Chapter 35: Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

30. A nurse explains to a pregnant patient with AIDS that her baby will be treated with antiretroviral drugs for _____ weeks after birth.

ANS: 6 six The usual antiretroviral protocol for an infant born to a mother with AIDS is for 6 weeks. DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 7 TOP: Treatment of Newborns of AIDS Patients KEY: Nursing Process Step: Implementation MSC:

COMPLETION 29. A nurse explains that HIV is introduced to the systemic circulation by the _____, which is found in the mucous membranes.

ANS: macrophage The macrophage introduces HIV into the system. DIF: Cognitive Level: Knowledge REF: p. 667 OBJ: 2 TOP: Macrophage KEY: Nursing Process Step: Implementation MSC:

17. A nurse removes a potted plant from the room of a patient with HIV. What is the nurse trying to prevent? a. Aspergillosis b. Candidiasis c. Coccidioidomycosis d. Cytomegalovirus (CMV)

ANS: A Aspergillosis can be contracted from the potting soil in and around the plant in the pot. DIF: Cognitive Level: Comprehension REF: p. 671 OBJ: 4 TOP: Aspergillosis KEY: Nursing Process Step: Implementation MSC:

20. What should a patient with HIV avoid to prevent bacillary angiomatosis (BA)? a. Cats b. Large crowds of people c. Consuming unwashed fruits d. Exposure to mosquito bites

ANS: A Cats and their fleas are thought to transmit BA. DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4 TOP: Prevention KEY: Nursing Process Step: Implementation MSC:

16. Which nursing diagnosis should take priority in the care of an outpatient with AIDS? a. Ineffective therapeutic regimen management b. Impaired physical mobility c. Impaired skin integrity d. Social isolation

ANS: A Failure to take anti-HIV drugs as scheduled can encourage resistant strains of HIV. DIF: Cognitive Level: Analysis REF: p. 676 OBJ: 7 TOP: Nursing Diagnosis: AIDS KEY: Nursing Process Step: Nursing Diagnosis MSC:

26. A nurse is designing a teaching plan for a patient with AIDS. What should be included relative to food preparation precautions? (Select all that apply.) a. Check expiration dates on frozen foods. b. Leave produce unwashed to preserve protective spray. c. Drink a small glass of red wine before each meal to stimulate the appetite. d. Eat three large, well-balanced meals daily. e. Avoid leftovers.

ANS: A, E Using food before the expiration date and avoiding leftovers reduce the risk of food contamination. Individuals with AIDS should wash all fresh produce to get rid of contaminants, eat several small meals daily, and avoid alcohol and caffeine. DIF: Cognitive Level: Application REF: p. 678 OBJ: 7 TOP: Nutritional Precautions KEY: Nursing Process Step: Implementation MSC:

11. What indicates that a patient has entered the third stage of HIV infection? a. T-helper CD4 cell count of 500 b. Rise in antibody count c. Drop in viral load d. Increase in T4 helper cells

ANS: A In the third stage of HIV infection, T-helper CD4 cells drop to approximately 500. Antibodies are always high throughout the infection but are ineffective. The viral count is high. DIF: Cognitive Level: Comprehension REF: p. 668 OBJ: 5 TOP: Third Stage of HIV Infection KEY: Nursing Process Step: Assessment MSC:

24. A nurse is caring for a patient with HIV infection who has been prescribed highly active antiretroviral therapy (HAART). What should the nurse warn the patient that inconsistent administration of the drug can result in? a. HIV strain becoming resistant to the drug b. Decrease in antibodies in the circulating volume c. Addition of another antiretroviral agent to the protocol d. Rapid increase in the symptoms of AIDS

ANS: A Inconsistent administration of HAART drugs can cause the HIV strain to become resistant to the drug. DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 6 TOP: HAART KEY: Nursing Process Step: Implementation MSC:

12. A nurse is preparing a teaching plan for a patient with HIV who has been diagnosed with microsporidiosis. Which implementation should be included? a. Drink 3 quarts of fluid a day to combat dehydration. b. Include milk products with every meal. c. Consume liberal amounts of fat for increased energy. d. Limit protein intake to reduce serum ammonia levels.

ANS: A The patients need plenty of fluids to combat the diarrhea and proteins for calories. They should avoid milk products and fat. DIF: Cognitive Level: Application REF: p. 670 OBJ: 7 TOP: Microsporidiosis KEY: Nursing Process Step: Implementation MSC:

23. Which statement by a patient diagnosed with AIDS should lead a nurse to suspect an infection by CMV? a. "I need to get glasses; I can't see as well as I did a few months ago." b. "I need to drink more water. This diarrhea has really dehydrated me." c. "I need to get smaller clothes. I have lost 10 lb in the past 6 weeks." d. "I need to take some pep pills. I don't have any energy."

ANS: A Visual changes indicate the presence of CMV retinitis, which will eventually lead to blindness. Diarrhea is indicative of a fungal infection, and decreases in weight and energy are expected manifestations of AIDS. DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4 TOP: Assessing CMV KEY: Nursing Process Step: Assessment MSC:

28. Which opportunistic fungal diseases threaten patients with HIV? (Select all that apply.) a. Aspergillosis b. Pneumocystis jiroveci c. Herpes simplex d. Oral hairy leukoplakia e. Tuberculosis

ANS: A, B Aspergillosis and P. jiroveci are caused by fungi. Herpes simplex and leukoplakia are caused by viruses. Tuberculosis is caused by bacteria. DIF: Cognitive Level: Knowledge REF: p. 670 OBJ: 7 TOP: Fungal Infections KEY: Nursing Process Step: Implementation MSC:

MULTIPLE RESPONSE 25. Which populations are at the highest risks of contracting HIV? (Select all that apply.) a. Health care workers who mishandle infected sharps b. Breastfed infants of HIV-infected mothers c. Persons sharing living quarters with an HIV-infected person d. Heterosexual partners of an HIV-infected person e. Newborns of an HIV-infected mother

ANS: A, B, D, E Sharing living quarters without intimate contact does not expose a person to HIV infection. DIF: Cognitive Level: Comprehension REF: p. 664 OBJ: 2 TOP: Prevalence of HIV KEY: Nursing Process Step: Implementation MSC:

27. Which factors explain the increase in HIV infections in persons over the age of 50 years? (Select all that apply.) a. Older persons are usually not questioned by health professionals about sex or drug abuse. b. Older persons are more promiscuous in earlier years. c. Older persons are less likely to seek HIV screening. d. Older persons mistake HIV symptoms as part of the discomforts of increased age. e. Older persons tend to use hormonal forms of contraception.

ANS: A, C, D Individuals older than 50 years of age are less likely to be questioned by health care professionals relative to sex activities or illicit drug use. Older adults are less likely to seek HIV screening and frequently accept the symptoms of HIV as part of increasing age. DIF: Cognitive Level: Comprehension REF: p. 674 OBJ: 7 TOP: Older Persons with HIV KEY: Nursing Process Step: N/A MSC:

6. A 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. What should the nurse anticipate that a positive blood analysis would show? a. High levels of CD8 cells b. High levels of HIV-infected cells c. Low levels of T cells d. Low levels of antibodies

ANS: B In the initial phase of HIV infection, high levels of HIV-infected cells, high levels of T cells, and high levels of antibodies are present as the body attempts to rid the body of the virus through the immune response. DIF: Cognitive Level: Comprehension REF: p. 668-669 OBJ: 2 TOP: Diagnosis of AIDS KEY: Nursing Process Step: Assessment MSC:

8. A 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. What is the most appropriate nursing response? a. "Flulike symptoms frequently are misdiagnosed as HIV." b. "In the latent stage, the physical symptoms are reduced, but the HIV is still present in the lymph nodes." c. "A high antibody count can overwhelm HIV infection in the early stage." d. "Antiretroviral drugs are very effective in the first stage in reducing symptoms."

ANS: B In the latent stage, the symptoms are reduced as the virus enters the lymph nodes. DIF: Cognitive Level: Application REF: p. 668 OBJ: 2 TOP: Stages of HIV Infection KEY: Nursing Process Step: Implementation MSC:

5. When is a patient with HIV considered to have progressed to AIDS? a. Two or more opportunistic infections are diagnosed. b. Kaposi sarcoma appears. c. CD4 cell level drops to 200. d. Patient tested positive for enzyme-linked immunosorbent assay (ELISA).

ANS: C A person with an HIV infection is not diagnosed with AIDS until the CD4 count falls to 200. Other AIDS markers exist as well. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 5 TOP: AIDS KEY: Nursing Process Step: Implementation MSC:

1. Which population, according to statistics from the Centers for Disease Control and Prevention (CDC), has the greatest incidence of human immunodeficiency viral (HIV) infection in the United States? a. Asian Americans b. African Americans c. Latinos d. Whites

ANS: B Of those with HIV infection in the United States, African Americans make up 49%, whites 27%, and Latinos 12%. Asian Americans were not reported. DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3 TOP: Human Immunodeficiency Virus (HIV) Incidence in the United States KEY: Nursing Process Step: Implementation MSC:

7. How long does the initial stage of an HIV infection usually last? a. 2 to 4 weeks b. 4 to 8 weeks c. 8 to 12 weeks d. 12 to 16 weeks

ANS: B The initial phase of an HIV infection lasts from 4 to 8 weeks. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2 TOP: Initial Phase of HIV Infection KEY: Nursing Process Step: Implementation MSC:

21. What sign should a nurse report when caring for the patient with AIDS who has cutaneous Kaposi sarcoma? a. Nausea b. Fatigue c. Abdominal pain d. Weight loss

ANS: C Abdominal pain may be an indication of organ involvement from Kaposi sarcoma. DIF: Cognitive Level: Comprehension REF: p. 673 OBJ: 2 TOP: Kaposi Sarcoma KEY: Nursing Process Step: Assessment MSC:

22. What should a nurse anticipate will happen when a patient's first ELISA result is positive? a. The diagnosis of AIDS is confirmed. b. The test is repeated in 6 to 8 months. c. Another blood sample must be obtained for testing. d. A Western blot test is performed on the same sample.

ANS: C If the ELISA result is positive, the ELISA is repeated. If the second ELISA result is positive, a Western blot test is performed. DIF: Cognitive Level: Application REF: p. 673 OBJ: 5 TOP: HIV Laboratory Tests KEY: Nursing Process Step: Planning MSC:

13. What should a patient be encouraged to do before the initiation of any anti-HIV drug protocol? a. Give up sexual activity for several months. b. Follow the strict dietary guidelines. c. Comply with the drug protocol. d. Involve the partner in a support program.

ANS: C Patients with HIV are assessed for their willingness to comply with the drug protocol because nonadherence causes the HIV organisms to become resistant to the drug. DIF: Cognitive Level: Application REF: p. 676 OBJ: 7 TOP: Compliance KEY: Nursing Process Step: Implementation MSC:

10. A nurse is caring for a patient with HIV infection taking Retrovir, a nucleoside antiviral that is a reverse transcriptase inhibitor. For what should the nurse be especially observant? a. Decreased urine output b. Hypertensive episodes c. Jaundice d. Edema of the face

ANS: C Retrovir has the potential of causing a fatal hepatotoxic reaction. Jaundice is a possible sign of hepatic impairment. DIF: Cognitive Level: Comprehension REF: p. 675 OBJ: 6 TOP: Drug Side Effects KEY: Nursing Process Step: Assessment MSC:

2. What does enzyme reverse transcriptase transcribe? a. DNA to mimic CD4 cells b. T4-helper cells to RNA c. HIV RNA to HIV DNA d. T4 cells to HIV virions

ANS: C Reverse transcriptase reverses the normal process and allows the RNA to be transcribed to the DNA rather than the DNA to be transcribed to the RNA. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2 TOP: Pathophysiology KEY: Nursing Process Step: Implementation MSC:

4. A nurse is assessing a patient with AIDS for risk factors. What is recognized as the most risky behavior in the patient history? a. Oral sex without contact with the glans penis b. Oral sex with a condom c. Use of sex toys d. Anal sex with a condom

ANS: D Anal sex, even with a condom, is a higher risk behavior than the other three options. DIF: Cognitive Level: Comprehension REF: p. 667 OBJ: 3 TOP: Risk Factors KEY: Nursing Process Step: Assessment MSC:

14. A patient with HIV complains to the home health nurse that he has been having watery diarrhea for the past 10 days. The nurse suspects toxoplasmosis. What is the most significant question for the nurse to ask? a. "Have you stopped taking your antiviral medication?" b. "Have you been drinking alcohol?" c. "Have you been eating aged cheese or organ meats?" d. "Do you have a cat?"

ANS: D Cat litter boxes and undercooked meats are the major sources of toxoplasmosis, which causes a persistent watery diarrhea. DIF: Cognitive Level: Comprehension REF: p. 669 OBJ: 4 TOP: Toxoplasmosis KEY: Nursing Process Step: Assessment MSC:

18. What childhood exposure causes painful shingles experienced by the patient with HIV? a. Measles b. Mumps c. Impetigo d. Chickenpox

ANS: D Chickenpox can be reactivated as shingles. DIF: Cognitive Level: Knowledge REF: p. 671 OBJ: 4 TOP: Shingles KEY: Nursing Process Step: Implementation MSC:

3. What is the most common form of transmission of the HIV virus? a. Injection drug use b. Heterosexual contact c. Exposure to contaminated blood products d. Male to male

ANS: D Male-to-male transmission is still the most common mode. DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3 TOP: Transmission of HIV KEY: Nursing Process Step: Planning MSC:

15. A patient with HIV is diagnosed with progressive multifocal leukoencephalopathy (PML). What should a nurse encourage the patient to do? a. Take daily exercise for 30 minutes. b. Avoid excessive fats in the diet. c. Remove all potted plants from inside the home. d. Prepare advanced directives.

ANS: D The completion of advanced directives is essential as this disease is rapidly progressing, and death usually occurs 4 to 6 weeks after diagnosis. DIF: Cognitive Level: Application REF: p. 672 OBJ: 7 TOP: PML KEY: Nursing Process Step: Planning MSC:

9. A nurse is educating patients about the progression of HIV infections. Which statement by the patient in the latent stage indicates that teaching has been effective? a. "I had better get my affairs in order. I don't have a lot of time left." b. "Whew! I thought when I got AIDS that I was a 'goner.'" c. "Now I won't have to take all those expensive drugs that I have been using." d. "I can still enjoy life and live pretty much as I want for the next several years."

ANS: D The latent stage may last as long as 12 years without developing into AIDS. Medications will be continued. DIF: Cognitive Level: Application REF: p. 668 OBJ: 7 TOP: Latent Stage of HIV Infection KEY: Nursing Process Step: Evaluation MSC:

19. Which nursing action should be implemented to increase the comfort of a patient with oral hair leukoplakia? a. Allow aspirin to melt in the mouth and then wash out with warm water. b. Encourage mouth rinses with warm salt water several times a day. c. Limit intake of ice cream and other cold foods. d. Offer fluids through a straw.

ANS: D Using a straw keeps fluids from flooding the entire oral cavity. Warm or acidic items are to be discouraged because they add to the discomfort. Ice cream and popsicles can numb the area. DIF: Cognitive Level: Application REF: p. 672 OBJ: 4 TOP: Oral Hair Leukoplakia KEY: Nursing Process Step: Planning MSC: