Chapter 37: Management of Patients With HIV Infection and AIDS

The nursing instructor is talking about HIV/AIDS with their pre-nursing pathophysiology class. The instructor explains to the class that the virus that causes HIV/AIDS is called a retrovirus. What characteristics of this retrovirus would the instructor talk with the class about? a) Transmission of the virus b) Cure rate of the virus c) The fact that it is a mutated virus originally thought to be bovine in nature d) HIV-1 and HIV-2 subtypes

HIV-1 and HIV-2 subtypes Explanation: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.

A nurse is working in a support group for clients with acquired immunodeficiency syndrome (AIDS). Which point is most important for the nurse to stress? a) Following safer-sex practices b) Refraining from telling anyone about the diagnosis c) Avoiding the use of recreational drugs and alcohol d) Telling potential sex partners about the diagnosis, as required by law

Following safer-sex practices Explanation: It's essential for clients with AIDS to follow safer-sex practices to prevent transmission of the human immunodeficiency virus. Although it's helpful if clients with AIDS avoid using recreational drugs and alcohol, it's more important that I.V. drug users use clean needles and dispose of used needles for purposes of avoiding transmission. Whether the client with AIDS chooses to tell anyone about the diagnosis is his decision; there is no legal obligation to do so.

A patient with HIV develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this patient? a) Mycobacterium avium complex (MAC) b) Tuberculosis c) Pneumocystis pneumonia d) Community-acquired pneumonia

The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly P. carinii) (Durham & Lashley, 2010). Without prophylactic therapy (discussed later), most people infected with HIV will develop PCP. The clinical presentation of PCP in HIV infection is generally less acute than in people who are immunosuppressed as a result of other conditions. Patients with HIV infection initially develop nonspecific signs and symptoms, such as nonproductive cough, fever, chills, shortness of breath, dyspnea, and occasionally chest pain. Arterial oxygen concentrations in patients who are breathing room air may be mildly decreased, indicating minimal hypoxemia.

A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? a) Nystatin (Mycostatin) b) Amphotericin B (Fungizone) c) Fluconazole (Diflucan) d) Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Trimethoprim-sulfamethoxazole (Bactrim, Septra) Explanation: To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

When do most perinatal HIV infections occur? a) Through casual contact b) Through breast feeding c) In utero d) After exposure during delivery

After exposure during delivery Explanation: Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery.

A patient receiving antiretroviral therapy is complaining of "not urinating enough." What is the nurse's best action? a) Administer fluids 100 mL/hour via IV therapy. b) Assess BUN and creatinine. c) Encourage the patient to drink more fluids. d) Assess liver function tests.

Assess BUN and creatinine. Explanation: Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing BUN and creatinine for patients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the patient's problem. Assessment of the problem should be undertaken before interventions.

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm? a) CDC category C: AIDS b) CDC category A: HIV asymptomatic c) CDC category B: HIV symptomatic d) Primary infection (acute HIV infection or acute HIV syndrome)

CDC category A: HIV asymptomatic Explanation: More than 500 CD4+ T lymphocytes/mmindicates CDC category A: HIV asymptomatic. The period from infection with HIV to the development of antibodies to HIV is known as primary infection and 200 to 499 CD4+ T lymphocytes/mm indicates CDC category B: HIV symptomatic. Less than 200 CD4+ T lymphocytes/mm3 indicates CDC category C: AIDS.

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: a) Oral candida. b) Anorexia. c) Chronic diarrhea. d) Nausea and vomiting.

Chronic diarrhea. Explanation: Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about? a) Integrase inhibitors b) Hydroxyurea (Hydrea) c) Protease inhibitor d) Reverse transcriptase inhibitors

Reverse transcriptase inhibitors Explanation: Reverse transcriptase inhibitors are drugs that interfere with the virus' ability to make a genetic blueprint. A protease inhibitor is a drug that inhibits the ability of virus particles to leave the host cell. The integrase inhibitors are a class of drug that prevents the incorporation of viral DNA into the host cell's DNA. Hydrea is a drug that is used as an adjunct therapy that tries to halt the progression of AIDS.

Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material? a) Viral core b) Deoxyribonucleic acid (DNA) c) Glycoprotein envelope d) Ribonucleic acid (RNA)

Ribonucleic acid (RNA) Explanation: HIV is a retrovirus that carries its genetic material in the form of RNA rather than DNA. HIV consists of a viral core containing the viral RNA, surrounded by an envelope consisting of protruding glycoproteins

Which of the following are antidepressants used in the treatment of AIDS? Select all that apply. a) Tofranil b) Norpramin c) Mycelex d) Prozac e) Megace

Tofranil • Norpramin • Prozac Explanation: Antidepressants such as Tofranil, Norpramin, and Prozac may be used, because these medications also alleviate the fatigue and lethargy that are associated with depression. Megace is an appetite stimulant. Mycelex is used for esophageal or oral candidiasis.

The balance between the amount of HIV in the body and the immune response is the: a) Window period b) Viral load test c) Anergy d) Viral set point

Viral set point Explanation: The balance between the amount of HIV in the body and the immune response is the viral set point. A viral load test measures the quantity of HIV RNA in the blood. The window period is the time from infection with HIV until seroconversion detected on HIV antibody test. Anergy is the loss or weakening of the body's immunity to an irritating agent or antigen

Which of the following microorganisms is known to cause retinitis in people with HIV/AIDS? a) Cryptococcus neoformans b) Pneumocystis carinii c) Mycobacterium avium d) Cytomegalovirus

Cytomegalovirus Explanation: Cytomegalovirus is a species-specific herpes virus. Cryptococcus neoformans is a fungus that causes an opportunistic infection in patients with HIV/AIDS. Mycobacterium avium is an acid-fast bacillus that commonly causes a respiratory illness. Pneumocystis carinii is an organism that is thought to be protozoan, but believed to be a fungus based on its structure.

Which of the following is an early manifestation of HIV encephalopathy? a) Headache b) Hallucinations c) Vacant stare d) Hyperreflexia

Headache Explanation: An early manifestation of HIV encephalopathy is a headache. Later stages include hyperreflexia, a vacant stare, and hallucinations.

A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action? a) Document the information. b) Call the health care provider to report. c) Administer acetaminophen (Tylenol). d) Administer Lidocaine cream for the rash.

Call the health care provider to report. Explanation: Fever and a rash could be indicative of a hypersensitivity reaction. Hypersensitivity reactions are also known as anaphylactic reactions and often involve skin rashes, fever, and bronchopulmonary issues such as bronchial constriction. The health care provider should be notified immediately and the medication stopped. Interventions need to be taken to assure that the patient's airway is not compromised. Administering Tylenol and documentation and treating the rash are not the priority, and would be completed after the patient was stabilized. (less)

Students are reviewing information from the Centers for Disease Control and Prevention (CDC) for a class presentation about preventing the transmission of HIV transmission. Which of the following would the students be least likely to include in their presentation? a) A dental dam is used for oral contact with the vagina or rectum. b) Male condoms must be used consistently and correctly to be effective. c) Nonlatex lambskin condoms are highly effective in preventing HIV infection. d) Circumcision is an effective means to reduce the risk of males acquiring HIV.

Nonlatex lambskin condoms are highly effective in preventing HIV infection. Explanation: Condoms, if used correctly and consistently, are highly effective in preventing HIV. Nonlatex condoms made from natural materials, such as lambskin, do not protect against HIV infection. Dental dams should be used for oral contact with the vagina or rectum. In 2007, the World Health Organization and UNAIDS recommended that circumcision be recognized as an effective strategy to reduce the risk of HIV acquisition in men.

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm? a) Stage 2 b) Primary infection (acute HIV infection or acute HIV syndrome) c) Stage 1 d) Stage 3

Correct response: Primary infection (acute HIV infection or acute HIV syndrome) Explanation: More than 500 CD4+ T lymphocytes/mm indicates CDC stage 1