NUR 397 HIV/AIDS

Which time frame is the window of opportunity to begin postexposure prophylaxis with combination antiretroviral therapy for a nurse who has been exposed to the blood of a patient who is HIV positive?

36 hours Rationale Postexposure prophylaxis (PEP) with cART is used for adults who have had an occupational exposure (e.g., a sharps injury), those who have had a nonoccupational exposure (e.g., consensual sexual exposure with a person of unknown HIV status), and those who have suffered a sexual assault. Starting cART as soon as possible (within the first 36 hours) is critical to preventing HIV infection. The time periods of 72 hours, 2 weeks, and 1 month are not within the critical window for treatment.

The nurse compares the number of CD4+ T cells in HIV infection and healthy adults and identifies that how many of the cells are present in a cubic millimeter of the healthy adult's blood?

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

According to the CDC, in the US and Canada, which population has the highest rates of new HIV infections?

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

Why does anal intercourse have the highest risk for HIV transmission?

Anal intercourse allows seminal fluid to make contact with rectal mucous membranes and also tears the mucous membranes, making infection more likely. Rationale Anal intercourse allows seminal fluid to make contact with rectal mucous membranes and also tears the mucous membranes, making infection more likely. Condoms can and should be used during anal intercourse to protect partners from HIV transmission. Anal intercourse may occur among homosexual and heterosexual men and women. Anal receptive intercourse is used for male-to-female intercourse as a form of contraceptive practice in certain cultures, but this is not why anal intercourse carries the highest risk for HIV infection.

Based on laboratory reports, the nurse concludes that a patient's immunity is compromised and provides which instruction to the patient? (select all that apply)

Avoid digging in the garden. Wash your genitals twice a day with antimicrobial soap if total bathing is not possible. Rationale The nurse may conclude the patient's immunity is compromised if the laboratory reports show that the patient has a low white blood cell count. This patient should avoid digging in the ground or gardening. If he or she does not take a complete bath or shower, he or she should at least clean the genitals, armpits, groin, and anal area twice a day with antimicrobial soap. The patient should not be advised to eat raw fruits and vegetables daily and should wash them thoroughly when they are consumed. The patient should not share deodorant with anyone. The patient should clean his or her toothbrush with liquid laundry bleach at least once a week.

Which nursing occurrence is a cause for postexposure prophylaxis with combination antiretroviral therapy? (select all that apply)

Being stuck by a contaminated sharp needle. Being a victim of sexual assault. Rationale PEP with cART is used for adults who have had an occupational exposure (e.g., a sharps injury), those who have had a nonoccupational exposure (e.g., consensual sexual exposure with a person of unknown human immune deficiency virus [HIV] status), and those who have suffered a sexual assault. Bodily substances not considered infectious for HIV unless obviously bloody include feces, saliva, and vomitus.

To prevent possible HIV transmission, which is the nurse's priority action after getting stuck by a hollow-bore needle through a latex glove?

Bleed the wound and wash it for at least 1 full minute. Rationale To prevent possible transmission of HIV after a needlestick, the priority action is to immediately bleed the wound and wash it carefully for at least 1 full minute. Drawing blood for testing is not the priority action, because the nurse should begin three-drug cART before all test results are known but not before bleeding and washing the wound. Reviewing the patient's chart and conducting a risk assessment will not rule out the need for immediate precautions for sharps injuries.

Which laboratory changes are most likely in a patient whose immune system is being overwhelmed by HIV?

CD4+ T cell counts fall, viral numbers rise Rationale 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.

In HIV, more virus particles are created when the virus enters which type of host cell?

CD4+ T-cell

As the HIV infection progresses, which immunity abnormality occurs with poor CD4+ T cell function? (select all that apply)

Decreased numbers of lymphocytes. Abnormally functioning macrophages. Increased production of incomplete and nonfunctional antibodies. Rationale As the HIV infection progresses, the following immunity abnormalities occur with poor CD4+ T-cell function: decreased numbers of lymphocytes, abnormally functioning macrophages, and increased production of incomplete and nonfunctional antibodies. Viral load is likely to increase while mature T-helper cells' numbers (also called CD4+ T-cells) decrease as HIV progresses.

How often should the patient taking tenofovir/emtricitabine for preexposure prophylaxis for HIV be tested for HIV?

Every 3 months.

The nurse educates a patient who is immunocompromised about preventing infection and identifies that which occurrence warrants immediate notification of the HCP.

Foul smelling or cloudy urine. Rationale The patient should report to the HCP 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 needs to contact the HCP for a temperature greater than 100°F (37.8°C).

When HIV enters the patient's CD4+ T cell, which is the new role served by the immune cell?

HIV factory Rationale 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+ T-cell does not become an antigen, antibody, or natural killer cell.

Which criterion is a component of a diagnosis of AIDS? (select all that apply)

HIV positive CD4+ T cell count percentage of less than 14% an opportunistic infection CD4+ T cell count of less than 200 cells/mm^3 Rationale A diagnosis of AIDS (HIV-III) requires that the adult be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm 3 (0.2 × 10 9/L) or less than 14% (even if the total CD4+ count is above 200 cells/mm 3 [0.2 × 10 9/L]) or an opportunistic infection. AIDS-related illnesses are a criterion for the Centers for Disease Control and Prevention (CDC) laboratory classifications but is not one of the criteria for a diagnosis of AIDS.

Which statement about HIV requires correction?

If the use of combination antiretroviral therapy causes the viral load to drop below detectable levels, there is no risk for HIV transmission. Rationale The statement requiring correction is, "If the use of cART causes the viral load to drop below detectable levels, there is no risk for HIV transmission." The viral load must be undetectable for greater than 6 months. When an HIV-positive adult starts cART and the viral load is undetectable for greater than 6 consecutive months, the risk for sexual transmission of HIV is reduced to zero. It is correct that the higher the viral load, the greater the risk for HIV transmission. It is correct that once a patient has a diagnosis of AIDS, even if the viral load drops, the AIDS status does not change. It is correct that a genetic difference may explain why some adults infected with HIV maintain a very low or even undetectable viral load for more than 10 years.

Based on the information documented in the health record, which action would the nurse take first for a patient with HIV-III (AIDS) being admitted with pneumocystic pnuemonia?

Institute neutropenic precautions. Rationale This patient has a weakened immune system because of HIV-III status as evidenced by low WBC and CD4+ cell counts. Therefore the nurse would initiate neutropenic precautions. The patient has a low albumin level, but increasing protein consumption is of lower priority. The nurse would continue to monitor the oxygen levels and potassium levels. They are borderline low and could lead to complications if they decrease any further.

Which features of HIV convert its RNA into DNA and insert it into the host's DNA?

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

How does gender affect HIV transmission?

The infection is more easily transmitted from infected men to uninfected women. Rationale HIV is more easily transmitted from infected men to uninfected women than vice versa, because HIV is most easily transmitted when infected body fluids come into contact with mucous membranes or nonintact skin. The vagina has more mucous membrane (surface area) than does the urethra of the penis. Women should use barrier methods of protection, including condoms, female condoms, and vaginal or dental dams, with all partners.

Which is true regarding the risk for HIV transmission from patients receiving combination antiretroviral therapy?

The patient's viral load may drop to undetectable levels, but there is still a risk for transmission.

Which defines the concept known as treatment as prevention of HIV?

The use of combination antiretroviral therapy reduces the viral load to undetectable levels, thereby reducing the risk for HIV transmission. Rationale 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.

When a patient's first positive HIV test result takes place within 6 months after a negative HIV test result, the nurse recognizes that the patient's laboratory classification, according to the CDC, will change from class 0 to class 1 if which event occurs?

When the CD4+ T cell count is great than 500 cells/mm^3 or a percentage of 29% or greater. Rationale Class 1 is when a patient has a CD4+ T-cell count of greater than 500 cells/mm 3 (0.5 × 10 9/L) or a percentage of 29% or greater. A length of time is not a criterion for moving to a different classification. Consecutive positive tests are also not part of the criteria. No AIDS-defining illnesses are present in Classes 1 or 2

Which medication education does the nurse provide for a patient who takes combination tenofovir/emtricitabine for pre-exposure prophylaxis for HIV?

You will be protected only after 7 days of consistent dosing Rationale PrEP is not protective until 7 days of consistent dosing allows a steady-state blood drug level to be achieved. The patient can miss 1 day after the initial 7 days of consistent dosing and still be protected. Two consecutively missed doses greatly reduce protection, and the patient needs to start over with another 7-day lead-in period until a new steady state is achieved before being sexually active. PrEP does not confer protection against other STIs. The once-daily oral dosing is currently the only approved dosing regimen. Two new injectable formulations of PrEP administered once every 12 weeks are being explored for effectiveness as an alternative to daily oral dosing.

The nurse recommends which method of sexual contact to reduce the risk of HIV transmission? (select all that apply)

abstinence monogamy condom use

Which sexual act carries the highest risk for the transmission of HIV?

anal sex Rationale Sexual acts or practices that permit infected seminal fluid to come into contact with mucous membranes or nonintact skin carry the highest risk for sexual transmission of HIV. The practice with the highest risk is anal intercourse with the penis and seminal fluid of an infected adult coming into contact with the mucous membranes of the uninfected partner's rectum. Anal intercourse allows seminal fluid to make contact with the rectal mucous membranes and also tears the mucous membranes, making infection more likely. Kissing is considered low risk for transmission unless obvious blood is present. Oral sex and vaginal sex are risky sexual acts for the transmission of HIV but less so than anal sex.

Which type of laboratory test measures a patient's response to the virus in patients with HIV?

antibody testing

Which phase of the HIV life cycle involves separating from the infected cell's membrane to search for another CD4+ T-cell to infect?

budding

Which fungal infection may occur as an opportunistic infection in patients with AIDS? (select all that apply)

candidiasis histoplasmosis Rationale Candidiasis and histoplasmosis are fungal infections that may occur as opportunistic infections in patients with AIDS. Giardiasis is a protozoal-like infection. Nocardiosis and tuberculosis are bacterial infections.

According to the CDC laboratory classifications for HIV, which class has defining features which include a CD4+ T cell count of greater than 500 cells/mm^3 or a percentage of 29% or greater?

class 1

According to the CDC laboratory classifications for HIV, which class has defining features which include a CD4+ T cell count between 200 and 499 cells/mm^3 or 14 and 28%?

class 2

According to the CDC laboratory classifications for HIV, which class has defining features which include a CD4+ T cell count of less than 200 cells/mm^3 or a percentage less than 14%?

class 3 Rationale Class 3 is when a patient has a CD4+ T-cell count of less than 200 cells/mm 3 (0.2 × 10 9/L) or a percentage of less than 14%. Class 0 is when a patient develops a first positive HIV test result within 6 months after a negative HIV test result. CD4+ T-cell counts are usually in the normal range. Class 1 is when a patient has a CD4+ T-cell count of greater than 500 cells/mm 3 (0.5 × 10 9/L) or a percentage of 29% or greater. Class 2 is when a patient has a CD4+ T-cell count between 200 and 499 cells/mm 3 (0.2 to 0.499 × 10 9/L) or a percentage between 14% and 28%.

Which element is required in the HIV testing process? (select all that apply)

counseling interpretation confidentiality

Which bacterial infection may occur as an opportunistic infection in patients with AIDS? (select all that apply)

nocardiosis tuberculosis Rationale Nocardiosis and tuberculosis are bacterial infections that may occur as opportunistic infections in patients with AIDS. Giardiasis is a protozoal-like infection. Candidiasis and histoplasmosis are fungal infections.

The nurse suspects which opportunistic infection in a patient with AIDS who experiences impaired vision, fever, malaise, and swollen lymph nodes?

cytomegalovirus Rationale The patient with AIDS, impaired vision, fever, malaise, and swollen lymph nodes most likely also has a CMV infection, which may specifically affect the eye (CMV retinitis). Kaposi sarcoma is marked by small, purplish brown, raised lesions on skin and mucous membranes that are usually not painful or itchy. Herpes simplex virus involves painful lesions, along with fever, pain, bleeding, enlarged lymph nodes, headache, myalgia, and malaise. Varicella-zoster virus (shingles) is marked by pain and burning along sensory nerve tracts, headache, low-grade fever, and fluid-filled blisters with or without crusts.

Which sign or symptom is a CNS indication of AIDS? (select all that apply)

dementia confusion

Which is an immunologic manifestation of AIDS?

fatigue Rationale Fatigue is an immunologic manifestation of AIDS. Nocardiosis is an opportunistic bacterial infection that may occur in a patient suffering from AIDS. Night sweats are an integumentary manifestation of AIDS. Nausea and vomiting are GI manifestations of AIDS.

Which clinical manifestation presents with adrenal insufficiency associated with AIDS? (select all that apply)

fatigue nausea electrolyte disturbances Rationale The clinical signs and symptoms of adrenal insufficiency associated with AIDS are fatigue, nausea, electrolyte disturbances, weight loss, and low blood pressure. Adrenal insufficiency with AIDS does not manifest in diarrhea, weight gain, or high blood pressure.

The nurse expects which symptom in an adult with an acute infection that has occurred within 4 weeks of first being infected with HIV? (select all that apply)

fever night sweats muscle aches Rationale Some adults develop an acute infection within 4 weeks of first being infected with HIV. Symptoms are similar to those seen with any virus and include fever, night sweats, and muscle aches. Memory loss is a central nervous system symptom that may occur with acquired immune deficiency syndrome (AIDS). Purplish lesions are a sign of Kaposi sarcoma that may occur with AIDS.

Which class of drugs for HIV infection prevents viral binding?

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

Which protozoal-like infection may occur as an opportunistic infection in patients with AIDS? (select all that apply)

giardiasis toxoplasmosis Rationale Giardiasis and toxoplasmosis are protozoal infections that may occur as opportunistic infections in patients with AIDS. Candidiasis is a fungal infection. Nocardiosis is a bacterial infection. Histoplasmosis is a fungal infection.

Which features of the HIV assist the viral particle in finding a host?

gp41 and pg120 docking proteins Rationale 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.

The nurse suspects which opportunistic infection in a patient with AIDS with painful genital lesions, fever, and malaise?

herpes simplex virus Rationale Herpes simplex virus (HSV) infection in HIV disease or AIDS occurs in the perirectal, oral, and genital areas. Lesions are painful, with chronic open areas after blisters rupture. The nurse should assess for fever, headache, painful and enlarged lymph nodes in the affected area, and malaise. CMV can infect the eye (CMV retinitis), respiratory and GI tracts, and the central nervous system. CMV infection causes fever, malaise, fatigue, and swollen lymph nodes. CMV retinitis impairs vision, ranging from slight impairment to total blindness. CMV can also cause diarrhea, abdominal bloating and discomfort, and weight loss. Kaposi sarcoma is marked by small, purplish brown, raised lesions on skin and mucous membranes that are usually not painful or itchy. Varicella-zoster virus (shingles) is marked by pain and burning along sensory nerve tracts, headache, low-grade fever, and fluid-filled blisters with or without crusts.

According to the Centers for Disease Control and Prevention, which minority group shows an increasing trend in new human immune deficiency virus infections?

hispanics Rationale Most new HIV infections reported in the United States and Canada occur among racial and ethnic minorities, particularly among blacks/African Americans and Hispanics, when compared with Caucasians, Asian Americans, and American Indians

Abnormal functioning of which body system is responsible for the signs and symptoms of HIV?

immune Rationale Abnormal functioning of the immune system is responsible for the signs and symptoms of HIV infection. Signs and symptoms may occur in the respiratory, cardiovascular, and GI symptoms, but abnormal functioning of the immune system is the underlying mechanism.

For which population may pre-exposure prophylaxis for HIV be appropriate? (select all that apply)

injection drug users men who have sex with men nonmonogamous heterosexually active men and women adults who are HIV negative and in a relationship with a partner who is HIV positive Rationale PrEP for HIV may be appropriate for injection drug users, men who have sex with men, nonmonogamous heterosexually active men and women, and adults who are HIV negative in relationships with partners who are HIV positive. Appropriateness of PrEP should be determined on an individual basis with risk assessment questions and blood and urine testing. PrEP is not appropriate for adults who are HIV positive.

Which class of drugs for HIV prevents the virus from inserting its DNA into the host's DNA?

integrase inhibitors Rationale 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 HIV to enter the cell. Fusion 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.

The nurse suspects which diagnosis in a patient with AIDS who has small, purplish brown, raised lesions on the skin?

kaposi sarcoma Rationale Kaposi sarcoma is marked by small, purplish brown, raised lesions on skin and mucous membranes that are usually not painful or itchy. CMV can infect the eye (CMV retinitis), respiratory and GI tracts, and the central nervous system. CMV infection causes fever, malaise, fatigue, and swollen lymph nodes. CMV retinitis impairs vision, ranging from slight impairment to total blindness. CMV can also cause diarrhea, abdominal bloating and discomfort, and weight loss. Herpes simplex virus involves painful lesions, along with fever, pain, bleeding, enlarged lymph nodes, headache, myalgia, and malaise. Varicella-zoster virus (shingles) is marked by pain and burning along sensory nerve tracts, headache, low-grade fever, and fluid-filled blisters with or without crusts.

Which disease and treatment related endocrine problem may occur in patients with HIV? (select all that apply)

lipoatrophy lipodystrophy diabetes adrenal insufficiency elevated triglycerides

Which sign or symptom is an immunologic indication of AIDS? (select all that apply)

lymphadenopathy high blood immunoglobulin levels Rationale Lymphadenopathy and high blood immunoglobulin levels are immunologic indications of AIDS. Nausea and diarrhea are GI signs and symptoms. Dementia and confusion are central nervous system signs and symptoms.

Which sign or symptom is a GI indication of AIDS? (select all that apply)

nausea diarrhea

Which type of exposure to HIV is described as consensual and nonconsensual sexual exposures involving insertive and receptive types of sex with oral, vaginal, or anal contact?

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

Which class of drugs for HIV reduces how well HIV genetic material can be converted into human genetic material?

nucleoside reverse transcriptase inhibitors Rationale 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 HIV to enter the cell. Fusion inhibitors prevent the interaction needed for entry of HIV into the CD4+ T-cell. New virus particles are made in the form of one long protein strand that is clipped by the enzyme HIV protease into smaller functional pieces. Protease inhibitors work here to inhibit HIV protease. HIV uses its enzyme integrase to get its DNA into the nucleus of the host's CD4+ T-cell and insert it into the host's DNA. Integrase inhibitors prevent viral DNA from integrating into the host's DNA.

Which factor is the distinction between HIV infection and AIDS?

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

When determining the financial resources of a patient with AIDS, the nurse recognizes that the information obtained will help the assessment of which patient status?

nutritional status Rationale The financial resources of a patient with AIDS 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 through the heart, veins, and arteries. The GI status is assessed through the mouth and oropharynx, presence of dysphagia, presence of abdominal pain, or the presence of nausea, vomiting, diarrhea, or constipation.

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

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

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

opportunistic infections Rationale 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.

A higher incidence of which condition occurs among pregnant women with HIV? (select all that apply)

pre-term labor transmission of disease low birth weight

Which class of drugs for HIV prevents new virus particles from splitting into functional pieces?

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

Which is a common means of HIV transmission? (select all that apply)

sexual perinatal parenteral Rationale Common means of HIV transmission include sexual (genital, anal, or oral sexual contact with exposure of mucous membranes to infected semen or vaginal secretions); perinatal (from the placenta, from contact with maternal blood and body fluids during birth or from breast milk from an infected mother to child); and parenteral (sharing of needles or equipment contaminated with infected blood or receiving contaminated blood products). HIV is not transmitted by casual contact in the home, school, or workplace. Sharing household utensils, towels and linens, and toilet facilities does not transmit HIV.

Which type of food item does the nurse instruct a patient with HIV to avoid? (select all that apply)

undercooked meat rare fish

The nurse suspects which diagnosis in a patient with AIDS who presents with headaches, fluid-filled blisters, and a low grade fever?

varicella zoster virus Rationale Varicella-zoster virus (shingles) is marked by pain and burning along sensory nerve tracts, headache, low-grade fever, and fluid-filled blisters with or without crusts. CMV can infect the eye (CMV retinitis), respiratory and GI tracts, and the central nervous system. CMV infection causes fever, malaise, fatigue, and swollen lymph nodes. CMV retinitis impairs vision, ranging from slight impairment to total blindness. CMV can also cause diarrhea, abdominal bloating and discomfort, and weight loss. Kaposi sarcoma is marked by small, purplish brown, raised lesions on skin and mucous membranes that are usually not painful or itchy. Herpes simplex virus involves painful lesions, along with fever, pain, bleeding, enlarged lymph nodes, headache, myalgia, and malaise.