Ch 14 ?'s
HIV is passed from person to person primarily through? 1. air droplet contact 2. hand to mouth contact 3. exposure to bodily fluids 4. mouth to mouth contact
3. exposure to bodily fluids
Antiviral medications are given to pts with HIV infection to: 1. prevent viral replication and destroy infected cells 2. destroy viral cells that are infected 3. slow viral replication and progression 4. destroy bacteria and prevent infection
3. slow viral replication and progression
The nurse explains that the enzyme reverse transcriptase transcribes: A. T4-helper cells to RNA B. HIV RNA to HIV DNA C. DNA to mimic CD4 cells D. T4 cells to HIV virons
B. HIV RNA to HIV DNA
A college student presents to the campus health clinic 2 days after unprotected sexual intercourse. The student is requesting an HIV test. After the initial test is negative result, the nurse provides which advice to the student? A. Return to the clinic as needed. B. Obtain a repeat test in 3 months. C. Begin an intense regimen of antibiotics. D. Visually inspect the body daily for dark skin spot
B. Obtain a repeat test in 3 months.
Kaposi's sarcoma is a common problem in patients with AIDS. The nurse should instruct the patient who is diagnosed with AIDS to report which of the following signs of Kaposi's sarcoma? A. Watery diarrhea B. Reddish-purple skin lesions C. Blood-tinged sputum D. Open, bleeding skin lesions
B. Reddish-purple skin lesions
The nurse explains that the initial stage of an HIV infection usually lasts from: A. 2 to 4 weeks B. 8 to 12 weeks C. 12 to 16 weeks D. 4 to 8 weeks
D. 4 to 8 weeks
The nurse cautions a patient with HIV infection who has been prescribed highly active antiretroviral therapy (HAART) that inconsistent administration of the drug can result in the: A. Rapid increase in the symptoms of AIDS B. Addition of another antiretroviral agent to the protocol C. HIV strain becoming resistant to the drug D. Decrease in antibodies in the circulating volume
C. HIV strain becoming resistant to the drug
When caring for the patient with AIDS who has cutaneous Kaposi's sarcoma, the nurse would report signs of: A. fatigue B. nausea C. abdominal pain D. weight loss
C. abdominal pain
The nursing diagnosis that would take priority in the care of an outpatient with AIDS would be: A. Ineffective therapeutic regimen management B. Impaired physical mobility C. Social isolation D. Impaired skin integrity
A. Ineffective therapeutic regimen management
What type of cells does HIV gradually destroy that are essential for resisting pathogens? 1. Neutrophils 2. T4 cells 3. B cells 4. Eosinophils
2. T4 cells
Which test for HIV infection is the most reliable diagnostic test? 1. ELISA 2. Western blot 3. CD4 count 4. CD8 count
2. Western blot
About how long after infection does the body produce enough antibodies to be detected by standard HIV testing? 1. 2-3 days 2. 1 week 3. 12 weeks 4. 6 months
3. 12 weeks
What is the leading cause of death in ppl with AIDS? 1. KS 2. Malnutrition 3. Infection 4. Encephalopathy
3. Infection
The nurse explains to a pregnant patient with AIDS that her baby will be treated with antiretroviral drugs for ____________________ weeks after birth.
6
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 recommendation will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents
C 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.
The nurse evaluates that teaching, relative to the progression of HIV infections, has been effective when the patient with HIV in the latent stage says: A. "Whew! I thought when I got AIDS that I was a 'goner.'" B. "Now I won't have to take all those expensive drugs that I have been using." C. "I had better get my affairs in order. I don't have a lot of time left." D. "I can still enjoy life and live pretty much as I want for the next several years."
D. "I can still enjoy life and live pretty much as I want for the next several years."
A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.
D The 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 (e.g., pneumonia, dementia, influenza) associated with HIV infection.
In reviewing a patient's chart to determine whether she has progressed from HIV disease to AIDS, the nurse should look for A. HIV-positive test result, CD4+ count below 200, history of opportunistic disease. B. Fever, chills, CD4+ count below 200. C. Weight loss, persistent generalized lymphadenopathy, chronic diarrhea. D. CD4+ count below 500, chronic fatigue, night sweats.
HIV postitive test, CD4 count below 200, history of opportunistic infections
The very anxious young man comes to the clinic believing that he may have HIV infection because of his persistent influenza-like symptoms and his risky sexual behavior. The nurse anticipates that a positive blood analysis would show: A. Low levels of CD8 cells B. Low levels of T cells C. High levels of HIV-infected cells D. Low levels of antibodies
C. High levels of HIV-infected cells
If the first ELISA is positive, then: A. The diagnosis of AIDS is confirmed. B. A Western blot test is performed on the same sample. C. The test is repeated in 6 to 8 months. D. Another blood sample must be obtained for testing.
C. The test is repeated in 6 to 8 months.
HIV patients who are suffering from depression should be frequently assessed for: A. suicidal ideation. B. fear of death. C. physical decline. D. support systems.
A. suicidal ideation.
A patient states that he feels terrific, but a blood test shows that he is HIV-positive. It is important for the nurse to discuss with him that HIV may remain dormant for several years. During this time, the patient A. experiences minor symptoms only. B. Experiences decreased immunity. C. is contagious. D. is not dangerous to anyone.
C. is contagious.
When the patient with HIV is diagnosed with progressive multifocal leukoencephalopathy (PML), the nurse encourages the patient to: A.Take daily exercise for 30 minutes. B.Remove all potted plants from inside the home. C. advanced directives. D. Avoid excessive fats in the diet.
C. prepare advanced directives.
Which 4 types of diagnostic blood work may aid in the diagnosis of HIV infection? Select all that apply? 1. ELISA 2. Western blot 3. PIT 4. T cell count 5. Viral load count 6. Lipid profile
1. ELISA 2. Western blot 4. T cell count 5. Viral load count
Which substances remain at high levels throughout the course of HIV infection? 1. HIV antibodies 2. CD8 cells 3. CD4 cells 4. Red blood cells
1. HIV antibodies
How is HIV transmitted? Select all that apply 1. Saliva 2. Breast milk 3. Semen 4. Urine 5. Blood 6. Vaginal fluids 7. Tears 8. Sweat
2. Breast milk 3. Semen 5. Blood 6. Vaginal fluids
What are 2 nursing interventions for an HIV pt who is experiencing N&V, diarrhea, and poor appetite? Select all that apply 1. Discuss ways to conserve energy and promote restful sleep 2. Talk to nurse practitioner about prescribing antinausea meds, an appetite stimulant, and an antidiarrheal 3. Encourage pt to ask questions and talk about feelings 4. Teach importance of regular dentsal care 5. Provide a diet high in protein and calories
2. Talk to nurse practitioner about prescribing antinausea meds, an appetite stimulant, and an antidiarrheal 5. Provide a diet high in protein and calories
A type of skin cancer that has dramatically increased as a result of AIDS is: 1. Basal cell carcinoma 2. Melanoma 3. KS 4. Venereal warts
3. KS
A pt with HIV has developed some GI infections, causing diarrhea, N&V, and poor appetite. What is he priority nrusing intervention for this pt? 1. Provide periods of rest during day 2. Provide a diet high in protein and low in calories 3. Monitor for fluid and electrolyte imbalance 4. Monitor for signs of infection
3. Monitor for fluid and electrolyte imbalance
The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient? a. "You will need to be retested in 2 weeks." b. "You do not need to fear infecting others." c. "Since you don't have symptoms and you have had a negative test, you do not have HIV." d. "We won't know for years if you will develop acquired immunodeficiency syndrome (AIDS)."
A HIV screening tests detect HIV-specific antibodies or antigens, but typically it takes a several week delay after initial infection before HIV can be detected on a screening test. Combination antibody and antigen tests (also known as fourth-generation tests) decrease the window period to within 3 weeks after infection. It is not known based on this information whether the patient is infected with HIV or can infect others.
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. Encourage adequate nutrition, exercise, and sleep. b. Teach about the side effects of antiretroviral agents. c. Explain opportunistic infections and antibiotic prophylaxis. d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
A 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. Maintaining healthy lifestyle behaviors is an important goal in this stage. 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.
Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV) testing needs? a. Age c. Symptoms b. Lifestyle d. Sexual orientation
A The current Centers for Disease Control and Prevention policy is to offer routine testing for HIV to all individuals age 13 to 64 years. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.
An older adult with chronic human immunodeficiency virus (HIV) infection who takes medications for coronary artery disease and hypertension has chosen to begin early antiretroviral therapy (ART). Which information will the nurse include in patient teaching? a. Many drugs interact with antiretroviral medications. b. HIV infections progress more rapidly in older adults. c. Less frequent CD4+ level monitoring is needed in older adults. d. Hospice care is available for patients with terminal HIV infection.
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 beginning early ART is not a candidate for hospice. Progression of HIV is not affected by age although it may be affected by chronic disease.
The nurse is caring for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.
The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Antibiotics may sometimes be prescribed to prevent infection. b. Continue taking antibiotics until all of the prescription is gone. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.
A, B, E All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza.
A pregnant woman with 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 it is an early stage of HIV infection, the infant will not contract HIV. d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
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.
A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms, because "they don't work." The nurse's most appropriate response would be A. "Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted diseases." B. "Condoms do not provide 100% protection, but when used with a spermicide you can be assured of complete protection against HIV and other STDs." C. "You are correct. Condoms don't always work, so your best protection is to limit your number of partners." D. "Condoms do not provide 100% protection, so you should always discuss with your sexual partners their HIV status or ask if they have any STD."
A. "Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted diseases."
A patient asks the nurse, "How does HIV cause AIDS?" The nurse's response should be A. "HIV attacks the immune system, a system that protects the body from foreign invaders, making it unable to protect the body from organisms that cause diseases." B. "HIV attacks the digestive system, decreasing the absorption of essential nutrients and causing weight loss and fatigue." C. "HIV attacks the respiratory system, making the lungs more susceptible to organisms that cause pneumonia." D. "HIV breaks down the cir
A. "HIV attacks the immune system, a system that protects the body from foreign invaders, making it unable to protect the body from organisms that cause diseases."
Members of the local emergency medical service unit have just transported an accident victim to the emergency department. They tell the ED nurse that the victim has AIDS, and they have blood on their hands and clothing. The nurse advises them to wash their hands and to change any clothing that is wet with blood. The nurse talks to them about getting a baseline HIV test and about future testing. They ask the nurse how long it will take before they will know if they are infected. The nurse's response should be A. "You will need to be tested in 3 months and again in 6 months, because 95% of people seroconvert to antibody-positive in 3 months and 99% in 6 months." B. "You will need to be tested in 6 weeks and regularly for the next 10 years, because that is the average length of time it takes to detect the virus by testing." C. "Transmission by occupational exposure is rare. There is no need for you to be concerned." D. "You will need to be tested in 3 weeks, because most people seroconvert in that length of time."
A. "You will need to be tested in 3 months and again in 6 months, because 95% of people seroconvert to antibody-positive in 3 months and 99% in 6 months."
The nurse clarifies that a patient with HIV does not necessarily have AIDS until: A. CD4 cell level drops to 200. B. Two or more opportunistic infections are diagnosed. C. Kaposi sarcoma appears. D. Tested positive for enzyme-linked immunosorbent assay (ELISA).
A. CD4 cell level drops to 200.
Before the initiation of any anti-HIV drug protocol, the patient is assessed for the willingness to: A. Comply with drug protocol. B. Involve the partner in a support program. C. Give up sexual activity for several months. D. Follow the strict dietary guidelines.
A. Comply with drug protocol.
The nurse is explaining the need to protect an immunocompromised HIV patient from infection to the patient's family. The nurse explains that the patient is immunocompromised because the pathophysiology of HIV centers on which process? A. Destruction of the T4 cells B. Insufficient number of neutrophils C. Inhibition of the inflammatory response D. An abnormal increase of immature white blood cells
A. Destruction of the T4 cells
The nurse caring for a patient with HIV infection who is taking Retrovir, a nucleoside antiviral that is a reverse transcriptase inhibitor, should be especially observant for side effects of: A. Granulocytopenia B. Hypertensive episodes C. Decreased urine output D. Edema of the face
A. Granulocytopenia
The nurse has been asked to present information regarding HIV risks to a group of young adults. Which populations are at risk for HIV infection? (Select all that apply.) A. Injection drug users B. Adolescents who engage in athletics (e.g. baseball, soccer, gymnastics) C. Patients who receive a transfusion with HIV-infected blood or blood products D. Neonates and breastfed infants of HIV-infected mothers (perinatal transmission) E. Laboratory technicians who use appropriate protocols for handling blood products F.Partners, including heterosexuals, who have unprotected sex with those infected with HIV
A. Injection drug users C. Patients who receive a transfusion with HIV-infected blood or blood products D. Neonates and breastfed infants of HIV-infected mothers (perinatal transmission) F.Partners, including heterosexuals, who have unprotected sex with those infected with HIV
A patient with AIDS states that several purple and white "spots" have appeared on the arm and the chest; they are not painful and are nonpruritic. Several days after the appearance of these spots, the patient believes there is also some blood in the stool. What might be the cause of the skin lesions and the blood in the stool? A. Kaposi sarcoma B. Herpes simplex C. Herpes zoster D. Basal cell carcinoma
A. Kaposi sarcoma
The nurse takes into consideration in planning care for a patient with acquired immunodeficiency syndrome (AIDS) that the common form of transmission of the HIV virus is: A. Male to male B. Exposure to contaminated blood products C. Heterosexual contact D. Injection drug use
A. Male to male
One of the implementations that the nurse could use to increase the comfort of a patient with oral hair leukoplakia is to: A. Offer fluids through a straw. B. Limit intake of ice cream and other cold foods. C. Encourage mouth rinses with warm salt water several times a day. D. Allow aspirin to melt in the mouth and then wash out with warm water.
A. Offer fluids through a straw.
A patient has recently had CD4 level testing, and the result was found to be 98 cells/mm3. The nurse realizes which condition has developed? A. The patient has AIDS. B. The patient is HIV positive. C. The patient has leukopenia. D. The patient has neutropenia.
A. The patient has AIDS.
Interventions such as promotion of nutrition, exercise, and stress reduction should be undertaken by the nurse for patients who have HIV infection, primarily because these interventions will A. improve immune function B. increase the patient's strength and ability to care for him- or herself. C. promote a feeling of well-being in the patient. D. prevent transmission of the virus to others.
A. improve immune function
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 how to dispose of tissues with respiratory secretions. b. Stock the patient's room with the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.
B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Explain to the patient that this is an expected finding. c. Request that an antibiotic be prescribed for the patient. d. Advise the patient that this indicates influenza infection.
B 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. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu. Ice will not decrease the swelling in persistent generalized lymphadenopathy
According to the Center for Disease Control and Prevention (CDC) guidelines, which personal protective equipment will the nurse put on before assessing a patient who is on contact precautions for Clostridium difficile diarrhea (select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection
B, C Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.
The nurse would suspect an infection by CMV when the patient with AIDS says: A. "I need to get smaller clothes. I have lost 10 pounds in the last 6 weeks." B. "I need to get glasses, I can't see as well as I did a few months ago." C. "I need to take some pep pills. I don't have any energy." D."I need to drink more water. This diarrhea has really dehydrated me."
B. "I need to get glasses, I can't see as well as I did a few months ago."
The nurse explains that nucleoside reverse transcriptase inhibitor drugs such as azidothymidine (AZT) works by blocking: A. Entry of the HIV virus to the circulating volume B. An enzyme needed for viral replication C. The fusion of the HIV to the human cell D. Lymph node infiltration
B. An enzyme needed for viral replication
The nurse lists the opportunistic fungal disease that threatens patients with HIV, which include: (Select all that apply.) A. Herpes simplex B. Aspergillosis C. Pneumocystis jiroveci D. Tuberculosis E. Oral hairy leukoplakia
B. Aspergillosis C. Pneumocystis jiroveci
To avoid the exposure to bacillary angiomatosis (BA), the nurse advises the patient with HIV to avoid: A. Exposure to mosquito bites B. Cats C. Consuming unwashed fruits D. Large crowds of people
B. Cats
In designing a teaching plan for a patient with AIDS, relative to food preparation precautions, the nurse would include the need to: (Select all that apply.) A. Leave produce unwashed to preserve protective spray. B. Check expiration dates on frozen foods. C. Eat three large, well-balanced meals daily. D. Drink a small glass of red wine before each meal to stimulate the appetite. E. Avoid leftovers.
B. Check expiration dates on frozen foods. E. Avoid leftovers.
The nurse reminds a group of high school students that although homosexual men are stereotyped as victims of HIV, the disease is also observed in: (Select all that apply.) A. Persons sharing living quarters with an HIV-infected person B. Heterosexual partners of an HIV-infected person C. Newborns of an HIV-infected mother D. Breast-fed infants of HIV-infected mothers E. Health care workers who mishandle infected sharps
B. Heterosexual partners of an HIV-infected person C. Newborns of an HIV-infected mother D. Breast-fed infants of HIV-infected mothers E. Health care workers who mishandle infected sharps
A nursing diagnosis for a patient with HIV/AIDS is Acute Confusion related to disease induced A. anemia B. dementia C. anxiety D. brain damage
B. dementia
Most children with AIDS contracted their disease by the following, except A. from receiving transfusions contaminated with the HIV virus. B. from other children who have AIDS. C. during intrauterine life with HIV-positive mother. D. during the birth process of HIV-positive mother.
B. from other children who have AIDS.
A patient informed of 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 how to reduce risky behaviors. b. Inform the patient about the available treatments. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to identify individuals who had intimate contact with the patient.
C After an initial positive antibody test result, 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 the HIV status of other individuals.
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 scheduled time? a. Nystatin tablet b. Oral acyclovir (Zovirax) c. Oral saquinavir (Invirase) d. Aerosolized pentamidine (NebuPent)
C It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day.
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate? a. "Thinking about dying will not improve the course of AIDS." b. "Do you think that taking an antidepressant might be helpful?" c. "Can you tell me more about the thoughts that you are having?" d. "It is important to focus on the good things about your life now."
C 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" or suggesting an antidepressant 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.
A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Clean drug injection equipment before each use." b. "Ask those who share equipment to be tested for HIV." c. "Consider participating in a needle-exchange program." d. "Avoid sexual intercourse when using injectable drugs."
C 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.
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 injury with a suture needle during a surgery b. Splash into the eyes while emptying a bedpan containing stool c. Needle stick with a needle and syringe used for a venipuncture d. Contamination of open skin lesions with patient vaginal secretions
C 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.
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions
C 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.
Which of these patients who have arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose rapid HIV-antibody test is positive b. Patient whose latest CD4+ count has dropped to 250/μL c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs
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 preventcomplications such as hypovolemia and shock.
The young man at the HIV clinic tells the nurse how relieved he is that he does not have HIV, because he now has no symptoms at all when just a few weeks ago he felt awful. The nurse's most helpful response would be: A. "A high antibody count can overwhelm HIV infection in the early stage." B. "Antiretroviral drugs are very effective in the first stage in reducing symptoms." C. "In the latent stage the physical symptoms are reduced, but the HIV is still present in the lymph nodes." D. "Flulike symptoms frequently are misdiagnosed as HIV."
C. "In the latent stage the physical symptoms are reduced, but the HIV is still present in the lymph nodes."
In assessing a patient with AIDS for risk factors, the nurse recognizes the most risky behavior that the patient reported as: A. Oral sex without contact with glans penis B. Oral sex with a condom C. Anal sex with condom D. Use of sex toys
C. Anal sex with condom
A patient is concerned about telling others he has HIV infection. In discussing his concerns, which response by the nurse is most appropriate? A.There is no reason to hide his disease. B. His diagnosis will be obvious to most people with whom he will come into contact. C. Care providers and sexual partners should be told about his diagnosis. D. Secrecy is a poor idea because it will lower his self-esteem.
C. Care providers and sexual partners should be told about his diagnosis.
The nurse explains that the painful shingles experienced by the patient with HIV is related to his childhood exposure to: A. Mumps B. Measles C. Chickenpox D. Impetigo
C. Chickenpox
The patient, age 21, has been treated for chlamydia and has a history of recurrent herpes. What should the nurse plan to do next? A. Refer this patient to a family planning clinic. B. Counsel this patient about testing for HIV and what the test results mean. C. Counsel this patient about her sexual and drug-use history, risk reduction measures, and testing for HIV. D. Counsel this patient about abstinence and a monogamous relationship.
C. Counsel this patient about her sexual and drug-use history, risk reduction measures, and testing for HIV.
The nurse includes in the teaching plan for a patient with HIV who has been diagnosed with microsporidiosis that the patient should: A. Include milk products with every meal. B. Limit protein intake to reduce serum ammonia levels. C. Drink 3 quarts of fluid a day to combat dehydration. D. Consume liberal amounts of fat for increased energy.
C. Drink 3 quarts of fluid a day to combat dehydration.
The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/ μL c. HIV-positive patient with a CD4+ count of 160/μL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis
D CMV retinitis is an 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.
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 will develop symptomatic HIV infection within 1 year." b. "The patient meets the criteria for a diagnosis of acute HIV infection." c. "The patient will be diagnosed with asymptomatic chronic HIV infection." d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
D Development of PCP meets the diagnostic criteria for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.
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. CD4+ cell count trajectory b. HIV genotype and phenotype c. Patient's tolerance for potential medication side effects d. Patient's ability to follow a complex medication regimen
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 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.
Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.
D 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 are also useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.
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. Take this medication on an empty stomach. b. Take this medication with a full glass of water. c. You may have vivid and bizarre dreams as a side effect. d. Continue to use contraception while taking this medication.
D To prevent harm, it is most critical to inform patients that efavirenz can cause fetal anomalies and should not be used in patients who may be or may become pregnant. The other information is also accurate, but it does not directly prevent harm. The medication should be taken on an empty stomach with water and patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.
The patient with HIV complains to the home health nurse that he has been having watery diarrhea for the last 10 days. Because the nurse suspects toxoplasmosis, a significant question for the nurse to ask would be: A. "Have you been drinking alcohol?" B. "Have you stopped taking your antiviral medication?" C. "Have you been eating aged cheese or organ meats?" D. "Do you have a cat?"
D. "Do you have a cat?"
A patient has just been told by his physician that he is HIV-positive. He asks the nurse, "When will I get AIDS?" The nurse's response should be A. "You can expect to develop signs and symptoms of AIDS within 6 months." B. "Most people get AIDS within 3-12 weeks after they are infected with HIV." C. "Don't worry. You may never get AIDS if you eat properly, exercise, and get plenty of rest." D. "It varies with every individual, but the average time is 8-10 years from the time a person is infected, and some go much longer."
D. "It varies with every individual, but the average time is 8-10 years from the time a person is infected, and some go much longer."
A 28-year-old married attorney with one child is in the first trimester of her second pregnancy. A colleague states that she is at no risk for HIV, so she would not need to be counseled about testing for HIV. The nurse's most appropriate response would be A. "We need to review her chart to determine if her first child was infected." B. "She's a professional woman in a monogamous relationship. She obviously is not at risk." C. "Women are not at great risk. The greatest risk is with gay men." D. "The fastest-growing segment of the population with AIDS is women and children. We need to assess her risks."
D. "The fastest-growing segment of the population with AIDS is women and children. We need to assess her risks."
A patient, age 25, has just been admitted to the unit with a diagnosis of AIDS. The nurse's colleague says, "I'm pregnant. It is not safe for me or my baby if I am assigned to his case." The nurse's response should be A. "You should ask for a transfer to another unit because contact with this patient would put you and your baby at risk for AIDS." B. "We should recommend that this patient be transferred to an isolation unit." C. "Wear a mask, gown, and gloves every time you go into his room and use disposable trays, plates, and utensils to serve his meals." D. "This patient would not be a risk for your baby if you use standard precautions and avoid direct contact with blood or body fluids."
D. "This patient would not be a risk for your baby if you use standard precautions and avoid direct contact with blood or body fluids."
The school nurse uses a chart to demonstrate that, according to statistics from the Centers for Disease Control and Prevention (CDC), the population with the greatest incidence of human immunodeficiency viral (HIV) infection in the United States is: A.Whites B. Latinos C. Asian Americans D. African Americans
D. African Americans
The nurse removes a potted plant from the room of a patient with HIV as a preventive measure against: A. Coccidioidomycosis B. Cytomegalovirus (CMV) C. Candidiasis D. Aspergillosis
D. Aspergillosis
The caregiver for a patient with AIDS requires some input on maximizing calorie and nutrient intake. The caregiver states that the patient tolerates liquids better than solid food. The nurse can suggest which nutrient-dense liquid supplement? A. Homemade eggnog B. One or two soft-cooked eggs C. Applesauce with a crushed multivitamin D. Meal replacement beverages, such as Ensure or Carnation Instant Breakfast
D. Meal replacement beverages, such as Ensure or Carnation Instant Breakfast
The nurse is aware that the patient has entered the third stage of HIV infection when the patient has: A. Rise in antibody count B. Drop in viral load C. Increase in T4 helper cells D. T-helper CD4 cell count of 500
D. T-helper CD4 cell count of 500
In addition to hand washing, what important precaution must the nurse take when changing the dressing of an AIDS patient? A. Wearing mask B. Strict isolation C. Wearing gloves D. Wearing gown and gloves
D. Wearing gown and gloves
For most people who are HIV-positive, marker antibodies are usually present 10-12 weeks after exposure. The development of these antibodies is called A. opportunistic infection. B. immunocompetence. C. immunodeficiency. D. seroconversion.
D. seroconversion.
While teaching community groups about AIDS, the nurse informs people that the most common method of transmission of the HIV virus currently is: A. perinatal transmission. B. exposure to contaminated blood. C. nonsexual exposure to saliva and tears. D. sexual contact with an HIV-infected partner.
D. sexual contact with an HIV-infected partner.
A 21-year-old male who has been an IV heroin user has been experiencing fever, weight loss, and diarrhea and has been diagnosed as having AIDS. At this time, he has a low-grade fever, severe diarrhea, and a productive cough. He is admitted with Pneumocystis carinii pneumonia. When caring for the patient, the nurse should A. use a gown, mask, and gloves to administer oral medications. B. use a mask when taking the patient's temperature. C. a gown when assisting the patient to use the bedpan. D. use a gown, mask, and gloves when assisting the patient with his bath.
D. use a gown, mask, and gloves when assisting the patient with his bath.