Ch. 17 HIV-Related Cancers
Every attempt should be made to continue chimeric antigen receptor T-cell therapy (cART) through antineoplastic therapy. While a nurse's patient with AIDS-related diffuse large-cell B-cell lymphoma (DLBCL) is receiving R-CHOP, the nurse should do which one of the following? A. Monitor for overlapping toxicities that may occur with combination therapy B. Administer steriods to decrease the risk of inflammatory response C. Administer Shingrix to decrease risk of varicella-zoster virus reactivation D. hold antineoplastic therapy in the setting of low CD4+ counts
A. Monitor for overlapping toxicities that may occur with combination therapy Rationale: cART and antineoplastic agents may have similar toxicity profiles (i.e. diarrhea, hepatotoxicity, pancreatitis, QT prolongation, etc.) and combination therapy may compound the toxicities when utilizing combination therapy for treatment. Therefore, patients should be monitored for overlapping toxicities when undergoing combination therapy. Steroid use increases the risk for inflammatory response (i.e. IRIS) rather than decreasing inflammation. Vaccines should be modified during or after cancer treatment due to continued immune defect, while antineoplastic therapy should continue to be administered in the setting of low CD4+ counts as these counts are a temporary condition.
An oncology nurse has volunteered her time at a community health fair and is working a booth on the prevention of various cancers. Included in her materials are teaching materials on how to reduce the possibility of HIV transmission. Which one of the following would most likely be included in any of the educational materials she plans to hand out? A. Provide education about the use of latex condom with a water-based lubricant to reduce risk B. Provide education about the use of latex condom with a petroleum-based lubricant to reduce risk C. Provide education about the best way to share household toiletries such as razors and other personal items D. Sharing information on mixing a solution of 1-part household bleach to 10 parts water for use in clean-up of emesis or other body fluid spills, with or without using gloves.
A. Provide education about the use of latex condom with a water-based lubricant to reduce risk Rationale: The nurse should provide education about the use of latex condom with a water-based lubricant to reduce risk. A water-based lubricant is recommended because petroleum-based lubricants or cosmetic creams weaken the condom, greater chance of HIV transmission. To decrease the risk of transmission, a latex condom should be used during every episode of vaginal, rectal of oral intercourse. Personal hygiene items- such as a toothbrush or a razor -- should not be shared, so the best method is to avoid sharing altogether. The solution of 1 part household blech to 10 parts water during cleanup of emesis or other body fluid spills is correct and can be used, but the person cleaning should always wear gloves for protection against the spread of disease.
The average time from human immunodeficiency virus (HIV) infection to symptomatic disease is best described as which one of the following? A. dependent on pre-existing health B. approximately 15 years C. dependent on age at time of exposure D. dependent on number of sexual partner
A. dependent on pre-existing health Rationale: The average time from infection to active AIDS is approximately 10 years, not 15 years. It can be shorter in older adults and children. The average time from human immunodeficiency virus (HIV) infection to symptomatic disease depends on inoculation method, exposure, pre-existing health, and prompt initiation of treatment for antiretroviral disease, so A would be the best representative answer. The average time of infection is not dependent on the patient's age at time of exposure nor it is dependent on the number of sexual partners.
Lifestyle factors such as nutrition, health, and smoking may result in infection with other strains of HIV and ____________. Choose one of the following that completes the statement. A. slow the disease progression B. influence the course of infection C. may hasten the disease progression D. are seen in approximately 37% of cases
B. Influence the course of infection Rationale: Lifestyle factors including nutritional status, overall health, and tobacco use may influence the course of infection. These lifestyle factors neither slow nor do they hasten the disease progression, as it is difficult to distinguish between comorbid infection a true causal relationship. There is an increased risk of infection in uncircumcised males related to dendritic cells on the foreskin. Other factors that might influence the progression of the disease might include the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis C virus, human papillomarvirus (HPV), herpes simplex 6 (HSV-6), herpes simplex 8 (HSV-8) and other viruses. Approximately 67% of cases in gay, bisexual, and other men who have sex with men comprises half of newly infected HIV infection and half of people living with the disease, and not the 37% of cases listed in answer D, making that answer incorrect as well.
A characteristic of HIV-related lymphoma includes which one of the following? A. A CD4+ count of 400/mm^3 B. an active EBV infection C. the presence of CD20+ marker D. an early manifestations of HIV infection
B. an active EBV infection Rationale: An active EBV infection is present in 44% to 67% of HIV lymphomas. In HIV-related lymphoma, the CD4+ count is typically less than 200/mm^3, not 400/mm^3, it lacks the CD20+ marker, and is a late manifestation of HIV infection.
HIV-infected patients diagnosed with primary CNS lymphoma have which one of the following? A. extensive bone marrow involvement B. a normal CD4+ count C. a 20% chance of ocular involvement D. a concurrent CMV infection
C. A 20% chance of ocular involvement Rationale: Ocular involvement occurs in 20% of patients diagnosed with primary central nervous system lymphoma, and commonly have multifocal lesions. HIV-infected patients do not have extensive bone marrow involvement, nor do they have other organ/tissue involvement. This patient population also has a low CD4+ count and do not generally have concurrent CMV but EBV infection.
The three stages of HIV are which one of the following? (choose the correct progression of disease): A. chronic/progressive disease, acquired immune deficiency syndrome (AIDS), acute infection B. acute infection, AIDS, chronic/progressive infection C. acute infection, chronic/progressive infection, AIDS D. chronic/progressive disease/acute infection
C. Acute infection, chronic/progressive infection, AIDS Rationale: Acute infection occurs, then proceeds to a chronic/progressive infection before manifesting into AIDS. During the chronic/progressive infection stage, qualitative and quantitative T4-lymphocyte dysfunction occurs, with resultant defects in both cellular and humoral immunity as immunoregulatory function of T4 cells is gradually impaired. The order in answer A f chronic/progressive disease, AIDS, and acute infection is incorrect since acute infection would come before either of the two steps. B is also incorrect. While acute infection occurs first in the progression of the disease, contracting AIDS is the final step and does not come prior to chronic/progress infection. Finally, D is incorrect, and also incomplete, as the answer omits the final stage of AIDS.
A nurse is caring for a 29-year-old female patient who was recently diagnosed with AIDS. Her CD4 count is 293, and she is on active antiretroviral therapy. Based on the information provided, the nurse would educate the patient on the fact that she is at increased risk for developing which one of the following types of cancer? A. lung cancer B. acute myeloid leukemia C. cervical cancer D. kidney cancer
C. Cervical Cancer Rationale: HIV-infected women are at an increased risk for cervical dysplasia that rapidly progresses to cervical cancer. AIDS-defining cancers include non-Hodgkin lymphoma (NHL), Burkitt lymphoma, Kaposi sarcoma, and cervical cancer. B-cell lymphoma is the most frequently diagnosed AIDS-defining malignancy. AIDS-defining malignancies are more common shortly after initiation of active retroviral therapy, particularly among patients with low CD4 counts. Lung, acute myeloid leukemia, and kidney cancer are all non-AIDS defining cancers.
J.J.is a 54-year-old HIV-infected male patient who has been admitted for treatment of PCP pneumonia with intravenous Bactrim. On Day 2 of his admission, the patient develops altered mental status, fever, shortness of breath and leukocytosis. His nurse anticipates the patient is experiencing signs and symptoms of which one of the following? A. worsening PCP pneumonia B. anaphylactic reaction to Bactrim C. immune reconstitution syndrome D. superimposing infection
C. Immune reconstitution syndrome Rationale: Immune reconstitution syndrome occurs with severe inflammatory or infectious reactions, as well as with initial cART therapy. Immune reconstitution syndrome has occurred with toxoplamosis, pneumocystis, other opportunistic infections in HIV disease, and EBV reactivation. Immune reconstitution syndrome has also been linked to rituximab administration. Anaphylaxis to Bactrim would likely occur with the first dose so the patient not be experiencing symptoms such as altered mental status, fevers, and shortening of breath on Day 2. Superimposing infection or worsening PCP pneumonia would not necessarily be accompanied by altered mental status, as A is incorrect as well.
A registered nurse at an HIV clinic educates her HIV-positive patients that they are at risk for which one of the following malignancies: A. oral and esophageal cancers B. prostate and anal cancers C. breast and ovarian cancers D. B-cell lymphoma and Burkitt lymphoma
D. B-cell lymphoma and Burkitt lymphoma Rationale: Both B-cell lymphoma (NHL) and Burkitt lymphoma are AIDS-defining malignancies, as well as Kaposi sarcoma and cervical cancer. AIDS-defining malignancies are malignancies related specifically to HIV infection and the subsequently altered immune system. Non-AIDS defining malignancies include oral, esophgeal, prostate, anal, breast, and ovarian cancers.
Which one of the following statements is TRUE regarding the incidence of HIV in the United States? A. Incidence among African Americans and white gay males continues to increase B. Diagnoses among young Hispanic/Latino gay and bisexual men has decreased C. Heterosexual contact with HIV-infected individuals accounts for about 34% of new HIV diagnoses. D. Those older than 50 years of age are the fastest growing HIV-positive population.
D. Those older than 50 years of age are the fastest growing HIV-positive population. Rationale: Increases in the incidence of HIV-positive adults over 50 years of age are attributable to prolonged survival with disease, age-related physiologic changes enhancing risk of transmission, and propensity to engage in unprotected sex. Incidence among African Americans/white gay males has remained stable and not increased, while diagnoses among young Hispanic/Latino gay and bisexual men have increased, and not decreased. Hetero-sexual contact with HIV-infected individuals accounts for about 24% of new HIV diagnoses, and not 34% as is listed incorrectly in answer C.
Based on a nurse's current knowledge of survival factors in Kaposi sarcoma, the nurse understands what which of the following is true. A. there has been a dramatic decrease in survival despite the era of cART B. the median survival is less than 6 months C. prior or comorbid major opportunistic infections have no impact on survival D. survival is shorter in patients with gastrointestinal lesions or B symptoms.
D. survival is shorter in patients with gastrointestinal lesions of B symptoms. Rationale: Gastrointestinal lesions or B symptoms (fever, night sweats, unintentional weight loss) shorten the survival in patients diagnosed with Kaposi syndrome. The era of cART has increased survival dramatically, and no decrease in survival rates has been reported. Prior or comorbid major opportunistic infections worsen survival, rather than having no impact. The median survival rate is less than one year, but not less than six months.
As part of any patient education program, an oncology nurse must access the patient's health literacy and ability to comply with complex therapies, and multiple appointments with medical specialists. Which one of the following is an affect that health literacy has on a patient's quality of care? A. Low health literacy in patients has little impact on maintaining regular medical care. B. Low health literacy is not associated with English not being the first language spoken by a patient since interpreters are readily available at most healthcare institutions. C. Only 5% of patients who score low on a health literacy assessment have been found to maintain regular medical care. D. Studies of antiretroviral adherence reflect low rates of medication adherence among individuals with low health literacy.
D. Studies of antiretroviral adherence reflect low rates of medication adherence among individuals with low health literacy. Rationale: It is correct that studies of antiretroviral adherence reflect low rates of medication adherence among individuals with low health literacy, linking a low health literacy score with adherence to medication. Low health literacy has a large- not a small- impact on maintaining regular medical care. In fact, only 17% to 40% of patient who have scored low on health literacy scores have maintained regular medical care. This statistic, though, is greater than the 5% of patients maintaining regular medical care, which is an exaggerated number, making answer C an incorrect response. Finally, low health literacy is associated with English not being the first language, mental health disorder, and lack of understanding of how to access care and support (and interpreters are not readily available in every place where healthcare is being provided).
