(2) HIV and STDs

"A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? a) ""Inform all potential sexual partners about the infection, even if it is inactive."". b) ""Use a condom during sexual activity if the infection becomes active again."" c) ""If the infection has healed, you probably don't have to use a condom."" d) ""Refrain from all sexual activity until you don't have another outbreak for a year."""

A

A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for which of the following characteristic findings of syphilis in the primary clinical stage? A) Chancre B) Alopecia C) Condylomata lata D) Regional adenopathy

A

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea has presented at the clinic. The student knows that the care plan for this patient should be include what in the treatment of gonorrhea? a) Concurrent treatment for chlamydia b) Avoidance of the use of tampons c) Vaginal smears every 6 months d) Radiation therapy to destroy cancerous cells

A

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported? a) Syphilis b) Condylomata acuminata c) Genital herpes d) Hepatitis B

A

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Being asymptomatic b) All options are correct c) B

A

Standard precautions should be used when providing care for A) All patients regardless of diagnosis. B) Pediatric and gerontologic patients. C) Patients who are immunocompromised. D) Patients with a history of infectious diseases.

A

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age? a) 26 b) 35 c) 18 d) 32

A

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which of the following would the nurse expect to include as the most common STI in the United States? a) Chlamydia b) Syphilis c) Genital herpes d) Gonorrhea

A

A client who was tested for human immunodeficiency virus (HIV) after a recent exposure had a negative result. During the post-test counseling session, the nurse tells the client which of the following? a) the test should be repeated in 6 months b) this ensures that the client is not infected with the HIV virus c) the client no longer needs to protect himself from sexual partners d) the client probably has immunity to the acquired immunodeficiency virus

A - A negative test result indicates that no HIV antibodies were detected in the blood sample. A repeated test in 6 months is recommended because false-negative test results have occurred early in the infection. Options B, C, and D are incorrect.

Teaching for patients with a sexually transmitted disease (STD) would include (select all that apply) A) Treatment of sexual partner is important. B) Douching may help provide relief of itching. C) Cotton undergarments are preferred over synthetic materials. D) Sexual abstinence is indicated during the communicable phase of the disease. E) Condoms should be used during as well as after treatment during sexual activity.

A,C,D,E

A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus? (Select all that apply.) A. Perinatal exposure B. Pregnancy C. Monogamous sex partner D. Older adult woman E. Occupational exposure

A. CORRECT: Perinatal exposure is a risk factor associated with HIV. Women who are pregnant should take cautionary measures to prevent HIV exposure. B. INCORRECT: Women who are pregnant should be tested for HIV, but pregnancy is not a risk factor associated with this virus. C. INCORRECT: Having a monogamous sex partner is not a risk factor associated with the HIV virus. D. CORRECT: Being an older adult woman is a risk factor associated with the HIV virus due vaginal dryness and the thinning of the vaginal wall. E. CORRECT: Occupational exposure, such as being a health care worker, is a risk factor associated with the HIV virus.

"A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. ""The EIA test will need to be repeated to verify the results."" b. ""A viral culture will be done to determine the progression of the disease."" c. ""It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)."" d. ""The Western blot

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

ANS: A The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.

"The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions."

ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

ANS: B It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

ANS: C A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? a) Podophyllum resin b) Tetracycline c) Ceftriaxone d) Acyclovir

B

"A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. ""The patient meets the criteria for a diagnosis of an acute HIV infection."" b. ""The patient will be diagnosed with asymptomatic chronic HIV infection

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

"The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling ""constantly tired."" c. The patient is unable to state the side effects of the medications. d. The patient states, ""Sometimes I miss a dose of zidovudine (AZT)."""

ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT.

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

ANS: D CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count.

Nurse Jaja is giving an injection to Ms. X. After giving an injection, the nurse accidentally stuck her finger with the needle when the client became very agitated. To determine if the nurse became infected with HIV when is the best time to test her for HIV antibodies? a. Immediately and repeat the test after 12 weeks b. Immediately and repeat the test after 4 weeks c. After a week and repeat the test in 4 months d. After a weeks and repeat the test in 6 months

Answer A. Keyword: BEST TIME. Rationale: To determine if a preexisting infection is present a test should be done immediately and is repeated again in 3 months time (12 weeks) to detect seroconversion as a result of the needle stick.

Human Immunodeficiency virus belongs to which classifications? a. Rhabdovirus b. Rhinovirus c. Retrovirus d. Rotavirus

Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid dependent reverse transcriptase.

A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend? A) Use of gloves during patient contact B) Frequent and thorough hand washing C) Prophylactic, broad-spectrum antibiotics D) Fitting and appropriate use of N95 masks

B

Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What is the typical span of time between infection and developing symptoms with syphilis? a) 14 days b) 21 days c) 35 days d) 28 days

B

Which information would be most appropriate for a nurse to provide to a client who has never used a condom? a) A condom can be used, even if it is old, so long as the pack is unopened. b) A new condom should be used for each sex act. c) Cheap condoms of any brand can be used based on monetary constraints. d) A fresh condom should be unrolled over a limp penis before it becomes erect.

B

Which client problem relating to altered nutrition is a consequence of AIDS? A. Increased appetite B. Decreased protein absorption C. Increased secretions of digestive juices D. Decreased gastrointestinal absorption

B Often the complications of the acquired immunodeficiency syndrome (AIDS) have a negative impact on nutritional status. Weight loss and protein depletion are commonly seen among the AIDS population.

A client with acquired immunodeficiency syndrome has a respiratory infection from Pneumocystis jiroveci and a nursing diagnosis of Impaired Gas Exchange written in the plan of care. Which of the following indicates that the expected outcome of care has not yet been achieved? A. Client has clear breath sounds B. Client now limits his fluid intake C. Client expectorates secretions easily D. Client is free of complaints of shortness of breath

B The status of the client with a diagnosis of Impaired gas exchange would be evaluated against the standard outcome criteria for this nursing diagnosis. These would include the client stating that breathing is easier and is coughing up secretions effectively, and has clear breath sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.

"The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodie B. CD4+ T cell count below 200/µL C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µl"

B. CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

"A 45-year-old waitress with a history of IV drug use also is HIV-positive. She has been following her antiretroviral medication regimen faithfully and is doing well. She's attending college to get a social work degree and is focused on a bright future. In her regular CD counts, what factor will indicate she has progressed from HIV to AIDS? a) CD count > 200/mm b) CD count > 100/mm c) CD count < 200/mm d) CD count < 100/mm"

C

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

C

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Development of gummas b) Palmar rash c) Genital chancres d) Development of central nervous system lesions

C

A client is diagnosed with late stage human immunodeficiency virus (HIV), and the client and family are extremely upset about the diagnosis. The priority psychosocial nursing intervention for the client and family is to: a) tell the client and family to stop smoking because it will predispose the client to respiratory infections b) tell the client and family that raw or improperly washed foods can produce microbes c) encourage the client and family to discuss their feelings about the disease d)

C - The priority psychosocial nursing intervention for the client and family is to encourage the client and family to discuss their feelings about the disease. Options A, B, and D identify physiological not psychosocial concerns.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.

C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection

A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/µL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

Correct answer: a Rationale: AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.

Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

Correct answer: c Rationale: Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (see Table 15-10).

Screening for HIV infection generally involves a. laboratory analysis of blood to detect HIV antigen. b. electrophoretic analysis for HIV antigen in plasma. c. laboratory analysis of blood to detect HIV antibodies. d. analysis of lymph tissues for the presence of HIV RNA.

Correct answer: c Rationale: The most useful screening tests for HIV detect HIV-specific antibodies

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Syphillis b) Gonorrhea c) Chlamydia d) Genital herpes

D

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)? a) Hive-like rash for the past 2 days b) Clear vaginal discharge c) Weight gain of 5 lbs in one year d) Five different sexual partners

D

"For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan? A. ""Follow a low-protein, high-carbohydrate diet."" B. ""Eat three large meals per day."" C. ""Include unpasteurized dairy products in the diet."" D. ""Follow a high-protein, high-calorie diet."

D Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-cooked meats.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

c

"A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings? Please choose from one of the following options. A. The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). B.The patient is now in the latent stages of HIV infection C.These findings provide evidence that the patient has

The patient is diagnosed with acquired immunodeficiency syndrome (AIDS).

"A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. ""The EIA test will need to be repeated to verify the results."" b. ""A viral culture will be done to determine the progression of the disease."" c. ""It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)."" d. ""The Western blot

a

"Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure"

a

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

a

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

a

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

a

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

a,b,c

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand w

a,b,e

"A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. ""Avoid sexual intercourse when using injectable drugs."" b. ""It is important to participate in a needle-exchange program."" c. ""You should ask those who share equipment to be tested for HIV."" d. ""I recommend cleaning drug injection equipment before each use."""

b

"A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, ""I am very nervous about making my baby sick."" Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contrac

b

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

b

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

b

"A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/uL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. ""The patient meets the criteria for a diagnosis of an acute HIV infection."" b. ""The patient will be diagnosed with asymptomatic chronic HIV infectio

c

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

c

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? a. Increased viral load b. Decreased neutrophil count c. Increased CD4+ T cell count d. Decreased white blood cell count

c. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

"A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, ""I feel obsessed with thoughts about dying. Do you think I am just being morbid?"" Which response by the nurse is best? a. ""Thinking about dying will not improve the course of AIDS."" b. ""It is important to focus on the good things about your life now."" c. ""Do you think that taking an antidepressant might be helpful to you?"" d. ""Can you tell me more about the kind of thoughts that you are having?""

d

A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.

d

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

d

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue d. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpe

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? a. Droplet precautions b. Contact precautions c. Airborne precautions d. Standard precautions

d. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.

"What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. ""Set up"" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances."

"Correct answer: d Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life."

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a. The patient has the virus present and can transmit the infection to others. b. The patient is not able to transmit the virus to others through sexual contact. c. The patient will be prescribed lower doses of antiretroviral medications for 2 months. d. The syndrome has been cured, and

"a. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. ""Undetectable"" indicates that the viral load is lower than the test is able to report. ""Undetectable"" does not mean that the virus has been eliminated from the body or that the indivi"

Which interventions does the home health nurse teach to family members to reduce confusion in the client diagnosed with AIDS dementia? (Select all that apply.) A) Report any behavior changes. B) Use the Glasgow Coma Scale on a daily basis. C) Change the decorations in the home according to the season. D) Put the bed close to the window. E) Write out all instructions and have the client read them over before performing a task. F) Ask the client when he or she wants to shower or bathe. G) Mark off

-(C, D, F, G) C) Change the decorations in the home according to the season. Rationale: Seasonal decorations in the home helps with maintaining orientation. D) Put the bed close to the window. Rationale: This allows the client to visualize seasonal and weather changes and assists in orientation. F) Ask the client when he or she wants to shower or bathe. Rationale: Involving the client in planning the daily schedule helps with orientation. G) Mark off the days of the calendar, leaving open the current date. Rationale: Using calendars and crossing off past dates helps with orientation. Incorrect: A) Report any behavior changes. Rationale: This does not reduce confusion. B) Use the Glasgow Coma Scale on a daily basis. Rationale: This assessment tool is used by the home health nurse. E) Write out all instructions and have the client read them over before performing a task. Rationale: Instructions should be kept short, simple, and verbal. H) For continuity, the primary caregiver should be t

"A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority? a) Acute pain related to the development of the genital lesions b) Deficient knowledge related to the disease and its transmission c) Ineffective coping related to the increased stress associated with the infection d) Hyperthermia related to body's response to an infectious process"

A

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A

A client is diagnosed with human immunodeficiency virus (HIV) infection. The nurse prepares a care plan for the client, knowing that HIV is primarily a condition in which: a) immunosuppression occurs and is indicated by a T4 lymphocyte count of less than 200/mm3 b) bacterial infection occurs, causing weakness c) fungal infection occurs, causing a rash and pruritus d) protozoan infection occurs, causing a fever and nonproductive cough

A - HIV infection causes immunosuppression and is indicated by a T4 lymphocyte count of less than 200/mm3. Although bacterial, fungal, and protozoal infection can occur, these occur as opportunistic infections as a result of the immunosuppression.

"A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient? a) The virus causes ""cold sores"" of the lips. b) Treatment is focused on relieving symptoms. c) The virus may be cured with antibiotics. d) The virus when active may not be contracted during intercourse."

B

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease

"A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) ""This combination of medications will eradicate the infection faster than a single antibiotic."" b) ""Many people infected with gonorrhea are infected with chlamydia as well."" c) ""The combination of these two antibiotics reduces the risk o

B

"A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, ""I am very nervous about making my baby sick."" Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contrac

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock

"A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following? a) ""The discharge is yellowish but thin."" b) ""I noticed a strange fishy odor during my period."" c) ""The discharge looks almost like cottage cheese."" d) ""I've been experiencing some really intense itching."""

B

A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.

ANS: D The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection.

The blood test first used to identify a response to HIV infection is: a. Western blot b. ELISA test c. CD4+ T-cell count d. CBC

Answer B. Keyword: FIRST. Rationale: The ELISA test is the first screening test for HIV. A Western blot test confirms a positive ELISA test. Other blood tests that support the diagnosis of HIV include CD4+ and CD8 + counts, CBC, immunoglobulin levels, p24 antigen assay, and quantitative ribonucleic acid assays.

The nurse observes precaution in caring for Mr. X as HIV is most easily transmitted in: a. Vaginal secretions and urine b. Breast milk and tears c. Feces and saliva d. Blood and semen

Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EASILY transmitted in blood, semen and vaginal secretions. However, it has been noted to be found in fecal materials, urine, saliva, tears and breast milk.

"A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, ""This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs."" How should the nurse proceed? a) Do nothing because the client's sexual habits place him at risk for contracting other STDs. b) Educate the client about why it'

B

"A 22-year-old male is being treated at a college health care clinic for gonorrhea. Which of the following teaching points should the nurse include in patient teaching? A) ""While being treated for the infection, you will not be able to pass this infection on to your sexual partner."" B) ""While you're taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol."" C) ""It's important to complete your full course of antibiotics in order to ensure th

B

"A client is diagnosed with chlamydia and is distraught. ""How can I have this problem? I don't have any symptoms!"" she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as a) 100% b) 75% c) 50% d) 25%"

B

"Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States? a) Gonorrhea b) Chlamydia c) Herpes simplex 1 d) HPV"

B

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? a) Painful red papules on the shaft of the penis b) Foul-smelling discharge from the penis c) Rashes on the palms of the hands and soles of the feet d) Cauliflower-like warts on the penis

B

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a) 60 to 70 years b) 15 to 24 years c) 25 to 29 years d) 30 to 45 years

B

"A mother brings her young child to the clinic for an evaluation of an infection. The mother states, ""He's been taking antibiotics now for more than 2 months and still doesn't seem any better. It's like he's always sick."" During the history and physical examination, which of the following would alert the nurse to suspect a primary immunodeficiency? a) Superficial wound on the child's left leg b) History of fungal diaper rash c) Ten ear infections in the past year d) Weight within age-appropria

C

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise? a) Reduce food intake. b) Encourage large, high-fat meals. c) Avoid residue, lactose, fat, and caffeine. d) Increase the intake of iron and zinc.

C

A nurse is teaching a community health class of women and explains that a sexually transmitted infection (STI) is associated with an increased risk of infertility in women. Which of the following STIs would the nurse identify? a) Herpes simplex b) Syphilis c) Chlamydia d) Gonorrhea

C

Screening for chlamydia is recommended for young women because A) Chlamydia is frequently comorbid with HIV. B) Chlamydial infections may progress to sepsis. C) Untreated chlamydial infections can lead to infertility. D) Chlamydial infections are treatable only in the early stages of infection.

C

"Which is the most common HIV-related neurological complication? A. Tuberculosis B. Kaposi's sarcoma C. Toxoplasmosis D. Lymphoma"

C Toxoplasmosis is the most common central nervous system infection in patients with the acquired immunodeficiency syndrome (AIDS) who are not receiving appropriate prophylaxis. This infection has a worldwide distribution and is caused by the intracellular protozoan parasite, Toxoplasma gondii.

"A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient? a) ""It's important to start treatment soon, so you will be prescribed pills today."" b) ""I'd like to give you an HPV vaccination if that's okay with you."" c) ""There is a chance that these will clear up on their own without any

C) There is a chance that these will clear up on their own without any tx Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

"A 30-year-old female patient has sought care because of the recent appearance of itchy lesions on her vulva, some of which have recently burst. The patient's description of her problem would lead you to first suspect A) HIV. B) Gonorrhea. C) Chlamydia. D) Genital herpes."

D

"A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease."

D

"The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions."

b

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

b,c

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? a) Risk for infection related to altered immune cell function b) Impaired skin integrity related to persistent deep skin abscesses c) Anxiety related to an inherited disorder d) Grieving related to the poor prognosis of the condition

A

A nurse is caring for a client who is suspected of having HIV. Which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select all that apply.) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-lymphocyte count D. CD4+ T-lymphocyte percentage of total lymphocytes E. Cerebrospinal fluid (CSF) analysis

A. CORRECT: Positive results of a Western blot test confirm the presence of HIV infection. B. CORRECT: Positive results of an indirect immunofluorescence assay confirm the presence of HIV infection. C. INCORRECT: CD4+ T-lymphocyte count assists with classifying the stage of HIV infection. D. INCORRECT: CD4+ T-lymphocyte percentage of total lymphocytes assists with classifying the stage of HIV infection. E. INCORRECT: CSF analysis can be used to confirm meningitis.

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

The nurse is gathering data from a male client who is suspected of having gonorrhea. Which of the following would the nurse most likely find? a) Testicular pain b) Purulent rectal discharge c) Pain on urination d) Skin rash

C

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

ANS: C Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.

Human Papilloma Virus in AIDS patients is manifested as: A. Cough, evening fever, night sweats, weight loss and anemia B. Persistent fever, tachypnoea, hypoxia, cyanosis and tachycardia. C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis D. Watery diarrhea, abdominal pain, nausea and vomiting

C Dermatologic human papillomavirus (HPV) infection in HIV patients manifests as both anogenital and nongenital skin disease. Cutaneous HPV-related disease in nongenital skin is also increased in HIV-positive patients, in the form of benign common warts, epidermodysplasia verruciformis-like skin lesions, and nonmelanoma skin cancers.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.

C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection.

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact

Correct answer: a Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment.

Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including needles, syringes, pipes, and straws

Correct answer: a Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner

During HIV infection a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

Correct answer: c Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

"After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client states which of the following? a) ""I will clean my kitchen counter with hot water."" b) ""Alcohol is good to clean any skin areas that are dry or chafed."" c) ""I should avoid eating cooked fruits and vegetables."" d) ""I should avoid being around other people who have an infection."""

D

What is the main reason why it is difficult to develop a vaccine against HIV? a. HIV is still unknown to human b. HIV mutates easily c. HIV spreads rapidly throughout the body d. HIV matures easily

"Answer B. Keyword: MAIN REASON. Rationale: HIV was identified in 1983, thus, A is incorrect. By 1988 two strains of HIV existed, HIV-1 and HIV-2. Viruses spread rapidly and mature easily but these factors don't affect the potential for development against HIV. Mutating too easily makes it hard to create a vaccine against it."

A client is diagnosed with oral candidiasis. Nurse Tina knows that this condition in AIDS is treated with: A. Trimethoprim + sulfamethoxazole B. Fluconazole C. Acyclovir D. Zidovudine

"B Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin ""swish and swallow""). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments."

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a. The patient has the virus present and can transmit the infection to others. b. The patient is not able to transmit the virus to others through sexual contact. c. The patient will be prescribed lower doses of antiretroviral medications for 2 months. d. The syndrome has been cured, and

"a. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. ""Undetectable"" indicates that the viral load is lower than the test is able to report. ""Undetectable"" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others."

Which interventions does the home health nurse teach to family members to reduce confusion in the client diagnosed with AIDS dementia? (Select all that apply.) A) Report any behavior changes. B) Use the Glasgow Coma Scale on a daily basis. C) Change the decorations in the home according to the season. D) Put the bed close to the window. E) Write out all instructions and have the client read them over before performing a task. F) Ask the client when he or she wants to shower or bathe. G) Mark off

(C, D, F, G) C) Change the decorations in the home according to the season. Rationale: Seasonal decorations in the home helps with maintaining orientation. D) Put the bed close to the window. Rationale: This allows the client to visualize seasonal and weather changes and assists in orientation. F) Ask the client when he or she wants to shower or bathe. Rationale: Involving the client in planning the daily schedule helps with orientation. G) Mark off the days of the calendar, leaving open the current date. Rationale: Using calendars and crossing off past dates helps with orientation.

"When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education? A) ""I will need to isolate any tissues I use so as not to infect my family."" B) ""I will notify all of my sexual partners so they can get tested for HIV."" C) ""Unprotected sexual contact is the most common mode of transmission."" D) ""I do not need to worry about spreading this virus to others by sweating a

A

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect to find which of the following once the microorganism disseminates throughout the body? a) Painful joints b) Intermenstrual bleeding c) Sore throat d) Painful urination

A

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? a) Human papilloma virus b) Haemophilus ducreyi bacillus c) Herpes virus d) Treponema pallidum

A

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? a) Gonorrhea b) Candidiasis c) Chancroid d) Trichomoniasis

A

"A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. ""Avoid sexual intercourse when using injectable drugs."" b. ""It is important to participate in a needle-exchange program."" c. ""You should ask those who share equipment to be tested for HIV."" d. ""I recommend cleaning drug injection equipment before each use."""

ANS: B Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky c

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

"A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule"

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART

Ms. X is diagnosed with acquired immunodeficiency syndrome (AIDS). The nurse caring for this patient is aware that for a patient to be diagnosed with HIV she should have which condition? a. Infection of HIV, have a CD4+ T-cell count of 500 cells/microliter, history of acute HIV infection b. Infection with Tuberculosis, HIV and cytomegalovirus c. Infection of HIV, have a CD4+ T-cell count of >200 cells/microliter, history of acute HIV infection d. Infection with HIV, history of HIV infection and

Answer C. The three criteria for a client to be diagnosed with AIDS are the following: • HIV positive • CD4+ T-cell count below 200 cells/microliter • Have one or more specific conditions that include acute infection of HIV

"A client with genital herpes asks the nurse about what to expect with the infection. Which of the following responses would be most appropriate? a) Once you take the medication, the infection will be gone for good. b) You might have to try several different medications before finding one that works. c) Even though you don't have symptoms, you could still spread the infection. d) You can expect other outbreaks, each of which will be longer than the first."

C

Antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

Correct answer: b Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

During HIV infection a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

Correct answer: c Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes)

"A client with genital herpes simplex infection asks the nurse, ""Will I ever be cured of this infection?"" Which response by the nurse would be most appropriate? a) ""All you need is a dose of penicillin and the infection will be gone."" b) ""There is a new vaccine available that prevents the infection from returning."" c) ""Once you have the infection, you develop an immunity to it."" d) ""There is no cure, but drug therapy helps to reduce symptoms and recurrences."""

D

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes? a) Emergence of hard, painless nodules on the shaft of the penis b) Presence of purulent, whitish discharge from the penis c) Production of cloudy, foul-smelling urine d) Itching, pain, and the emergence of pustules on the penis

D

A nurse is providing care to a client with chlamydia. The nurse anticipates that the client will also receive treatment for which of the following? a) Mycoplasma b) Trichomoniasis c) Human papillomavirus d) Gonorrhea

D

A patient comes to the free clinic complaining of urethral discharge. On assessment, the nurse notes that the patient is feverish. During the assessment, the patient admits to having unprotected sex. The nurse suspects the patient may have a diagnosis of what? a) HIV b) Chlamydia c) Syphilis d) Gonorrhea

D

A client with acquired immunodeficiency syndrome (AIDS) has a nursing diagnosis of Imbalanced nutrition: less than body requirements. The nurse plans which of the following goals with this client? a) consume foods and beverages that are high in glucose b) plan large menus and cook meals in advance c) eat low-calorie snacks between meals d) eat small, frequent meals throughout the day

D - The client should eat small, frequent meals throughout the day. The client also should take in nutrient-dense and high-calorie meals and snacks rather than those that are high in glucose only. The client is encouraged to eat favorite foods to keep intake up and plan meals that are easy to prepare. The client can also avoid taking fluids with meals to increase food intake before satiety sets in.

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT: A. Reduce HIV-associated morbidity and prolong the duration and quality of survival B. Restore and preserve immunologic function C. Maximally and durably suppress plasma HIV viral load D. Elimination of HIV entirely from the body

D Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky c

c

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

c

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

c

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

c

"The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling ""constantly tired."" c. The patient is unable to state the side effects of the medications. d. The patient states, ""Sometimes I miss a dose of zidovudine (AZT)."""

d

"Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken."

d

"Which member of the health care team demonstrates reducing the risk for infection for the client with acquired immunodeficiency syndrome (AIDS)? A) The dietary worker hands the disposable meal trays to the LPN assigned to the client. B) The social worker encourages the client to verbalize about stressors at home. C) Housekeeping thoroughly cleans and disinfects the hallways near the client's room. D) Health care provider orders vital signs including temperature every 8 hours."

"(A) A) The dietary worker hands the disposable meal trays to the LPN assigned to the client. Rationale: This limits the number of health care personnel entering the room. Incorrect: B) The social worker encourages the client to verbalize about stressors at home. Rationale: Verbalizing stressors does not reduce the risk for infection. C) Housekeeping thoroughly cleans and disinfects the hallways near the client's room. Rationale: Bathrooms, not hallways, that are cleaned at least once daily by housekeeping reduces infection. D) Health care provider orders vital signs including temperature every 8 hours. Rationale Vital signs, including temperature, should be taken every 4 hours to detect potential infection."

"The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted living facility. Which responses fit the Centers for Disease Control and Prevention's (CDC's) recommendations for HIV testing? (Select all that apply.) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' B) ''In 1986, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from a penitentiary.'' D) ''I used to smoke marijuana 30 years ago, but

"(A, C, F) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' Rationale: People who have had sexually transmitted diseases should be tested for HIV. C) ''Seven years ago, I was released from a penitentiary.'' Rationale: HIV testing is recommended for people who are or have been in jails or prisons. F) ''At 68, I am going to get married for the fourth time.'' Rationale: People who are planning to get married should be tested for HIV."

"The home health nurse is making an initial home visit to the client currently living with family members after being hospitalized with pneumonia and newly diagnosed with AIDS. Which statement by the nurse best acknowledges the client's fear of discovery by his family? A) ''Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?'' B) ''Is there somewhere private in the home we can go and talk?'' C) ''I hope that all of your family members know

"(B) B) ''Is there somewhere private in the home we can go and talk?'' Rationale: A nonthreatening approach initially to find out whether the client has informed family members or desires privacy is very important. Incorrect: A) ''Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?'' Rationale: The client has a right to privacy and can make the decision whether to post handwashing signs. Caution signs invade the client's right to privacy. C) ''I hope that all of your family members know about your disease and how you need to be protected, since you have been so sick.'' Rationale: Protection from infection is important, but this approach is not respectful of the client's right to privacy. D) ''It is your duty to protect your family members from getting AIDS.'' Rationale: This statement by the nurse is rather intimidating. It is the client's right whether he wants to make the decision to inform or not inform family members about the

"The home health nurse is making an initial home visit to the client currently living with family members after being hospitalized with pneumonia and newly diagnosed with AIDS. Which statement by the nurse best acknowledges the client's fear of discovery by his family? A) ''Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?'' B) ''Is there somewhere private in the home we can go and talk?'' C) ''I hope that all of your family members know

"(B) B) ''Is there somewhere private in the home we can go and talk?'' Rationale: A nonthreatening approach initially to find out whether the client has informed family members or desires privacy is very important."

"Which statement made to the nurse by a health care worker assigned to care for the client with HIV indicates a breach of confidentiality and requires further education by the nurse? A) ''I told the family members they needed to wash their hands when they enter and leave the room.'' B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' C) ''Yes, I understand the reasons w

"(B) B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' Rationale: Discussing this client's illness outside the client's room is a breach of confidentiality. Incorrect: A) ''I told the family members they needed to wash their hands when they enter and leave the room.'' Rationale: Instruction on handwashing to family members or friends is not a breach of confidentiality. C) ''Yes, I understand the reasons why I have to wear gloves when I bathe my client.'' Rationale: This recognizes standard precautions in direct care, and is not a breach of confidentiality. D) ''The client's spouse told me she got HIV from a blood transfusion.'' Rationale: The health care worker assigned is relaying the conversation to the nurse. This is not a breach of confidentiality"

"Which statement made to the nurse by a health care worker assigned to care for the client with HIV indicates a breach of confidentiality and requires further education by the nurse? A) ''I told the family members they needed to wash their hands when they enter and leave the room.'' B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' C) ''Yes, I understand the reasons w

"(B) B) ''The other health care worker and I were out in the hallway discussing how we were concerned about getting HIV from our client, so no one could hear us in the client's room.'' Rationale: Discussing this client's illness outside the client's room is a breach of confidentiality."

"The nurse is instructing an unlicensed health care worker on the care of the client with HIV who also has active genital herpes. Which statement by the health care worker indicates effective teaching of standard precautions? A) ''I need to know my HIV status, so I must get tested before caring for any clients."" B) ''Putting on a gown and gloves will cover up the itchy sores on my elbows.'' C) ''Washing my hands and putting on a gown and gloves is what I must do before starting care.'' D) ''I w

"(C) C) ''Washing my hands and putting on a gown and gloves is what I must do before starting care.'' Rationale: Standard precautions include whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes. Incorrect: A) ''I need to know my HIV status, so I must get tested before caring for any clients."" Rationale: Knowing HIV status is important for preventing transmission of HIV, but is not a standard precaution. B) ''Putting on a gown and gloves will cover up the itchy sores on my elbows.'' Rationale: Health care workers with weeping dermatitis should not provide direct client care regardless of the use of gown and gloves. D) ''I will wash my hands before going into the room, and then put on gown and gloves only for direct contact with the client's genitals."" Rationale: Unlicensed health care workers cannot make the determination of what is required for PPE or standard precaution"

"The nurse is instructing an unlicensed health care worker on the care of the client with HIV who also has active genital herpes. Which statement by the health care worker indicates effective teaching of standard precautions? A) ''I need to know my HIV status, so I must get tested before caring for any clients."" B) ''Putting on a gown and gloves will cover up the itchy sores on my elbows.'' C) ''Washing my hands and putting on a gown and gloves is what I must do before starting care.'' D) ''I w

"(C) C) ''Washing my hands and putting on a gown and gloves is what I must do before starting care.'' Rationale: Standard precautions include whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes."

A client with acquired immunodeficiency syndrome (AIDS) is experiencing shortness of breath related to Pneumocystis jiroveci pneumonia. Which measure should the nurse include in the plan of care to assist the client in performing activities of daily living? a) provide supportive care with hygiene needs b) provide meals and snacks with high-protein, high calorie, and high-nutritional value c) provide small, frequent meals

") A - Providing supportive care with hygiene needs as needed reduces the client's physical and emotional energy demands and conserves energy resources for other functions such as breathing. Options B, C, and D are important interventions for the client with AIDS but do not address the subject of activities of daily living. Option B will assist the client in maintaining appropriate weight and proper nutrition. Option C will assist the client in tolerating meals better. Option D will decrease the client's risk of infection."

"The nurse is describing the HIV virus infection to a client who has been told he is HIV positive. Which information regarding the virus is important to teach? 1. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in. 2. The HIV virus can be eradicated from the host body with the correct medical regimen. 3. It is difficult for the HIV virus to replicate in humans because it is a monkey virus. 4. The HIV virus uses the client's own red blood cells to reprodu

"*1. Retroviruses never die; the virus may become dormant, only to be reactivated at a later time.* 2. ""Eradicated"" means to be completely cured or done away with. HIV cannot be eradicated. 3. The HIV virus originated in the green monkey, in whom it is not deadly. HIV in humans replicates readily using the CD4 cells as reservoirs. 4. The HIV virus uses the CD4 cells of the immune system as reservoirs to replicate itself. TEST-TAKING HINT: If the test taker is not aware of the definition of a word, the individual monitoring the test may be able to define the word, but this is not possible on the NCLEX-RN examination. Of the answer options, option ""1"" has the most important information regarding prognosis and potential spread to noninfected individuals."

"The nurse presents a seminar on HIV testing to a group of seniors and their caregivers in an assisted living facility. Which responses fit the Centers for Disease Control and Prevention's (CDC's) recommendations for HIV testing? (Select all that apply.) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' B) ''In 1986, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from a penitentiary.'' D) ''I used to smoke marijuana 30 years ago, but

"-(A, C, F) A) ''I am 78 years old and I was treated and cured of syphilis many years ago.'' Rationale: People who have had sexually transmitted diseases should be tested for HIV. C) ''Seven years ago, I was released from a penitentiary.'' Rationale: HIV testing is recommended for people who are or have been in jails or prisons. F) ''At 68, I am going to get married for the fourth time.'' Rationale: People who are planning to get married should be tested for HIV. Incorrect: B) ''In 1986, I received a transfusion of platelets.'' Rationale: People who received blood transfusions between 1978 and 1985 should be tested for HIV. D) ''I used to smoke marijuana 30 years ago, but I have not done any drugs since.'' Rationale: HIV testing is recommended only for injection drug users. E) ''I had sex with a man with a disreputable past from New York back in the late 1960s, but I have been happily married since 1971.'' Rationale: AIDS cases were extremely rare prior to the 1970s. G) ''Downtown was

The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding? 1. The client is fortunate not to have contracted HIV from an infected needle. 2. The client must be repeatedly exposed to HIV before becoming infected. 3. The client may be in the primary infection phase of an HIV infection. 4. The antibody test is negative because the client has a different flu vi

"1. The client may be in the primary infection stage when the body has not had time to develop antibodies to the HIV virus. 2. Repeated exposure to HIV increases the risk of infection, but it only takes one exposure to develop an infection. *3. The primary phase of infection ranges from being asymptomatic to severe flu-like symptoms, but during this time, the test may be negative although the individual is infected with HIV.* 4. The client may or may not have a different virus, but this is not the reason the test is negative. TEST-TAKING HINT: Answer options ""1"" and ""4"" assume the client is negative for the HIV virus. Therefore, these options should be eliminated as correct answers unless the test taker is completely sure the statement is correct."

The client diagnosed with AIDS is complaining of a sore mouth and tongue. When the nurse assesses the buccal mucosa, the nurse notes white, patchy lesions covering the hard and soft palates and the right inner cheek. Which interventions should the nurse implement? 1. Teach the client to brush the teeth and patchy area with a soft-bristle toothbrush. 2. Notify the HCP for an order for an antifungal swish-and-swallow medication. 3. Have the client gargle with an antiseptic-based mouthwash several

"1. This client probably has oral candidiasis, a fungal infection of the mouth and esophagus. Brushing the teeth and patchy areas will not remove the lesions and will cause considerable pain. *2. This most likely is a fungal infection known as oral candidiasis, commonly called thrush. An antifungal medication is needed to treat this condition.* 3. Antiseptic-based mouthwashes usually contain alcohol, which is painful for the client. 4. The foods the client has eaten did not cause this condition. TEST-TAKING HINT: The client is complaining of a ""sore mouth."" The test taker must notice all the important information in the stem before attempting to choose an answer. How are brushing the area, an antiseptic mouthwash, or the"

"During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous membranes, and listleness. Which nursing diagnosis focuses attention on the client's most immediate problem? A. Deficient fluid volume related to diarrhea and abnormal fluid loss B. Imbalanced nutrition: less than body requirements related to nausea and vomiting C. Disturbed thought processes r

"A Based on the client's assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the client's fluid status. Although imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time."

"When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. ""I will need to isolate any tissues I use so as not to infect my family."" B. ""I will notify all of my sexual partners so they can get tested for HIV."" C. ""Unprotected sexual contact is the most common mode of transmission."" D. ""I do not need to worry about spreading this virus to others by sweating at the gym."""

"A. ""I will need to isolate any tissues I use so as not to infect my family."" HIV is not spread casually. 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. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat."

A nurse working in an outpatient clinic is assessing a client who reports night sweats and fatigue. He states he has had a cough along with nausea and diarrhea. His temperature is 38.1° C (100.6° F) orally. The client is afraid he has HIV. Which of the following actions should the nurse take? (Select all that apply.) A. Perform a physical assessment. B. Determine when current symptoms began. C. Teach the client about HIV transmission. D. Draw blood for HIV testing. E. Obtain a sexual history.

"A. CORRECT: The nurse should perform a physical assessment to gather data about the client's condition. This is an appropriate action by the nurse. B. CORRECT: The nurse should gather more data to determine whether the clinical manifestations are acute or chronic. This is an appropriate action by the nurse. C. INCORRECT: Teaching the client about HIV transmission is not an appropriate action by the nurse at this time. This is not a priority action for the nurse to include at this time. D. INCORRECT: Drawing blood for HIV testing is not an appropriate action by nurse at this time. This is not a priority action for the nurse to include at this time. E. CORRECT: The nurse should obtain a sexual history to determine how the virus was transmitted. This is an appropriate action by the nurse."

"A nurse is caring for a client who has HIV and has been newly diagnosed with Burkitt's lymphoma. Which of the following HIV infection stages is the client in? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4"

"A. INCORRECT: In stage 1, there are no defining conditions. B. INCORRECT: In stage 2, there are no defining conditions. C. CORRECT: In stage 3, there are one or more defining conditions present. These can include candidiasis of the esophagus, bronchi, trachea, or lungs; chronic ulcers of herpes simplex; HIV‑related encephalopathy; disseminated or extrapulmonary histoplasmosis; Kaposi's sarcoma; and Burkitt's lymphoma. D. INCORRECT: In stage 4, there is no information available."

"Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure"

"ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus."

"A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, ""I feel obsessed with thoughts about dying. Do you think I am just being morbid?"" Which response by the nurse is best? a. ""Thinking about dying will not improve the course of AIDS."" b. ""It is important to focus on the good things about your life now."" c. ""Do you think that taking an antidepressant might be helpful to you?"" d. ""Can you tell me more about the kind of thoughts that you are having?""

"ANS: D More assessment of the patient's psychosocial status is needed before taking any other action. The statements, ""Thinking about dying will not improve the course of AIDS"" and ""It is important to focus on the good things in life"" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings."

"Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken."

"ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule."

"After the first injection of an immunotherapy program, the nurse notices a large, red wheal on the client's arm, coughing, and expiratory wheezing. Which intervention should the nurse implement first? A. Notifying the health care provider immediately B. Administering I.M. epinephrine per protocol C. Beginning oxygen by way of nasal cannula D. Starting an I.V. line for medication administration"

"B Immediately on noticing the client's sign and symptoms, the nurse would determine that the client is experiencing anaphylaxis to the injection. The first action is to give 0.2 to 0.5 ml of 1:1,000 epinephrine I.M. Notifying the health care provider, beginning oxygen administration, and starting an I.V. line follow after the initial injection of epinephrine is administered."

"Nurse Vince sustained a dirty needle stick injury. Which diagnostic test would be ordered on a client? A. Enzyme-linked immunosorbent assay (ELISA) B. SUDS screening test C. Antibody titers D. Skin biopsy for Kaposi's sarcoma"

"B SUDS screening test results are available in 30 to 60 minutes. The test is performed on a client to determine if the health care worker with a dirty needle stick injury should begin antiretroviral treatment. ELISA test results indicate exposure to or infection with human immunodeficiency virus (HIV), but the test does not diagnose acquired immunodeficiency syndrome (AIDS). Antibody titers would not be appropriate to determine whether the health care worker has been exposed to HIV or hepatitis. Kaposi's sarcoma is usually associated with AIDS but not immediately after a needle stick."

"When preparing the newly diagnosed client with HIV and significant other for discharge, which explanation by the nurse accurately describes proper condom use? A) ''Condoms should be used when lesions on the penis are present.'' B) ''Always position the condom with a space at the tip of an erect penis.'' C) ''Make sure it fits loosely to allow for penile erection.'' D) ''Use adequate lubrication such as petroleum jelly.''"

"B) B) ''Always position the condom with a space at the tip of an erect penis.'' Rationale: This allows for the collection of semen at the tip of the condom. Incorrect: A) ''Condoms should be used when lesions on the penis are present.'' Rationale: Condoms must be used at all times with sexual activity, with or without the presence of lesions. C) ''Make sure it fits loosely to allow for penile erection.'' Rationale: Condoms should be applied on an erect penis and should fit snugly, leaving space without air at the tip. D) ''Use adequate lubrication such as petroleum jelly.'' Rationale: Lubricants should be water-based only."

"When preparing the newly diagnosed client with HIV and significant other for discharge, which explanation by the nurse accurately describes proper condom use? A) ''Condoms should be used when lesions on the penis are present.'' B) ''Always position the condom with a space at the tip of an erect penis.'' C) ''Make sure it fits loosely to allow for penile erection.'' D) ''Use adequate lubrication such as petroleum jelly.''"

"B) B) ''Always position the condom with a space at the tip of an erect penis.'' Rationale: This allows for the collection of semen at the tip of the condom."

"The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? A. Assessment of lung sounds B. Assessment of sexual behavior C. Assessment of living conditions D. Assessment of drug and syringe use E. Assessment of exposure to an ill person"

"B. Assessment of sexual behavior D. Assessment of drug and syringe use With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB)."

"Which intervention should the nurse implement when caring for a client diagnosed with Pneumocystis carinii pneumonia related to acquired immunodeficiency syndrome who is crying over the loss of friends and family members because they will not talk to him anymore? A. Advising the client not to worry, and telling him everything will be alright B. Asking the health care provider for a psychiatric consult to assess the client's mental functioning C. Sitting down and listening to the client's concer

"C rying is evidence that the client is beginning to express concerns to the nurse. In response, active, nonjudgmental listening would most appropriate because is aids in the development of a trusting relationship. Advising the client not to worry or saying that everything will be alright provides false reassurance, which does not help the client cope. Further assessment is needed to determine whether a psychiatric consult should be considered. Telling the client that the friends were not true friends discounts the client's feeling and hinders the development of a therapeutic relationship."

"A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. ""The baby will probably be infected with HIV."" B. ""Only an abortion will keep your baby from having HIV."" C. ""Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."" D. ""The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

"C. ""Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."" 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. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk."

"A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. ""The baby will probably be infected with HIV."" B. ""Only an abortion will keep your baby from having HIV."" C. ""Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."" D. ""The duration and frequency of contact with the organism will determine if the baby gets HIV infection."""

"C. ""Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."" 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. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk."

"The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count"

"C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion."

"What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. ""Set up"" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances. Correct answer: d Rationale: The best approach to impro

"Correct answer: d Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life."

"The decision to begin antiretroviral therapy is based on: A. The CD4 cell count B. The plasma viral load C. The intensity of the patient's clinical symptoms D. All of the above"

"D A person's CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections."

"The nurse is admitting a client diagnosed with protein-calorie malnutrition secondary to AIDS. Which intervention should be the nurse's first intervention? 1. Assess the client's body weight and ask what the client has been able to eat. 2. Place in contact isolation and don a mask and gown before entering the room. 3. Check the HCP's orders and determine what laboratory tests will be done. 4. Teach the client about total parenteral nutrition and monitor the subclavian IV site."

*1. The client has a malnutrition syndrome. The nurse assesses the body and what the client has been able to eat.* 2. Standard Precautions are used for clients diagnosed with AIDS, the same as for every other client. 3. The nurse should check the orders but not before assessing the client. 4. The client will probably be placed on total parenteral nutrition and will need to be taught these things, but this is not the first action.

The school nurse is preparing to teach a health class to ninth graders regarding sexually transmitted diseases. Which information regarding acquired immunodeficiency syndrome (AIDS) should be included? 1. Females taking birth control pills are protected from becoming infected with HIV. 2. Protected sex is no longer an issue because there is a vaccine for the HIV virus. 3. Adolescents with a normal immune system are not at risk for developing AIDS. 4. Abstinence is the only guarantee of not becom

1. Birth control pills provide protection against unwanted pregnancy but they do not protect females from getting sexually transmitted diseases. In fact, because of the reduced chance of becoming pregnant, some women may find it easier to become involved with multiple partners, increasing the chance of contracting a sexually transmitted disease. 2. There is no vaccine or cure for the HIV virus. 3. Adolescents are among the fastest-growing population to be newly diagnosed with HIV and AIDS. *4. Abstinence is the only guarantee the client will not contract a sexually transmitted disease, including AIDS. An individual who is HIV negative in a monogamous relationship with another individual who is HIV negative and committed to a monogamous relationship is the safest sexual relationship.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities

"A nurse is completing discharge instructions with a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? A. ""I will wear gloves while changing the pet litter box."" B. ""I will rinse raw fruits with water before eating them."" C. ""I will wear a mask when around family members who are ill."" D. ""I will cook vegetables before eating them."""

A. INCORRECT: A client who has AIDS should avoid changing the pet litter box to prevent acquiring toxoplasmosis. B. INCORRECT: A client who has AIDS should avoid consuming raw fruits due to the presence of bacteria that can cause opportunistic infections. C. INCORRECT: Due to compromised immune response, a client who has AIDS should avoid contact with family members who are ill. D. CORRECT: A client who has AIDS should cook vegetables before eating to kill bacteria that cause opportunistic infections.

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manage

B. Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager

B. Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs

B. Viral replication will be inhibited. 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 that 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.

The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to A) Gardasil. B) Antibiotic therapy. C) Wart removal options. D) Treatment with antiviral drugs.

C

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Palmar rash b) Development of gummas c) Development of central nervous system lesions d) Genital chancres

D

Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral loa

Correct answers: a, b, c Rationale: The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

Which statement about metabolic side effects of ART is true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include central fat accumulation and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlip

Correct answers: b, c, d Rationale: Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient? a) Alteration in comfort related to impaired skin integrity b) Fear related to complications c) Noncompliance with treatment regimen related to age d) Knowledge deficit related to modes of transmission

D

"A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule"

d