Chapter 14 (HIV)
Stock the patients room with all the necessary personal protective equipment.
The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)?
Discuss a change in antiretroviral therapy.
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient?
The patient has developed acquired immunodeficiency syndrome (AIDS).
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?
The EIA test will need to be repeated to verify the results.
A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient?
Patients ability to comply with ART schedule
A patient who is human immunodeficiency virus (HIV)-infected has a CD4 + cell count of 400/L. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?
Remind the patient about the need to return for retesting to verify the results
A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?
The patient will maintain intact perineal skin.
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?
Most infants born to HIV-positive mothers are not infected with the virus
A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, I am very nervous about making my baby sick. Which information will the nurse include when teaching the patient?
Continue to use contraception while on this medication
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?
Many medications have interactions with antiretroviral drugs
An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching?
Encourage adequate nutrition, exercise, and sleep.
Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4 + cell count of 800/L and an undetectable viral load. What is the priority nursing intervention at this time?
a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine
The nurse cares 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
The patient states, Sometimes I miss a dose of zidovudine (AZT).
The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care?
Prevention of HIV transmission between sexual partners
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?
Explain to the patient that this is an expected finding
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take?
Oral saquinavir (Invirase)
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time?
Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis
The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?
Patient age
Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing?
Patient who has had 10 liquid stools in the last 24 hours
Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first?
Needle stick with a needle and syringe used to draw blood
Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patients human immunodeficiency virus (HIV) status is unknown?
