RNSG 1343 Complex Concepts of Adult Health Ch 19 Evolve

In North America, the highest rates of new human immunodeficiency virus (HIV) infections occur among which population?

African American and Hispanic adults (In North America, the highest rates of new HIV infections occur among African American and Hispanic adults. Women, men who have sex with men, and adults who have used injection drugs have lower rates of infection.)

Which are required elements of the human immunodeficiency virus (HIV) testing process? Select all that apply.

Counseling. Interpretation. Confidentiality. (HIV testing requires counseling, interpretation, and confidentiality. Written consent and health insurance coverage are not required.)

Which central nervous system (CNS) signs and symptoms may occur in a patient with acquired immunodeficiency syndrome (AIDS)? Select all that apply.

Dementia Confusion (Dementia and confusion are CNS signs and symptoms that may occur in a patient with AIDS. Nausea and diarrhea are gastrointestinal signs and symptoms. Lymphadenopathy and hypergammaglobulinemia are immunologic signs.)

To prevent infection in the patient with human immunodeficiency virus (HIV), the nurse should educate the patient to avoid which foods? Select all that apply.

Raw vegetables Undercooked meat Pepper and paprika (To prevent infection, the patient with HIV should avoid eating raw vegetables, undercooked meats, and pepper and paprika. Salty foods and cooked fruits do not have a high risk of causing infection.)

Some adults develop an acute infection within four weeks of first being infected with human immunodeficiency virus (HIV). What symptoms may indicate this acute HIV infection? Select all that apply.

Fever. Night sweats. Muscle aches. (Some adults develop an acute infection within four weeks of first being infected with HIV. Symptoms are similar to those seen with any virus and include fever, night sweats, and muscle aches. Memory loss is a central nervous system symptom that may occur with acquired immunodeficiency syndrome (AIDS). Purplish lesions are a sign of Kaposi sarcoma that may occur with AIDS.)

Consensual and nonconsensual sexual exposures involving insertive and receptive types of sex with oral, vaginal, or anal contact are considered which type of exposure to human immunodeficiency virus (HIV)?

Non-occupational (Consensual and nonconsensual sexual exposures involving insertive and receptive types of sex with oral, vaginal, or anal contact are considered non-occupational exposure. Perinatal exposure involves transmission from the mother to the infant. Parenteral transmission may occur from occupational or non-occupational exposure as a result of injection drug use. Occupational exposure is defined as contact between blood, tissue, or selected body fluids from a patient who is positive for HIV and the blood, broken skin, or mucous membranes of a health care professional.)

What is true regarding the risk of human immunodeficiency virus (HIV) transmission from patients receiving combination antiretroviral therapy (cART)?

The patient's viral load may drop to undetectable levels, but there is still a risk of transmission. (In patients receiving cART, the patient's viral load may drop to undetectable levels, but there is still a risk of transmission. It is not true that there is no risk of transmission. The patient remains HIV positive. Viral load and risk of transmission are likely to be reduced with cART.)

The number of CD4+ T-cells is reduced in human immunodeficiency virus (HIV) disease. How many CD4+ T-cells are usually present in a cubic millimeter (mm 3) of a healthy adult's blood?

800-1000 (A healthy adult usually has 800-1000 CD4+T-cells/mm 3. A patient with 200-499 CD4+T-cells/mm 3 meets the criteria for stage 2 of the Centers for Disease Control and Prevention (CDC) Case Definition of HIV disease. A patient with greater than 500 CD4+T-cells/mm 3 meets the criteria for stage 1 CDC Case Definition of HIV disease. More than 1000 CD4+T-cells/mm 3 may be present in a healthy adult but are not typical.)

In patients with human immunodeficiency virus (HIV), which type of laboratory test measures the patient's response to the virus rather than parts of the virus?

Antibody testing (Antibody tests are used to measure the patient's response to the virus (the antigen) rather than parts of the virus. Stool testing and skin biopsies test for opportunistic infections. Viral load testing directly measures the actual amount of HIV viral RNA particles present in the blood.)

A diagnosis of acquired immunodeficiency syndrome (AIDS) requires the patient to meet which criteria? Select all that apply.

CD4+ T-cell count less than 14%. Diagnosis of an opportunistic infection. CD4+ T-cell count less than 200 cells/mm 3 (0.2 × 109/L). (A diagnosis of AIDS requires the patient have a CD4+ T-cell count less than 14%, diagnosis of an opportunistic infection, and/or a CD4+ T-cell count less than 200 cells/mm 3 (0.2 × 109/L). A CD4+ T-cell count from 14-28% and a CD4+ T-cell count above 200 cells/mm 3 (0.2 × 109/L) are not criteria for a diagnosis of AIDS.)

What laboratory changes are most likely in a patient whose immune system is being overwhelmed by human immunodeficiency virus (HIV)?

CD4+ T-cell counts fall, viral numbers rise (In early HIV infection before the disease is evident, the immune system can still attack and destroy most of the newly created virus particles. However, with time, the number of HIV particles overwhelms the immune system. Gradually CD4+ T-cell counts fall, viral numbers (viral load) rise, and without treatment, the patient eventually dies of opportunistic infection or cancer. Laboratory findings in a patient whose immune system is being overwhelmed by HIV would not show both CD4+ T-cell counts and viral numbers falling, CD4+ T-cell counts rising while viral numbers fall, or both CD4+ T-cell counts and viral numbers rising.)

What class of drugs for human immunodeficiency virus (HIV) infection prevents viral binding?

Entry inhibitors (Viral binding to the CD4 receptor and to either of the co-receptors is needed for the HIV virus to enter the cell. Entry inhibitors prevent the interaction needed for entry of HIV into the CD4+ T-cell. New virus particles are made in the form of one long protein strand that is clipped by the enzyme HIV protease into smaller functional pieces. Protease inhibitors work here to inhibit HIV protease. HIV then uses its enzyme integrase to get its DNA into the nucleus of the host's CD4+ T-cell and insert it into the host's DNA. Integrase inhibitors prevent viral DNA from integrating into the host's DNA. NRTIs prevent viral replication by reducing how well reverse transcriptase can convert HIV genetic material into human genetic material.)

Which features of the human immunodeficiency virus (HIV) virus assist the viral particle in finding a host?

Gp41 and gp120 docking proteins (Viral particle features include an outer envelope with special "docking proteins," known as gp41 and gp120, which assist in finding a host. The RNA and lipid bilayer, p17 matrix and p24 capsid, and reverse transcriptase and integrase enzymes are other features of the HIV viral particle that do not assist in finding a host.)

When the human immunodeficiency virus (HIV) virus enters the patient's CD4+ T-cell, what is the new role served by the immune cell?

HIV factory (Effects of HIV infection are related to the new genetic instructions that now direct CD4+ T-cells to change their role in immune system defenses. The new role is to be an "HIV factory," making up to 10 billion new viral particles daily. The CD4+ cell does not become an antigen, antibody, or natural killer cell.)

Which minority group shows an increasing trend in human immunodeficiency virus (HIV) infection?

Hispanics (The Hispanic population is experiencing an increasing trend in HIV infections. Compared to Caucasians, Asian Americans, and American Indians, HIV infections reported in the United States are riding most among Hispanics.)

How does the assessment of the financial resources of the patient with AIDS help the nurse?

It helps in assessing the nutritional status of the patient. (The financial resources of an AIDS patient may give the nurse insight into the patient's food intake, weight loss or gain, general condition of skin, and overall nutritional status of the patient. Cognitive changes, motor changes, and sensory disturbances are part of the assessment of the neurologic status of the patient. The cardiovascular status is assessed via the heart, veins, and arteries. The gastrointestinal status is assessed through the mouth and oropharynx, presence of dysphagia, presence of abdominal pain, or the presence of nausea, vomiting, diarrhea, or constipation.)

Abnormal functioning of which body system is responsible for the signs and symptoms of human immunodeficiency virus (HIV) disease?

Immune (Abnormal functioning of the immune system is responsible for the signs and symptoms of HIV disease. Signs and symptoms may occur in the respiratory, cardiovascular, and gastrointestinal symptoms, but abnormal functioning of the immune system is the underlying mechanism.)

What class of drugs for human immunodeficiency virus (HIV) infection prevents the virus from inserting its DNA into the host's DNA?

Integrase inhibitors

Which immunologic signs and symptoms may occur in a patient with acquired immunodeficiency syndrome (AIDS)? Select all that apply.

Lymphadenopathy Hypergammaglobulinemia (Lymphadenopathy and hypergammaglobulinemia are immunologic signs that may occur in a patient with AIDS. Nausea and diarrhea are gastrointestinal signs and symptoms. Dementia and confusion are central nervous system signs and symptoms.)

What class of drugs for human immunodeficiency virus (HIV) infection reduces how well HIV genetic material can be converted into human genetic material?

Nucleoside reverse transcriptase inhibitors (NRTIs) (NRTIs prevent viral replication by reducing how well reverse transcriptase can convert HIV genetic material into human genetic material. Viral binding to the CD4 receptor and to either of the co-receptors is needed for the HIV virus to enter the cell. Entry inhibitors prevent the interaction needed for entry of HIV into the CD4+ T-cell. New virus particles are made in the form of one long protein strand that is clipped by the enzyme HIV protease into smaller functional pieces. Protease inhibitors work here to inhibit HIV protease. HIV uses its enzyme integrase to get its DNA into the nucleus of the host's CD4+ T-cell and insert it into the host's DNA. Integrase inhibitors prevent viral DNA from integrating into the host's DNA.)

Which factor distinguishes a diagnosis of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)?

Number of CD4+ T-cells (Everyone who has AIDS has an HIV infection, but not everyone who has HIV has AIDS. The distinction is the number of CD4+ T-cells and whether any opportunistic infections have occurred. Viral load, course of treatment, and duration of infection are not distinguishing factors between HIV and AIDS diagnoses.)

Patients with low CD4+ T-cell counts are at risk for what conditions caused by organisms that are present as part of the body's microbiome and usually kept in check by normal immunity?

Opportunistic infections (As the CD4+ T-cell level drops, the patient is at an increased risk for bacterial, fungal, and viral infections, as well as opportunistic cancers. Opportunistic infections are those caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity. These infections are not known as primary infections or secondary infections. Many opportunistic infections are also acquired immunodeficiency syndrome (AIDS)-defining conditions, but AIDS-defining conditions are not necessarily opportunistic infections.)

Which term describes infections caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity but may cause infection in patients with acquired immunodeficiency syndrome (AIDS)?

Opportunistic infections (Opportunistic infections are infections caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity but may cause infection in patients with AIDS. Opportunistic infections may be viral infections, as well as fungal, bacterial, and protozoal infections and malignancies. Co-occurring infections is a more general term to describe infections that occur simultaneously. Opportunistic infections may be sexually transmitted but are not necessarily transmitted this way.)

What class of drugs for human immunodeficiency virus (HIV) infection prevents new virus particles from splitting into functional pieces?

Protease inhibitors (New virus particles are made in the form of one long protein strand that is clipped by the enzyme HIV protease into smaller functional pieces. Protease inhibitors work here to inhibit HIV protease. Viral binding to the CD4 receptor and to either of the co-receptors is needed for the HIV virus to enter the cell. Entry inhibitors prevent the interaction needed for entry of HIV into the CD4+ T-cell. HIV then uses its enzyme integrase to get its DNA into the nucleus of the host's CD4+ T-cell and insert it into the host's DNA. Integrase inhibitors prevent viral DNA from integrating into the host's DNA. NRTIs prevent viral replication by reducing how well reverse transcriptase can convert HIV genetic material into human genetic material.)

Which features of the human immunodeficiency virus (HIV) virus convert HIV's RNA into DNA and insert it into the host's DNA?

Reverse transcriptase and integrase enzymes (The HIV enzyme reverse transcriptase converts HIV's RNA into DNA, which makes the viral genetic material the same as human DNA. HIV then uses its enzyme integrase to get its DNA into the nucleus of the host's. The RNA and lipid bilayer, p17 matrix and p24 capsid, and gp41 and gp120 docking proteins are other features of the HIV viral particle that do not convert HIV's RNA into DNA and insert it into the host's DNA.)

According to the Centers for Disease Control and Prevention (CDC) classifications, what stage of human immunodeficiency virus (HIV) is marked by CD4+ T-cell count greater than 500 cells/mm 3 (0.5 × 109/L) or 29% or greater?

Stage 1 (Stage 1 CDC Case Definition describes a patient with CD4+ T-cell count greater than 500 cells/mm 3 (0.5 × 109 /L) or 29% or greater. An adult at this stage has no AIDS-defining illnesses. Stage 0 CDC Case Definition describes a patient who develops a first positive HIV test result within six months after a negative HIV test result. Changing the patient';s status to stage 1, 2, or 3 does not occur until six months have elapsed since the stage 0 designation, even when CD4+ T-cell counts decrease or an AIDS-defining condition is present. Stage 2 CDC Case Definition describes a patient with CD4+ T-cell count between 200-499 cells/mm 3 (0.2-0.449 × 109/L) or 14-28%. An adult at this stage has no AIDS-defining illnesses. Stage 3 CDC Case Definition describes any patient with CD4+ T-cell count less than 200 cells/mm 3 (0.2 × 109/L) or less than 14%. An adult who has higher CD4+ T-cell counts or percentages but who also has an AIDS-defining illness meets the Stage 3 CDC Case Definition.)

According to the Centers for Disease Control and Prevention (CDC) classifications, what stage of human immunodeficiency virus (HIV) is marked by CD4+ T-cell count less than 200 cells/mm 3 (0.2 × 109/L) or less than 14%?

Stage 3 (Stage 3 CDC Case Definition describes any patient with CD4+ T-cell count less than 200 cells/mm 3 (0.2 × 109/L) or less than 14%. An adult who has higher CD4+ T-cell counts or percentages but who also has an AIDS-defining illness meets the Stage 3 CDC Case Definition. Stage 0 CDC Case Definition describes a patient who develops a first positive HIV test result within six months after a negative HIV test result. Stage 1 CDC Case Definition describes a patient with CD4+ T-cell count greater than 500 cells/mm 3 (0.5 × 109 /L) or 29% or greater. An adult at this stage has no AIDS-defining illnesses. Stage 2 CDC Case Definition describes a patient with CD4+ T-cell count between 200-499 cells/mm 3 (0.2-0.449 × 109/L) or 14-28%. An adult at this stage has no AIDS-defining illnesses.)

What defines the concept known as treatment as prevention (TAP) of human immunodeficiency virus (HIV)?

The use of combination antiretroviral therapy (cART) reduces the viral load to undetectable levels, thereby reducing the risk of HIV transmission. (Once an adult is placed on cART, reducing the viral load to undetectable levels significantly reduces the risk that HIV will be transmitted, a concept known as TAP. TAP is not defined by a lack of written consent for routine testing, the use of HIV-specific antiretroviral drugs in an HIV-uninfected adult to prevent HIV infection, or expanded screening recommendations.)

The nurse has been exposed to the blood of a patient who is human immunodeficiency virus (HIV) positive. What is the window of opportunity to begin postexposure prophylaxis (PEP) for the best possible outcome in preventing HIV infection?

Two hours (Once the exposure has been discovered, PEP with combination antiretroviral therapy (cART) within two hours of the exposure has the best possible outcome in preventing HIV infection. The window of opportunity for best outcome closes when prophylaxis is started after 72 hours. The professional receiving prophylaxis must return for complete electrolytes, creatinine, and blood counts two weeks after starting cART and periodic HIV testing at one, three, and six months.)

The nurse is caring for a patient who recently had a first positive human immunodeficiency virus (HIV) test result within six months after a negative HIV test result. According to the Centers for Disease Control and Prevention (CDC) classifications, when should the patient's status be changed from stage 0 to stage 1, 2, or 3?

When six months have elapsed and the conditions for another stage are met (According to CDC classifications, Stage 0 CDC Case Definition describes a patient who develops a first positive HIV test result within six months after a negative HIV test result. Changing the patient's status to stage 1, 2, or 3 does not occur until six months have elapsed since the stage 0 designation, even when CD4+ T-cell counts decrease or an AIDS-defining condition is present. This status change is not based on a condition of time, CD4+ T-cell count, or presence of an AIDS-defining condition alone.)