Lewis Chapter 14: Infection and HIV

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 .

17. 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

The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? 1 All patients regardless of diagnosis 2 Pediatric and gerontologic clients 3 Patients who are immunocompromised 4 Patients with a history of infectious diseases

1 Standard precautions are designed for care of all patients in hospitals and health care facilities. Text Reference - p. 231

A human immunodeficiency virus (HIV)-infected patient tells the nurse that he or she is worried that he or she might have acquired immunodeficiency syndrome (AIDS). When is a diagnosis of AIDS in an HIV-infected patient confirmed? 1 The patient's CD4+ T cell count is below 200/μL. 2 The patient has flu-like symptoms. 3 Lipodystrophy with metabolic abnormalities is present. 4 Elevated platelet and white blood cell (WBC) counts are present.

1 AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/μL. Flu-like symptoms can be indicative of other diseases. Changes in WBC or platelet counts are not diagnostic criteria for AIDS (and WBC and platelet levels decrease, not increase). Changes in body shape because of lipodystrophy are not definitive diagnoses for AIDS. Text Reference - p. 235

A patient with acquired immunodeficiency syndrome (AIDS) comes into the clinic complaining of fatigue and knee pain. During the assessment, the nurse also notes that the patient is jaundiced. The nurse suspects that the patient is experiencing: 1 Hepatitis B virus (HBV) 2 Hepatitis C virus (HCV) 3 Cytomegalovirus (CMV) 4 Mycobacterium avium complex (MAC)

1 Although all of these are opportunistic infections that AIDS patients may acquire, HBV is correct here, because clinical manifestations consist of jaundice, fatigue, and joint pain. HCV is incorrect, because HCV clinical manifestations do not include joint pain. CMV is incorrect, because CMV is broken down into several specific categories that include retinitis, esophagitis, pneumonitis, and neurologic disease, in which none have the clinical manifestations of fatigue, jaundice, or joint pain. MAC is incorrect, because MAC clinical manifestations include gastroenteritis, watery diarrhea, and weight loss. Text Reference - p. 228

A female patient who is HIV positive is prescribed Efavirenz in large doses. What question should the nurse ask of the patient before administering the therapy to ensure drug safety? 1 "Are you pregnant?" 2 "Is your partner HIV positive?" 3 "Are you on your menses?" 4 "Have you ever had a blood transfusion?"

1 Efavirenz is an antiretroviral drug. Large doses could cause fetal anomalies; therefore, it is important to know if the patient is pregnant. Asking about the HIV status of the partner is unrelated to administration of the drug. The information about the patient's menses does not impact the antiretroviral therapy. A history of blood transfusion helps ascertain the mode of infection, but does not impact the drug therapy. Text Reference - p. 238

When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? 1 "I will need to isolate any tissues I use so as not to infect my family." 2 "I will notify all of my sexual partners so they can get tested for HIV." 3 "Unprotected sexual contact is the most common mode of transmission." 4 "I do not need to worry about spreading this virus to others by sweating at the gym."

1 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. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching. Text Reference - p. 232

During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidiodes immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans

1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus, and the presence of thrush indicate Candida albicans. Infection by Coccidiodes immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans. Text Reference - p. 236

A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: 1 Hyperthermia 2 Social isolation 3 Impaired memory 4 Sexual dysfunction

1 Temperature increase is the highest priority for the nurse because Pneumocystis jiroveci pneumonia (PCP) is an indication of AIDS (acquired immunodeficiency syndrome). Early detection and treatment of PCP is directly related to a positive outcome. Temperature increase in an immunosuppressed patient is always a concern. Social isolation is a secondary risk of all persons who test positive for human immunodeficiency virus (HIV). Impaired memory and sexual dysfunction may develop as complications in patients with HIV disease, but these issues are not always present. Text Reference - p. 236

A human immunodeficiency virus (HIV) patient on antiretroviral therapy comes into the clinic complaining that he or she is starting to feel like he or she did before starting the therapy. What should the nurse plan for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test

1 The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection. Text Reference - p. 235

A woman infected with human immunodeficiency virus (HIV) delivers a baby with congenital anomalies. The patient was put on Atripla (tenofovir DF+emtricitabine+efavirenz) during pregnancy to control her infection. The nurse recognizes that what is the probable cause for the fetal malformations? 1 Adverse effects of efavirenz 2 Adverse effects of tenofovir DF 3 Adverse effects of emtricitabine 4 Immune deficiency due to HIV

1 The use of efavirenz in large doses in pregnant women may cause fetal anomalies. Tenofovir and emtricitabine are usually not associated with fetal malformations. Tenofovir and emtricitabine are used for preexposure prophylaxis. Immune deficiency due to HIV rarely causes fetal malformation. Text Reference - p. 238

The human immunodeficiency virus (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. The nurse knows that the rationale behind these interventions is best described as? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities

1 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. Text Reference - p. 242

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.

1. 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 test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

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.

10. 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: 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.

11. 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: 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.

12. 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: 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.

13. 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 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.

14. 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: 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.

15. 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: 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

16. 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: 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.

18. 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: 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.

19. 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).

A patient currently taking emtricitabine, asks the nurse how this medication helps with the patient's human immunodeficiency virus (HIV) infection. The nurse would explain that it: 1 Prevents the binding of the HIV to cells, which prevents HIV entry into the cell. 2 Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. 3 Inhibits the action of the reverse transciptase enzyme, so that DNA is no longer converted to RNA. 4 Binds with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell.

2 Emtricitabine is classified as a nucleoside reverse transcriptase inhibitor (NRTI), and works by inserting DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. Medications that prevent binding of the HIV to cells are classified as entry inhibitors. Drugs that inhibit the action of the reverse transciptase enzyme so that DNA is no longer converted to RNA, are classified as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Medications that bind with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell, are classified as integrase inhibitors. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding. Text Reference - p. 237

Which virus causes Burkitt's lymphoma? 1 Echoviruses 2 Epstein-Barr 3 Rotaviruses 4 West Nile virus

2 Epstein-Barr virus causes mononucleosis and Burkitt's lymphoma. Echoviruses cause upper-respiratory tract infection, gastroenteritis, and aseptic meningitis. Rotaviruses cause gastroenteritis. The West Nile virus causes flu-like symptoms, meningitis, and encephalitis. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 227

A patient is enzyme immunoassay (EIA)-antibody negative for HIV. The patient informs the nurse about recent sexual contact with multiple partners. What is the most appropriate nursing action? 1 Reassure the patient that HIV infection is unlikely. 2 Suggest HIV retesting at three weeks, six weeks, and three months. 3 Advise a more specific test, such as the Western blot. 4 Suggest getting a genotype and phenotype assay done.

2 If the patient is EIA-antibody negative for HIV and has a history of risky behavior, such as sexual contact with multiple partners, the nurse should advise the patient to get retested at three weeks, six weeks, and three months. In the initial stages of infection, the viral antibody may not be detectable; therefore repeated testing may be required. The nurse should inform the patient that absence of antibody does not indicate absence of HIV infection, and to confirm, further testing may be required. If the repeated tests are positive, then a more specific and confirmatory test like Western blot may be done. Genotype and phenotype assays are done not to detect presence of infection, but to determine whether a patient's HIV is resistant to drugs used for antiretroviral therapy. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 236

The nurse understands that a patient with human immunodeficiency virus (HIV) starts to develop immune problems when his or her CD4 count: 1 drops below 200 2 drops below 500 3 is greater than 500 4 falls to between 800 to 1200

2 Immune problems start to occur when the count drops below 500 CD4 T cells. When it drops below 200 CD4 T cells, severe immune problems will develop and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 to 1200 CD4 T cells is normal for adults who do not have any immune dysfunction. Text Reference - p. 233

The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? 1 Personal protective equipment 2 Combination antiretroviral therapy 3 Counseling to report blood exposures 4 A negative evaluation by the manager

2 Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly 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. Text Reference - p. 240

The nurse should assess a patient with acquired immunodeficiency syndrome (AIDS) for which most common symptoms? 1 Tremors and bradykinesia 2 Hematuria and abdominal pain 3 Persistent vomiting and headache 4 Low-grade fever and persistent diarrhea

4 The symptoms of acquired immunodeficiency syndrome (AIDS) are variable, but low-grade fever and persistent diarrhea are common. The symptoms listed in the other answer options are not specifically associated with AIDS. Text Reference - p. 235

A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the nurse reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."

2 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4+ T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle. Text Reference - p. 237

A 25-year-old male patient has been diagnosed with human immunodeficiency virus (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? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs

2 The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs. Text Reference - p. 236

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.

2. 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/mL. 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." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

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.

20. 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: 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.

21. 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: 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.

22. 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: 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.

23. 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

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? 1 A new onset of polycythemia 2 Presence of mononucleosis-like symptoms 3 A sharp decrease in the patient's CD4+ count 4 A sudden increase in the patient's white blood cell (WBC) count

3 A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. Mononucleosis-like symptoms, such as malaise, headache, and fatigue, are typical of early HIV infection and seroconversion. A patient's WBC count is very unlikely to increase suddenly, with decreases being typical. Text Reference - p. 234

The nurse assesses a patient with recently diagnosed human immunodeficiency virus disease who has been admitted to the hospital with a new diagnosis of acquired immunodeficiency syndrome (AIDS). What assessment finding is most diagnostic of AIDS? 1 Sleeping six to eight hours per night 2 Feelings of fatigue in the evening 3 Steady weight loss over the past several months 4 Feelings of profound helplessness and hopelessness

3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss. Text Reference - p. 234

A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false-negative report. 3 The test should be repeated at three weeks, six weeks, and three months. 4 The patient is HIV positive, but the viral load is not detectable.

3 An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at three weeks, six weeks, and three months. The test is unlikely to give a false-negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he or she is HIV positive. Text Reference - p. 236

Which disease-causing fungus is responsible for thrush? 1 Trichophyton 2 Microsporum 3 Candida albicans 4 Aspergillus fumigatus

3 Candida albicans is a fungus that causes thrush. Trichophyton causes tinea pedis, or athlete's foot. Microsporum causes tinea capitis of the skin. Aspergillus fumigatus affects the ears and lungs. Test-Taking Tip: Identifying the content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 228

Mycobacterium leprae is identified in a patient's blood culture, and the nurse recognizes that it can cause what condition? 1 Diphtheria 2 Meningitis 3 Hansen's disease 4 Acute osteomyelitis

3 Mycobacterium leprae is a bacterium that causes Hansen's disease (leprosy). Diphtheria is caused by Corynebacterium diphtheriae. Meningitis is caused by Haemophilus influenza, Neisseria meningitides, or Pseudomonas aeruginosa. Acute osteomyelitis is caused by the bacterium Staphylococcus aureus. Text Reference - p. 227

A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1 "The baby probably will be infected with HIV." 2 "Only an abortion will keep your baby from having HIV." 3 "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4 "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

3 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 are two variables that influence 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. Text Reference - p. 240

The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching? 1 "I can't contract HIV unless there's an opportunistic infection present." 2 "Using a condom with a spermicide will give 100% protection from HIV." 3 "Using a condom with a spermicide will reduce my risk of contracting HIV." 4 "Kaposi sarcoma is one of the first opportunistic infections to show up in someone with HIV."

3 Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse. An opportunistic infection does not have to be present, a condom with spermicide does not provide 100% protection, and Kapos sarcoma is not one of the first opportunistic infections to appear in someone infected with HIV. Text Reference - p. 240

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.

3. 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 contact with the patient.

When reviewing the assessment data of a human immunodeficiency virus (HIV) patient, the nurse notes that the patient's CD4 cell count is below 200, and that the patient has lost more than 10% of his or her ideal body weight. The nurse suspects that the patient is experiencing: 1 Kaposi sarcoma 2 Cytomegalovirus (CMV) 3 Pneumocystis jiroveci pneumonia (PCP) 4 Acquired immunodeficiency syndrome (AIDS

4 A patient with HIV is diagnosed with AIDS when the CD4 T cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS. Text Reference - p. 235

A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? 1 Shaking hands 2 Sharing a toilet seat 3 Eating from the same utensils 4 Having unprotected sex

4 AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes. Text Reference - p. 231

A human immunodeficiency virus (HIV) patient comes into the clinic for a follow-up appointment with a temperature of 102o F. Which statement would the nurse report immediately? 1 "I woke up this morning with a mild headache." 2 "I vomited once this morning." 3 "I started coughing up some clear mucous when I woke up this morning." 4 "I have a rash that appeared on my stomach this morning."

4 Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 242

The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? 1 "I need to keep my appointments for follow-up laboratory work." 2 "I will call my health care provider if I am too sick to take these drugs." 3 "I won't take any new drugs or herbal products without checking with my health care provider first." 4 "Once my tests show that the virus has decreased, I cannot give HIV to another person."

4 Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first. Text Reference - p. 235 Topics

A patient has an undetectable level of plasma human immunodeficiency virus (HIV) RNA after six months of antiretroviral therapy. The patient exclaims, "I'm so glad to be cured!" Which response by the nurse is most therapeutic and accurate? 1 "Oh,that is wonderful. I'm glad everything worked out so well for you." 2 "No, you're wrong. You're never going to be cured—this is a lifelong illness." 3 "You should be very pleased, and I think you should celebrate the good news." 4 "An undetectable level means that your therapy was successful but not that you were cured."

4 Human immunodeficiency virus antiretroviral therapy can reduce viral load, resulting in an undetectable serum level. This does not indicate a cure; rather, it indicates that the therapy is working and that the patient must continue to take the medication. Congratulating the patient, or telling him or her to celebrate, is inaccurate and incorrect; telling the patient that he or she is wrong and will never be cured is nontherapeutic. Text Reference - p. 243

A patient receiving long-term antiretroviral therapy (ART) for HIV has developed lipodystrophy, hyperlipidemia, insulin resistance, and bone disease. Which should be the first intervention? 1 Suggest dietary changes to lower lipid levels. 2 Promote weight loss through exercise. 3 Advocate use of calcium supplements. 4 Change antiretroviral medications.

4 Long-term therapy with antiretroviral drugs may lead to development of certain metabolic disorders, including lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, renal disease, and cardiovascular disease. Therefore, the first intervention should be to change the antiretroviral drug and start medications that have fewer side effects. Other interventions like dietary changes, weight loss through exercise, and taking calcium supplements are general measures and may not contribute directly to the reduction of side effects. Text Reference - p. 243

The nurse assesses a patient who tests positive for HIV. Which finding would the nurse identify as the highest priority for follow-up? 1 Anorexia 2 Insomnia 3 Mood swings 4 Nonproductive cough

4 The patient who tests positive for HIV should be observed for the first sign of Pneumocystis jiroveci pneumonia, which is a dry, nonproductive cough. After evaluation of the nonproductive cough, follow-up care for anorexia, insomnia, and mood swings is secondary. Text Reference - p. 236

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.

4. 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: 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.

5. 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 contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

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.

6. 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: 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.

7. 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: 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.

8. 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 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.

9. 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