Chapter 22; Hoffman & Sullivan (Coordinating Care for Pts with HIV)

A nurse is working at a booth at a community wellness fair and focusing on prevention of transmission. Which comment made by a participant requires correction? "HIV can be transmitted through sexual intercourse." "HIV can be transmitted through a blood transfusion." "HIV can be transmitted from a pregnant or breastfeeding woman to her child." "HIV is seldom transmitted through IV drug use."

"HIV is seldom transmitted through IV drug use."

During an annual visit a client with in the asymptomatic stage of HIV says "I'm not sure if I want to go on. My lover has left me and I'm afraid to be near anyone. I feel like a recluse. It doesn't seem like life is worth living anymore." How should the nurse respond? Select all that apply. "Have you ever thought about hurting yourself?" "You might feel less lonely if you got a pet." "With medication you can live for years." "I can tell you feel alone." "Do you have a family member or friend that you are close to?"

"Have you ever thought about hurting yourself?" "I can tell you feel alone." "Do you have a family member or friend that you are close to?"

You are counseling a patient who has just tested negative for a possible HIV exposure. Which of the following statements indicates your teaching has been effective? A. "I need to get tested again in 6 months." B. "I won't need to continue using protection." C. "Because I am negative, I don't have HIV." D. "Because I tested negative, I can't infect anyone."

"I need to get tested again in 6 months."

A nurse is teaching a serodiscordant couple about safe HIV practices for prevention of transmission and early intervention of progression. Which statements should the nurse include? Select all that apply. "It is important to use condoms and avoid taking street drugs or alcohol." "You should clean blood spills immediately with water." "You should avoid eating raw or undercooked eggs, meat, poultry, or fish." "Signs and symptoms of the disease should immediately be reported to your primary health-care provider." "IT is important to take medications until the symptoms subside."

"It is important to use condoms and avoid taking street drugs or alcohol." "You should avoid eating raw or undercooked eggs, meat, poultry, or fish." "Signs and symptoms of the disease should immediately be reported to your primary health-care provider."

A nurse is caring for a client newly diagnosed with HIV. Which statement by the client is most concerning? "The nursing assistant always puts gloves on before entering my room." "My wife say's we will never be able to have sex again." "My nurse was talking with another nurse outside my door and wondering if I am bi-sexual." "I'm feeling more tired today."

"My nurse was talking with another nurse outside my door and wondering if I am bi-sexual." Rationale: this demonstrates HIPAA violation and breech of pt confidentiality

A nurse is listing the immunizations that an HIV-infected client should receive. Which statement is correct? "Influenza vaccine is given each spring and fall to an HIV-positive client." "Diphtheria, pertussis, and tetanus vaccines are given every 5 years to an HIV-positive client." "Live virus vaccines are an excellent choice for an HIV-positive client." "Pneumovax is given to an HIV-positive client with CD4+ greater than or equal to 200 every 5 years."

"Pneumovax is given to an HIV-positive client with CD4+ greater than or equal to 200 every 5 years." Rationale: Pneumovax vaccine is given to an HIV+ pt with CD4+ count greater than or equal to 200

The nurse is caring for a client with HIV. During ambulation, the client says, "I don't understand why I get so winded when I walk." How should the nurse reply? "It is probably from the aphthous ulcers you have in your throat." "The pneumocystis carinii pneumonia often causes shortness of breath with activity." "It's not uncommon for this to happen when there is a central nervous system infection." "Your mycobacterial infection can cause these symptoms."

"The pneumocystis carinii pneumonia often causes shortness of breath with activity."

A student nurse obtains a used needle stick during a clinical rotation. After a Rapid HIV test is negative, the student asks the progression of the HIV illness should the virus have been contracted. List the sequence of events in order based on the illness progression. 1. Viral transmission 2. Seroconversion 3. Acute viral infection 1 to 2 weeks 4. Symptomatic/AIDS average = 2 years 5. Asymptomatic chronic infection average = 3 to 10 years 6. Death

1. Viral transmission 2. Acute viral infection 1 to 2 weeks 3. Seroconversion 4. Asymptomatic chronic infection average = 3 to 10 years 5. Symptomatic/AIDS average = 2 years 6. Death

The nurse understands the correct statement about HIV disease is which of the following? A. HIV disease is diagnosed by determining viral load. B. A CD4+ count of 600 cells/μL or more indicates HIV, not AIDS. C. A CD4+ count of 200 cells/μL or less increases the chances for opportunistic infections. D. ART is started immediately after diagnosis if the CD4+ count is less than 200 cells/μL.

A CD4+ count of 200 cells/μL or less increases the chances for opportunistic infections.

Which of the following HIV+ patients is at greatest risk of developing TB? A patient with: A. A CD4+ count greater than 200 B. A cough and fever C. A positive PPD D. Recent pneumonia

A positive PPD

The nurse is preparing to provide care for a client with symptomatic chronic infection of HIV. Which actions should the nurse take in planning care? Select all that apply. Perform hand washing for a minimum of 15 to 30 seconds, and use personal protective equipment. Ensure that antiretroviral drugs (ART) are administered within 1 to 2 hours of the scheduled time. Include small, frequent meals and snacks such as nuts or nutritional supplements as ordered. Try to be nonjudgmental when caring for a client with AIDS. Provide referrals to social services to assist in the high cost of medication maintenance.

All are correct

The nurse is teaching a client with HIV about opportunistic infections (OI). Which statement should be included in the teaching session? Select all that apply. Avoid toxoplasmosis by not cleaning cat litter boxes. Avoid third world travel and large crowds to prevent TB exposure. Take daily iron to avoid anemia. Use condoms during sexual encounters to avoid syphilis. Control carbohydrate intake to prevent diabetes mellitus.

Avoid toxoplasmosis by not cleaning cat litter boxes. Avoid third world travel and large crowds to prevent TB exposure. Use condoms during sexual encounters to avoid syphilis.

A nurse checks the medication administration record of a client with HIV and finds that protease inhibitors (PIs) have been prescribed. Which adverse effects should the nurse be monitoring for? Select all that apply. Diabetes mellitus Neutropenia Hyperlipidemia Lactic acidosis Lipodystrophy

Diabetes Mellitus Hyperlipidemia Lipodystrophy

A nurse in the clinic has assessed several patients. It is a priority for the nurse to suggest follow-up to which of the following patients? The patient that reports: A. Chronic intermittent diarrhea for 6 months B. Difficulty swallowing food for 3 days C. Missing one dose of ART in the past week D. Nondetectable HIV viral load 3 months ago

Difficulty swallowing food for 3 days

A nurse is accidentally stuck with a needle used on an HIV-positive client. Which action of the nurse is most important for the nurse to take? Wipe the skin with a clean cloth Squeeze the affected area and pat dry it. Refrain from taking antiretroviral (ART) if the seropositivity test is negative. Ensure that an HIV test is conducted to ascertain seropositivity.

Ensure that an HIV test is conducted to ascertain seropositivity.

You are providing care for a patient newly diagnosed with HIV. Which nursing intervention is an essential priority in your plan of care? A. Dietary restriction for a soft diet B. Evaluating behaviors for depression C. Reverse isolation to reduce infection risk D. Teaching exercise and weight loss strategies

Evaluating behaviors for depression

A patient states she has recently been treated for gonorrhea. Her last HIV test was 18 months ago. When you review the orders, you notice that an HIV test has been ordered. What do you do? A. Explain that the test has been ordered and she can opt out. B. No discussion is necessary; just do the test. C. Obtain her written consent for the test. D. Provide pretest counseling before getting consent.

Explain that the test has been ordered and she can opt out.

Which is true regarding viral load of HIV? Select all that apply. It reflects the amount of viral replication. It is an indicator of disease progression. It is inversely related to the CD4+ lymphocyte count. It is the interval when HIV antibodies are first produced and rise to detectable levels. It slowly decreases as the CD4+ count falls.

It reflects the amount of viral replication. It is an indicator of disease progression. It is inversely related to the CD4+ lymphocyte count.

The nurse has received the following orders for a patient with AIDS who has recently been admitted to the unit. Which order should the nurse question? A. Hepatitis B vaccine—third dose B. Live virus infuenza vaccine C. Tetanus vaccine D. Pneumovax vaccine

Live virus infuenza vaccine

Which of the following statements regarding viral replication is correct? A. Endotoxin and/or exotoxin is required for viral proliferation. B. Must use host white blood cells for viral proliferation C. Pathogenic replication is facilitated by the administration of antivirals. D. Replicates by preventing phagocytosis by white blood cells

Must use host white blood cells for viral proliferation

Which is a clinical manifestation of mycobacterial infection in an HIV-positive client? Coughing Night sweats Severe headache Fever

Night sweats

The nurse observes that an HIV-positive client has dyspnea on exertion, but the symptom is absent when the client is at rest. Which situation would cause these symptoms? Anemia Pneumocystis carinii pneumonia (PCP) Meningitis TB

Pneumocystis carinii pneumonia (PCP)

An HIV-positive client with a CD4+ count of 225 comes to the clinic for an annual appointment and immunizations. Which immunization(s) should the nurse give today? Pneumovax and Influenza vaccine Diphtheria and Influenza vaccine Influenza vaccine only Tetanus and Influenza vaccine

Pneumovax and Influenza vaccine

A patient newly diagnosed with HIV asks about community support groups. What should the nurse do? A. Contact psychiatry for an evaluation for depression. B. Provide a list of groups in a neighboring community. C. Request a referral to the social work department. D. Suggest the family contact the physician.

Provide a list of groups in a neighboring community.

A nurse is caring for a patient in the emergency department. The patient asks for an HIV test. The nurse explains that a screening test can provide quick results and determine whether more testing is necessary. That test is a: A. CD4+ count B. ELISA C. Rapid test D. Viral load

Rapid test

The nurse is teaching a client with AIDS about the importance of compliance with the prescribed multi-drug therapy. Which statement best explains why more than one antiretroviral medication is necessary? The combination of medications keeps the virus from reproducing. The combination of medications has fewer adverse effects. The combination of medications prevents transmission of the illness. The combination of medications eliminates the opportunistic infections.

The combination of medications keeps the virus from reproducing.

A client with HIV arrives at the clinic with a fever of 101ᵒ F, a nonproductive cough, and fatigue. The client's CD4+ count is 184 cells/μL. How should the nurse interpret these findings? These findings demonstrate seroconversion. The patient is now in the symptomatic chronic infection stage of HIV infection The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). This is an expected finding because the patient has tested positive for HIV.

The patient is diagnosed with acquired immunodeficiency syndrome (AIDS).

The nurse is delegating care of a client with HIV to an unlicensed assistive personnel (UAP). The client has pneumocystis carinii pneumonia and genital herpes. Which precautions should the UAP take when delivering the meal trays and taking vital signs? Universal precautions Neutropenic precautions Bleeding precautions Contact precautions

Universal precautions

The nurse is assessing a client coming to the clinic for a routine visit. Which clinical finding indicates that the status of an HIV-positive client is deteriorating and needs additional exploring? Headache - 4 on 1 to 10 scale. Weight loss greater than 10% of previous recorded weight Low fever of 99.2ᵒ F Cough - dry and non-productive

Weight loss greater than 10% of previous recorded weight

A nurse is screening patients for their risk of developing HIV. The nurse should consider which patient at greatest risk? A. African American man B. Asian woman C. Caucasian man D. Latino woman

african american woman