NUR 397 Chapter 19: Care of patient with problems of HIV

Abnormal functioning of which body system is responsible for the signs and symptoms of human immunodeficiency virus (HIV) disease? 1.) Immune 2.) Respiratory 3.) Cardiovascular 4.) Gastrointestinal

1 Abnormal functioning of the immune system is responsible for the signs and symptoms of HIV disease. Signs and symptoms may occur in the respiratory, cardiovascular, and gastrointestinal symptoms, but abnormal functioning of the immune system is the underlying mechanism.Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.

Which minority group shows an increasing trend in human immunodeficiency virus (HIV) infection? 1.) Hispanics 2.) Caucasians 3.) Asian Americans 4.) American Indians

1 The Hispanic population is experiencing an increasing trend in HIV infections. Compared to Caucasians, Asian Americans, and American Indians, HIV infections reported in the United States are riding most among Hispanics.Test-Taking Tip: You have at least a 25% chance of selecting the correct response to a multiple choice item. If you are uncertain about a question, eliminate the choices you believe are wrong, and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A nurse is educating an immunocompromised patient about preventing infection. Which should the patient report to the health care provider immediately? 1.) Foul-smelling or cloudy urine 2.) Missing a dose of prescribed drugs 3.) An intermittent cough without sputum 4.) Temperature greater than 98°F

1 The patient should report to the physician immediately if there is foul-smelling or cloudy urine, because this may indicate infection. The patient should take all prescribed drugs but does not need to call the physician if he or she misses a dose; rather, he or she can read the drug's instructions that describe when to take the next dose. A persistent cough with or without sputum indicates an infection, but an intermittent cough does not. The patient only needs to contact the physician if his or her is about 100°F.

How often should the patient taking tenofovir/emtricitabine for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) be tested for HIV? 1.) Every three months 2.) Every 12 months 3.) Once before beginning PrEP 4.) After each contact that puts the patient at risk for infection

1 The patient taking tenofovir/emtricitabine for PrEP for HIV should be tested for HIV every three months. Every 12 months is longer than recommended. The patient should be tested once before beginning PrEP, but the patient must continue getting screened. After each contact that carries a risk of infection is more than necessary.

In human immunodeficiency virus (HIV) infections, more virus particles are created when the virus enters which type of host cell? 1.) CD4+ T-cell 2.) CD8+ T-cell 3.) Natural killer T-cell 4.) Gamma delta T-cell

1 To infect the host, HIV must first enter the bloodstream and then "hijack" certain cells, especially the CD4+ T-cell, also known as the CD4+ cell, helper/inducer T-cell, or T4-cell. This cell directs immunity and regulates the activity of all immune system cells. When HIV enters a CD4+ T-cell, it can then create more virus particles. CD8+ T-cells, natural killer T-cells, and gamma delta T-cells are other immune cells but are not involved directly in the replication of HIV.Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.

What class of drugs for human immunodeficiency virus (HIV) infection prevents viral binding? 1.) Entry inhibitors 2.) Protease inhibitors 3.) Integrase inhibitors 4.) Nucleoside reverse transcriptase inhibitors (NRTIs)

1 Viral binding to the CD4 receptor and to either of the co-receptors is needed for the HIV virus to enter the cell. Entry inhibitors prevent the interaction needed for entry of HIV into the CD4+ T-cell. New virus particles are made in the form of one long protein strand that is clipped by the enzyme HIV protease into smaller functional pieces. Protease inhibitors work here to inhibit HIV protease. HIV then uses its enzyme integrase to get its DNA into the nucleus of the host's CD4+ T-cell and insert it into the host's DNA. Integrase inhibitors prevent viral DNA from integrating into the host's DNA. NRTIs prevent viral replication by reducing how well reverse transcriptase can convert HIV genetic material into human genetic material.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

Which are required elements of the human immunodeficiency virus (HIV) testing process? Select all that apply. 1.) Counseling 2.) Interpretation 3.) Confidentiality 4.) Written consent 5.) Health insurance coverage

1,2,3 HIV testing requires counseling, interpretation, and confidentiality. Written consent and health insurance coverage are not required.Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

What laboratory changes are most likely in a patient whose immune system is being overwhelmed by human immunodeficiency virus (HIV)? 1.) CD4+ T-cell counts and viral numbers fall 2.) CD4+ T-cell counts fall, viral numbers rise 3.) CD4+ T-cell counts rise, viral numbers fall 4.) CD4+ T-cell counts and viral numbers rise

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

How does the assessment of the financial resources of the patient with AIDS help the nurse? 1.) It helps in assessing the neurologic status of the patient. 2.) It helps in assessing the nutritional status of the patient. 3.) It helps in assessing the cardiovascular status of the patient. 4.) It helps in assessing the gastrointestinal status of the patient.

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

What safer sex methods can reduce the risk of human immunodeficiency virus (HIV) transmission? Select all that apply. 1.) Oral sex 2.) Abstinence 3.) Monogamy 4.) Condom use 5.) Heterosexual sex

2,3,4 Safer sex methods of A, abstinence; B, be faithful (monogamous); and C, condom use can reduce HIV transmission. Abstinence and mutually monogamous sex with a noninfected partner are the only absolutely safe methods of preventing HIV infection from sexual contact. Oral sex and heterosexual sex are not considered safer sex methods.Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

The number of CD4+ T-cells is reduced in human immunodeficiency virus (HIV) disease. How many CD4+ T-cells are usually present in a cubic millimeter (mm 3) of a healthy adult's blood? 1.) 200-499 2.) 500-799 3.) 800-1000 4.) More than 1000

3 A healthy adult usually has 800-1000 CD4+T-cells/mm 3. A patient with 200-499 CD4+T-cells/mm 3 meets the criteria for stage 2 of the Centers for Disease Control and Prevention (CDC) Case Definition of HIV disease. A patient with greater than 500 CD4+T-cells/mm 3 meets the criteria for stage 1 CDC Case Definition of HIV disease. More than 1000 CD4+T-cells/mm 3 may be present in a healthy adult but are not typical.Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

In patients with human immunodeficiency virus (HIV), which type of laboratory test measures the patient's response to the virus rather than parts of the virus? 1.) Stool testing 2.) Skin biopsies 3.) Antibody testing 4.) Viral load testing

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

When the human immunodeficiency virus (HIV) virus enters the patient's CD4+ T-cell, what is the new role served by the immune cell? 1.) Antigen 2.) Antibody 3.) HIV factory 4.) Natural killer cell

3 Effects of HIV infection are related to the new genetic instructions that now direct CD4+ T-cells to change their role in immune system defenses. The new role is to be an "HIV factory," making up to 10 billion new viral particles daily. The CD4+ cell does not become an antigen, antibody, or natural killer cell.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

What class of drugs for human immunodeficiency virus (HIV) infection prevents the virus from inserting its DNA into the host's DNA? 1.) Entry inhibitors 2.) Protease inhibitors 3.) Integrase inhibitors 4.) Nucleoside reverse transcriptase inhibitors (NRTIs)

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

In North America, the highest rates of new human immunodeficiency virus (HIV) infections occur among which population? 1.) Women 2.) Men who have sex with men 3.) African American and Hispanic adults 4.) Adults who have used injection drugs

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

What defines the concept known as treatment as prevention (TAP) of human immunodeficiency virus (HIV)? 1.) Written consent for including HIV screening as part of routine testing is not required. 2.) The use of HIV-specific antiretroviral drugs in an HIV-uninfected adult serves the purpose of preventing HIV infection. 3.) The use of combination antiretroviral therapy (cART) reduces the viral load to undetectable levels, thereby reducing the risk of HIV transmission. 4.) Expanded screening recommendations include a one-time screen for all adults ages 15-65, annual screening of those at heightened risk, routine prenatal screening, and frequent testing in adults with repeated high-risk exposures.

3 Once an adult is placed on cART, reducing the viral load to undetectable levels significantly reduces the risk that HIV will be transmitted, a concept known as TAP. TAP is not defined by a lack of written consent for routine testing, the use of HIV-specific antiretroviral drugs in an HIV-uninfected adult to prevent HIV infection, or expanded screening recommendations.Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.

Which term describes infections caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity but may cause infection in patients with acquired immunodeficiency syndrome (AIDS)? 1.) Viral infections 2.) Co-occurring infections 3.) Opportunistic infections 4.) Sexually transmitted infections

3 Opportunistic infections are infections caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity but may cause infection in patients with AIDS. Opportunistic infections may be viral infections, as well as fungal, bacterial, and protozoal infections and malignancies. Co-occurring infections is a more general term to describe infections that occur simultaneously. Opportunistic infections may be sexually transmitted but are not necessarily transmitted this way.Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question.

What phase of the human immunodeficiency virus (HIV) life cycle involves separating from the infected cell's membrane to search for another CD4+ T-cell to infect? 1.) Virion 2.) Fusion 3.) Budding 4.) Uncoating

3 The budding phase of the HIV life cycle involves separating from the infected cell's membrane to search for another CD4+ T-cell to infect. Virion, fusion, and uncoating phases occur earlier in the HIV life cycle.

Which features of the human immunodeficiency virus (HIV) virus assist the viral particle in finding a host? 1.) RNA and lipid bilayer 2.) P17 matrix and p24 capsid 3.) Gp41 and gp120 docking proteins 4.) Reverse transcriptase and integrase enzymes

3 Viral particle features include an outer envelope with special "docking proteins," known as gp41 and gp120, which assist in finding a host. The RNA and lipid bilayer, p17 matrix and p24 capsid, and reverse transcriptase and integrase enzymes are other features of the HIV viral particle that do not assist in finding a host.Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers.

Which central nervous system (CNS) signs and symptoms may occur in a patient with acquired immunodeficiency syndrome (AIDS)? Select all that apply. 1.) Nausea 2.) Diarrhea 3.) Dementia 4.) Confusion 5.) Lymphadenopathy 6.) Hypergammaglobulinemia

3,4 Dementia and confusion are CNS signs and symptoms that may occur in a patient with AIDS. Nausea and diarrhea are gastrointestinal signs and symptoms. Lymphadenopathy and hypergammaglobulinemia are immunologic signs.

To prevent infection in the patient with human immunodeficiency virus (HIV), the nurse should educate the patient to avoid which foods? Select all that apply. 1.) Salty foods 2.) Cooked fruits 3.) Raw vegetables 4.) Undercooked meat 5.) Pepper and paprika

3,4,5 To prevent infection, the patient with HIV should avoid eating raw vegetables, undercooked meats, and pepper and paprika. Salty foods and cooked fruits do not have a high risk of causing infection.

What is true regarding the risk of human immunodeficiency virus (HIV) transmission from patients receiving combination antiretroviral therapy (cART)? 1.) The patient's viral load is low, so there is no risk of transmission. 2.) The patient is no longer HIV positive, so there is no risk of transmission. 3.) The patient's viral load and risk of transmission remain high, although other signs and symptoms may decrease. 4.) The patient's viral load may drop to undetectable levels, but there is still a risk of transmission.

4 In patients receiving cART, the patient's viral load may drop to undetectable levels, but there is still a risk of transmission. It is not true that there is no risk of transmission. The patient remains HIV positive. Viral load and risk of transmission are likely to be reduced with cART.Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

What class of drugs for human immunodeficiency virus (HIV) infection reduces how well HIV genetic material can be converted into human genetic material? 1.) Entry inhibitors 2.) Protease inhibitors 3.) Integrase inhibitors 4.) Nucleoside reverse transcriptase inhibitors (NRTIs)

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

Occupational exposure of the health care worker's broken skin or mucous membranes to which body fluids from a patient with human immunodeficiency virus (HIV)-positive status requires postexposure prophylaxis? Select all that apply. 1.) Feces 2.) Saliva 3.) Vomit 4.) Breast milk 5.) Amniotic fluid

4,5 Occupational exposure is defined as contact between blood, tissue, or selected body fluids, including breast milk and amniotic fluid, from a patient who is positive for HIV and the blood, broken skin, or mucous membranes of a health care professional. Bodily substances not considered infectious for HIV unless obviously bloody include feces, saliva, and vomit.