, sore throat, headache, malaise, and nausea, as well as muscle and joint pain. Which process explains these clinical manifestations? Select all that apply.

- Acute HIV infection - Seroconversion Rationale: In this case, the patient would have acquired HIV infection from the sexual partner. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompany seroconversion (when HIV-specific antibodies develop) during the window period.

Which strategies would the nurse teach a patient with a history of substance abuse about eliminating the risk of human immunodeficiency virus (HIV) transmission? Select all that apply.

- Always use sterile equipment to inject drugs. - Clean equipment used to inject the drugs you use. - Do not participate in sexual intercourse while under the influence of drugs. Rationale: The major risk for HIV related to using drugs involves sharing equipment or having unsafe sexual experiences while under the influence of drugs. Basic risk reduction rules include not using drugs, not sharing equipment if you do use drugs, and not having sexual intercourse when under the influence of any drug (including alcohol) that impairs decision making.

The nurse is comparing cell-mediated immunity and humoral immunity. Which of these are characteristics of humoral immunity? Select all that apply.

- Antibodies are produced. - Involves B lymphocyte cells. - Examples include anaphylactic shock and transfusion reaction. Reaction: Humoral immunity involves B lymphocyte cells and produces antibodies. Examples include anaphylactic shock, atopic diseases, transfusion reaction, and bacterial infections. The other responses reflect cell-mediated immunity. Humoral immunity does not involve T lymphocytes and macrophages (cell-mediated immunity does). Cancer cell destruction and graft rejection are examples of cell-mediated immunity.

The nurse witnesses an adult experiencing a systemic anaphylactic reaction following multiple stings from a bee. Which clinical manifestations are associated with this type of reaction? Select all that apply.

- Hypotension - Dizziness Rationale: Hypersensitivity to a foreign substance can cause an anaphylactic reaction. In such cases, histamine is released, causing bronchial constriction, and there is a marked increase in capillary permeability and dilation of arterioles. This decreased peripheral resistance is associated with hypotension and inadequate circulation to major organs, which results in dizziness.

A patient develops severe respiratory distress and hypotension within a few minutes after receiving a newly prescribed IV medication. Which actions does the nurse take? Select all that apply.

- Maintain IV access. - Administer high-flow O 2 via face mask. - Administer 0.3 to 0.5 mg epinephrine. Rationale: The nurse should immediately stop the infusion while maintaining IV access; normal saline should be initiated. The patient should be given high-flow O 2 (8-10 L/min) via face mask and can be given up to 100% as needed. 0.3 to 0.5 mg of epinephrine (1 mg/mL preparation) should be given and can be repeated every 5 to 15 minutes. The patient will be hypotensive; the patient should be placed in a recumbent position with the feet raised position or in the Trendelenburg position.

For the patient who tests positive for human immunodeficiency virus (HIV), which clinical manifestation would the nurse identify as the higher priority, warranting follow-up care?

- New or productive cough Rationale: The patient who tests positive for HIV should be informed to report a new or productive cough within 24 hours after symptoms begin as the cough may indicate development of an opportunistic infection. After evaluation of the cough, follow-up care would proceed for anorexia, insomnia, and mood swings.

A patient arrives in the emergency department with swelling of the lips and tongue three days after starting a daily dose of an antihypertensive medication. Which reaction does the nurse recognize that the patient is experiencing?

Angioedema Rationale: Angioedema is a localized cutaneous lesion similar to urticaria but involving deeper layers of the skin and submucosa. The principal areas of involvement include the eyelids, lips, tongue, larynx, hands, feet, gastrointestinal tract, and genitalia.