Chapter 35 HIV and AIDS
A clinic nurse is caring for a client admitted with acquired immunodeficiency syndrome (AIDS). The nurse has assessed that the client is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of which complication?
HIV
A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention?
focus on control and prevention
Which of the following indicates that a client with HIV has developed AIDS?
herpes ulcer persisting for 2 months
Since the emergence of the human immunodeficiency virus (HIV), there have been significant changes in epidemiologic trends. At present, members of which group are most affected by new cases of HIV?
male-to-male sexual contact
A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in?
primary infection
A client is in the primary infection stage of human immunodeficiency virus (HIV). Which statement regarding this client's current health status is most accurate?
The client is infected with HIV but lacks HIV-specific antibodies.
A client requires a blood transfusion for anemia and is concerned about the risk of contracting acquired immune deficiency syndrome (AIDS). What is the best response by the nurse?
"The blood is screened very carefully; the risk is 1 in 2,000,000."
A client in stage 1 of HIV feels well and questions having the virus. Which response by the nurse is appropriate?
"There is an equal amount of virus and the cells to combat the virus in your body."
An 18-year-old client who is pregnant has tested positive for human immunodeficiency virus (HIV) and asks the nurse if her baby is going to be born with HIV. Which response by the nurse is the best?
"Your baby could contract HIV before, during, or after delivery."
Antiretroviral medications should be offered to clients with T-cell counts less than
350 cells/mm3.
A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year?
50 mm3 to 150 mm3
A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?
AIDS
A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea?
Administer antidiarrheal medications on a scheduled basis, as prescribed.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
Bank autologous blood.
A has been diagnosed HIV positive. What will determine the initiation of antiretroviral drug therapy? Select all that apply.
CD (T-cell) count less than 350/mm
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
CD4+ counts
A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's:
Electrolyte levels
Which blood test confirms the presence of antibodies to HIV?
Enzyme-linked immunosorbent assay (ELISA)
A client underwent an antibody test for human immunodeficiency virus (HIV) as part of a screening process and has just been told that the results were positive. Which anticipatory guidance regarding the next step should the nurse provide to the client?
Follow-up testing will be promptly performed to confirm the result.
Students are reviewing information from the Centers for Disease Control and Prevention (CDC) for a class presentation about preventing the transmission of HIV. Which of the following would the students be least likely to include in their presentation
Nonlatex lambskin condoms are highly effective in preventing HIV infection.
Which nursing actions essential before an ELISA test is performed?
Obtain a written consent from the client.
A client with human immunodeficiency virus (HIV) is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this client should expect the health care provider to prescribe which medication for the management of the client's diarrhea?
Octreotide acetate
The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS?
Pneumocystis pneumonia
A nurse is providing ongoing care for a client who is positive for human immunodeficiency virus (HIV), and assessment reveals a client with a newly delayed and shortened speech pattern. The client, who previously had no neurological or motor deficits, has forgotten that they are in the hospital and has trouble getting out of bed. Which problem is the client most likely experiencing related to these signs and symptoms?
Subcortical neurodegenerative disease
A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment?
TMP-SMZ
A male patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows antibodies to the AIDS virus are present in the blood, this indicates what?
The patient has been infected with HIV.
A client comes to the clinic to obtain HIV test results. The physician states that the client has a CD4 cell count of 300 cells/mm3 and a high viral load. What will the physician discuss with the client?
initiation of antiretroviral therapy
Which microorganism is known to cause retinitis in people with HIV/AIDS?
cytomegalovirus
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS?
liquids
What test will the nurse assess to determine the client's response to antiretroviral therapy?
viral load
A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?
"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?
Antibodies to HIV are not present in his blood.
When do most perinatal HIV infections occur?
After exposure during delivery
A patient with a recent diagnosis of HIV is soon to begin highly active antiretroviral treatment (HAART). When performing health education related to the patient's new medication regimen, the nurse should prioritize interventions relevant to which of the following nursing diagnoses?
Ineffective adherence
A client with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in clients with AIDS, by increasing body fat stores?
Megestrol
A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces?
Perianal region and oral mucosa
The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action?
Place the client on respiratory isolation and inform the physician.
A nurse is preparing to administer saquinavir, which is prescribed for a client who is HIV positive. What type of drug does the nurse identify saquinavir as?
Protease inhibitor (PI)
A client's antibody test for HIV showed no antibodies. For which reason would the client need to have a nucleic acid test completed before being told that testing for HIV is negative?
The client may be in stage 0 of the disease
The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?
The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."
A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission?
Urine
A client's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the client's immune response. This is known as what physiologic state?
Viral set point
A hospital client is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test?
arrange for a portable x-ray to be used
A client has come into contact with HIV. As a result, HIV glycoproteins have fused with the client's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle?
attatchment
A nurse is planning the care of a client with acquired immunodeficiency syndrome (AIDS) who is admitted to the unit with Pneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this client?
ineffective airway clearance
A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effects should the nurse closely monitor in the client?
numbness of extremeties
A client reports "feeling under the weather" for several weeks and is having blood work done to try and determine the cause. The physician is including an ELISA test in the blood work. What would be the expected next step if the ELISA is positive?
repeat Elisa test
The nurse knows to follow the CDC's guidelines for Standard Precautions while caring for patients regardless of known or unknown infectious status. The nurse is aware that barrier protection is not necessary for which body fluid?
sweat
A nurse is assessing a client with HIV who has been admitted with pneumonia. In assessing the client, which of the following observations takes immediate priority?
tachypnea and restlessness
A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate?
obtain a stool sample for possible pathogens
A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention?
teach the client guided imagery
The nurse teaches the client that reducing the viral load will have what effect?
Longer survival
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior?
The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure.
An HIV-infected client presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the client's increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug?
azirthromiosin
A client with a history of IV drug use is HIV-positive. The client has been following an antiretroviral medication regimen faithfully and is doing well, attending college to get a social work degree, and focused on a bright future. In regular CD counts, what factor will indicate that this client has progressed from HIV to AIDS?
CD count <200/mm
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?
Chronic diarrhea
The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count?
Greater than 500/mm3
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic?
HIV-1 is more prevalent than HIV-2 subtypes
The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse?
The client has converted from HIV infection to AIDS.
A client who is HIV/AIDS positive has orders for laboratory tests to be performed. What precautions should the nurse observe whenever there is a risk of exposure to the blood and body fluids of an infected client?
Transport the specimens of body fluids in leak-proof containers.
A client is administered foscarnet to treat a case of cytomegalovirus (CMV) retinitis. Which adverse effect should the nurse closely monitor in this client?
electrolyte imbalance
In a client infected with human immunodeficiency virus (HIV), CD4+ levels are measured to determine the:
extent of immune system damage.
Which of the following is the first barrier method that can be controlled by the woman?
female condom
Which condition is an early manifestation of HIV encephalopathy?
headache
A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education?
importance of personal hygien
HIV is harbored within which type of cell?
lymphocyte
Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment?
past substance abuse
