HIV & AIDS Practice Questions

The school nurse is preparing to teach a health class to ninth graders regarding sexually transmitted diseases. Which information regarding acquired immunodeficiency syndrome (AIDS) should be included? 1. Females taking birth control pills are protected from becoming infected with HIV. 2. Protected sex is no longer an issue because there is a vaccine for the HIV virus. 3. Adolescents with a normal immune system are not at risk for developing AIDS. 4. Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV.

1. Birth control pills provide protection against unwanted pregnancy but they do not protect females from getting sexually transmitted diseases. In fact, because of the reduced chance of becoming pregnant, some women may find it easier to become involved with multiple partners, increasing the chance of contracting a sexually transmitted disease. 2. There is no vaccine or cure for the HIV virus. 3. Adolescents are among the fastest-growing population to be newly diagnosed with HIV and AIDS. *4. Abstinence is the only guarantee the client will not contract a sexually transmitted disease, including AIDS. An individual who is HIV negative in a monogamous relationship with another individual who is HIV negative and committed to a monogamous relationship is the safest sexual relationship.*

Which type of isolation technique is designed to decrease the risk of transmission of recognized and unrecognized sources of infections? 1. Contact Precautions. 2. Airborne Precautions 3. Droplet Precautions. 4. Standard Precautions.

1. Contact Precautions are a form of transmission-based precautions used when the infectious organism is known to be spread by contact with a substance. 2. Airborne Precautions are used for bacteria which are very small molecules carried at some distance from the client on air currents. The bacterium which causes tuberculosis is an example of such bacteria. A special isolation mask is required to enter the client's negative air pressure room. 3. Droplet Precautions are used for organisms causing flu or some pneumonias. The organisms have a larger molecule and "drop" within three (3) to four (4) feet. A normal isolation mask is used with this client. *4. Standard Precautions are used for all contact with blood and body secretions.* TEST-TAKING HINT: Isolation procedures are basic nursing knowledge, and the test taker must know, understand, and be

The nurse is discussing autoimmune diseases with a class of nursing students. Which signs and symptoms are shared by rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)? 1. Nodules in the subcutaneous layer and bone deformity. 2. Renal involvement and pleural effusions. 3. Joint stiffness and pain. 4. Raynaud's phenomenon and skin rash.

1. Nodules and bony deformity are symptoms of RA but not of SLE. 2. Organ involvement occurs in SLE but not RA. *3. Joint stiffness and pain are symptoms occuring in both diseases.* 4. Raynaud's phenomenon and skin rashes are associated with SLE. TEST-TAKING HINT: There are a number of illnesses sharing the same symptoms. The test taker must be aware of the symptoms that distinguish one illness from another.

Which intervention is an important psychosocial consideration for the client diagnosed with AIDS? 1. Perform a thorough head-to-toe assessment. 2. Maintain the client's ideal body weight. 3. Complete an advance directive. 4. Increase the client's activity tolerance.

1. Performing the head-to-toe assessment is a nursing consideration, not a client consideration. This is a physiological intervention, not a psychosocial one. 2. Maintaining body weight is physical. *3. Clients diagnosed with AIDS should be encouraged to discuss their end-of-life issue with the significant others and to put those wishes in writing. This is important for all clients, not just those diagnosed with AIDS.* 4. Activity tolerance is a physical problem.

The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply. 1. Use a sunscreen of SPF 30 or greater when in the sunlight. 2. Notify the HCP immediately when developing a low-grade fever. 3. Some dyspnea is expected and does not need immediate attention. 4. The hands and feet may change color if exposed to cold or heat. 5. Explain the client can be cured with continued therapy.

*1. Sunlight or UV light exposure has been shown to initiate an exacerbation of SLE, so the client should be taught to protect the skin when in the sun.* *2. A fever may be the first indication of an exacerbation of SLE.* 3. Dyspnea is not expected and could signal respiratory involvement. *4. Raynaud's phenomenon is a condition in which the digits of the hands and feet turn red, blue, or white in response to heat or cold and stress. It occurs with some immune inflammatory processes.* 5. SLE is a chronic disease and there is no known cure. TEST-TAKING HINT: Dyspnea is an uncomfortable sensation of not being able to breathe. Usually clients are not told this is normal regardless of the disease process. Content - Medical: Category of Health Alteration - Immune System: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Physiological Adaptation: Cognitive Level - Synthesis.

The nurse is admitting a client diagnosed with protein-calorie malnutrition secondary to AIDS. Which intervention should be the nurse's first intervention? 1. Assess the client's body weight and ask what the client has been able to eat. 2. Place in contact isolation and don a mask and gown before entering the room. 3. Check the HCP's orders and determine what laboratory tests will be done. 4. Teach the client about total parenteral nutrition and monitor the subclavian IV site.

*1. The client has a malnutrition syndrome. The nurse assesses the body and what the client has been able to eat.* 2. Standard Precautions are used for clients diagnosed with AIDS, the same as for every other client. 3. The nurse should check the orders but not before assessing the client. 4. The client will probably be placed on total parenteral nutrition and will need to be taught these things, but this is not the first action.

The nurse caring for a client who is HIV positive is stuck with the stylet used to start an IV. Which intervention should the nurse implement first? 1. Flush the skin with water and try to get the area to bleed. 2. Notify the charge nurse and complete an incident report. 3. Report to the employee health nurse for prophylactic medication. 4. Follow up with the infection control nurse to have lab work done.

*1. The nurse should attempt to flush the skin and get the area to bleed. It is hoped this will remove contaminated blood from the body prior to infecting the nurse.* 2. The nurse should notify the charge nurse after flushing the area and trying to get it to bleed. 3. This should be done within four (4) hours of the exposure, not before trying to rid the body of the potential infection. 4. This is done at three (3) months and six (6) months after initial exposure. TEST-TAKING HINT: In questions asking the test taker to select the first action, all the options could be appropriate interventions, but the test taker must decide which has the most immediate need and the most benefit. Directly caring for the wound is of the most benefit.

The nurse enters the room of a female client diagnosed with SLE and finds the client crying. Which statement is the most therapeutic response? 1. "I know you are upset, but stress makes the SLE worse." 2. "Please explain to me why you are crying." 3. "I recommend going to an SLE support group." 4. "I see you are crying. We can talk if you would like."

.1. Unless the nurse has SLE and has been through the exact same type of tissue involvement, then the nurse should not tell a client "I know." This does not address the client's feelings. 2. The nurse should never ask the client "why." The client does not owe the nurse an explanation of his or her feelings. 3. Support groups should be recommended, but this is not the best response when the client is crying. *4. The nurse stated a fact, "You are crying," and then offered self by saying "Would you like to talk?" This addresses the nonverbal cue, crying, and is a therapeutic response.* TEST-TAKING HINT: The question asks for a therapeutic response, which means a feeling must be addressed. Therapeutic responses do not ask "why," so the test taker could rule out option "2."

The 26-year-old female client is complaining of a low-grade fever, arthralgias, fatigue, and a facial rash. Which laboratory tests should the nurse expect the HCP to order if SLE is suspected? 1. Complete metabolic panel and liver function tests. 2. Complete blood count and antinuclear antibody tests. 3. Cholesterol and lipid profile tests. 4. Blood urea nitrogen and glomerular filtration tests.

1. SLE can affect any organ system, and these tests are used to determine the possibility of the liver being involved, but they are not used to diagnose SLE. *2. No single laboratory test diagnoses SLE, but the client usually presents with moderate to severe anemia, thrombocytopenia, leukopenia, and a positive antinuclear antibody.* 3. Female clients with SLE develop atherosclerosis at an earlier age, but cholesterol and lipid profile tests are not used to diagnose the disease. 4. These tests may be done to determine SLE infiltration in the kidneys but not to diagnose the disease itself. TEST-TAKING HINT: A complete metabolic panel is ordered for many different diseases; cholesterol and lipid panels are usually ordered for atherosclerosis, and BUN and glomerular filtration tests are specific to the kidneys. Options "1," "3," and "4" could be ruled out because they are specific to other diseases or not specific enough.

The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for this client? 1. The client will maintain reproductive ability. 2. The client will verbalize feelings of body-image changes. 3. The client will have no deterioration of organ function. 4. The client's skin will remain intact and have no irritation.

1. SLE is frequently diagnosed in young women and reproduction is a concern for these clients, but it is not the most important goal. 2. The client's body image is important, but this is not the most important. *3. SLE can invade and destroy any body system or organ. Maintaining organ function is the primary goal of SLE treatment.* 4. Measures are taken to prevent breakdown, but skin breakdown is not life threatening. TEST-TAKING HINT: When the question asks for "priority," the test taker should determine if one of the options has lifethreatening information or could result in a serious complication for the client.

The client diagnosed with Pneumocystis pneumonia (PCP) is being admitted to the intensive care unit. Which HCP's order should the nurse implement first? 1. Draw a serum for CD4 and complete blood count STAT. 2. Administer oxygen to the client via nasal cannula. 3. Administer trimethoprim-sulfamethoxazole, a sulfa antibiotic, IVPB. 4. Obtain a sputum specimen for culture and sensitivity.

1. Serum blood work, although ordered STAT, does not have priority over oxygenation of the client. *2. Oxygen is a priority, especially with a client diagnosed with a respiratory illness.* 3. It is extremely important to initiate IV antibiotic therapy to a client diagnosed with an infection as quickly as possible, but this does not have priority over oxygen. 4. Culture specimens should be obtained prior to initiating antibiotic therapy, but oxygen administration is still the first action. TEST-TAKING HINT: Airway, breathing, and providing oxygen to the tissues is the top priority in any nursing situation. If the cells are not oxygenated, they die.

The client diagnosed with an acute exacerbation of SLE is prescribed high-dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE? 1. The steroids will increase the body's ability to fight the infection. 2. The steroids will decrease the chance of the SLE spreading to other organs. 3. The steroids will suppress tissue inflammation, which reduces damage to organs. 4. The steroids will prevent scarring of skin tissues associated with SLE.

1. Steroid medications mask the development of infections because steroids suppress the immune system's response. 2. SLE does not metastasize, or "spread"; it does invade other organ systems, but steroids do not prevent this from happening. *3. The main function of steroid medications is to suppress the inflammatory response of the body.* 4. Steroid medications can delay the healing process, theoretically making scarring worse. TEST-TAKING HINT: Steroids are a frequently administered medication class. The test taker must know the common actions, side effects, adverse effects, and how to administer the medications safely.

The client diagnosed with an acute exacerbation of SLE is being discharged with a prescription for an oral steroid which will be discontinued gradually. Which statement is the scientific rationale for this type of medication dosing? 1. Tapering the medication prevents the client from having withdrawal symptoms. 2. So thyroid gland starts working, because this medication stops it from working. 3. Tapering the dose allows the adrenal glands to begin to produce cortisol again. 4. This is the health-care provider's personal choice in prescribing the medication.

1. Steroids are not addicting. 2. The adrenal gland, not the thyroid gland, produces the glucocorticoid cortisol. *3. Tapering steroids is important because the adrenal gland stops producing cortisol, a glucocorticosteroid, when the exogenous administration of steroids exceeds what normally is produced. The functions of cortisol in the body are to regulate glucose metabolism and maintain blood pressure.* 4. Tapering the dose is standard medical practice, not a whim of the HCP. TEST-TAKING HINT: Basic knowledge of anatomy and physiology eliminates option "2." Tapering steroid medication is basic knowledge for the nurse administering a steroid.

The nurse and a female unlicensed assistive personnel (UAP) are caring for a group of clients on a medical floor. Which action by the UAP warrants immediate intervention by the nurse? 1. The UAP washes her hands before and after performing vital signs on a client. 2. The UAP dons sterile gloves prior to removing an indwelling catheter from a client. 3. The UAP raises the head of the bed to a high Fowler's position for a client about to eat. 4. The UAP uses a fresh plastic bag to get ice for a client's water pitcher.

1. The UAP should wash the hands before and after client care. *2. The UAP can remove an indwelling catheter with nonsterile gloves. This is a waste of expensive equipment. The nurse is responsible for teaching UAPs appropriate use of equipment and supplies and cost containment.* 3. Raising the head of the bed to a 90-degree angle (high Fowler's position) during meals helps to prevent aspiration. 4. Using a clean plastic bag to access the ice machine indicates the assistant is aware of infection control procedures. TEST-TAKING HINT: This is really an "except" question—there will be three (3) options with desired actions and only one (1) needs to change.

The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding? 1. The client is fortunate not to have contracted HIV from an infected needle. 2. The client must be repeatedly exposed to HIV before becoming infected. 3. The client may be in the primary infection phase of an HIV infection. 4. The antibody test is negative because the client has a different flu virus.

1. The client may be in the primary infection stage when the body has not had time to develop antibodies to the HIV virus. 2. Repeated exposure to HIV increases the risk of infection, but it only takes one exposure to develop an infection. *3. The primary phase of infection ranges from being asymptomatic to severe flu-like symptoms, but during this time, the test may be negative although the individual is infected with HIV.* 4. The client may or may not have a different virus, but this is not the reason the test is negative. TEST-TAKING HINT: Answer options "1" and "4" assume the client is negative for the HIV virus. Therefore, these options should be eliminated as correct answers unless the test taker is completely sure the statement is correct.

The client recently diagnosed with SLE asks the nurse, "What is SLE and how did I get it?" Which statement best explains the scientific rationale for the nurse's response? 1. SLE occurs because the kidneys do not filter antibodies from the blood. 2. SLE occurs after a viral illness as a result of damage to the endocrine system. 3. There is no known identifiable reason for a client to develop SLE. 4. This is an autoimmune disease that may have a genetic or hormonal component.

1. The kidneys filter wastes, not antibodies, from the blood. 2. The problem is an overactive immune system, not damage to the endocrine system. There is no research supporting a virus as an initiating factor. 3. SLE is an autoimmune disease characterized by exacerbations and remission. There is empirical evidence indicating hormones may cause the development of the disease, and some drugs can initiate the process. *4. There is evidence for familial and hormonal components to the development SLE. SLE is an autoimmune disease process in which there is an exaggerated production of autoantibodies.* TEST-TAKING HINT: The test taker could eliminate options "1" and "2" by referring to basic anatomy and physiology and the function of the kidneys and endocrine system.

The client diagnosed with AIDS is complaining of a sore mouth and tongue. When the nurse assesses the buccal mucosa, the nurse notes white, patchy lesions covering the hard and soft palates and the right inner cheek. Which interventions should the nurse implement? 1. Teach the client to brush the teeth and patchy area with a soft-bristle toothbrush. 2. Notify the HCP for an order for an antifungal swish-and-swallow medication. 3. Have the client gargle with an antiseptic-based mouthwash several times a day. 4. Determine what types of food the client has been eating for the last 24 hours.

1. This client probably has oral candidiasis, a fungal infection of the mouth and esophagus. Brushing the teeth and patchy areas will not remove the lesions and will cause considerable pain. *2. This most likely is a fungal infection known as oral candidiasis, commonly called thrush. An antifungal medication is needed to treat this condition.* 3. Antiseptic-based mouthwashes usually contain alcohol, which is painful for the client. 4. The foods the client has eaten did not cause this condition. TEST-TAKING HINT: The client is complaining of a "sore mouth." The test taker must notice all the important information in the stem before attempting to choose an answer. How are brushing the area, an antiseptic mouthwash, or the

A nurse is caring for a client who has HIV and has been newly diagnosed with Burkitt's lymphoma. Which of the following HIV infection stages is the client in? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

A. INCORRECT: In stage 1, there are no defining conditions. B. INCORRECT: In stage 2, there are no defining conditions. C. CORRECT: In stage 3, there are one or more defining conditions present. These can include candidiasis of the esophagus, bronchi, trachea, or lungs; chronic ulcers of herpes simplex; HIV‑related encephalopathy; disseminated or extrapulmonary histoplasmosis; Kaposi's sarcoma; and Burkitt's lymphoma. D. INCORRECT: In stage 4, there is no information available.

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

ANS: A The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.

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? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease

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

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.

ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.

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? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

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? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

ANS: C A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.

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? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

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/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

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? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

ANS: C Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams

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? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.

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? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

ANS: D CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count.

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

ANS: D More assessment of the patient's psychosocial status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.

The nurse should use which solution to destroy HIV? A. Mild soap and water B. A hypochlorite solution C. Water only D. Bath oil

Answer B is correct. A hypochlorite solution is 1 part bleach to 10 parts water. This solution has been found to effectively kill the virus that causes AIDS. Answer A is incorrect because hot water and strong soaps should be used, but these are not the most effective solution for killing HIV. Answers C and D are incorrect because water only and bath oil have not been shown to kill the virus that causes AIDS.

The pregnant client with AIDS asks whether she should try to breast feed her baby after delivery. Which response is most appropriate? A. You can breast feed after the third day post-partum. B. Breast milk can cause cross contamination, leading to HIV infection in the infant. C. There is no risk with breast-feeding your infant when you have HIV infection. D. What did your doctor tell you about breast-feeding?

Answer B is correct. Breast-feeding your infant when you are HIV positive is contraindicated. Answer A is incorrect because it does not matter whether the mother breast-feeds immediately after delivery or waits to begin breast-feeding for three days. The breast milk is still likely to be contaminated. Answer C is incorrect because there is a risk with breast-feeding. Answer D is incorrect because this answer does not help the client to make an informed decision regarding breastfeeding with HIV.

Which statement, if made by a client with AIDS, indicates understanding of the illness? A. I need to eat yogurt every day to provide needed calcium for my bones. B. I should peel and cook fruits before eating them. C. I can enjoy foods from the salad bar at my local restaurant. D. I might have to floss my teeth more often to prevent gum disease

Answer B is correct. Fruits should be washed thoroughly and peeled before eating because they often contain bacteria. Answer A is incorrect because yogurt contains live cultured bacteria and can lead to opportunistic infections. Answer C is incorrect because the client should avoid eating from the salad bar; bacteria grows in foods that are not kept refrigerated. In addition, foods grown in or on the ground should be avoided. Answer D is incorrect because flossing the teeth might cause bleeding and infection. Use of soft toothbrushes and frequent dental check-ups help to prevent oral disease.

The client with AIDS has a CD4 +T-cell count of 175 cu.mm/liter. The nurse is aware that: A. He is relatively free of HIV. B. He is at risk for opportunistic infections. C. He is likely to be asymptomatic. D. He is in remission with his disease.

Answer B is correct. The client with a CD4 +T-cell count of less than 200 is at risk for opportunistic diseases so B is correct. Answers A, C, and D are incorrect statements.

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? a. Increased viral load b. Decreased neutrophil count c. Increased CD4+ T cell count d. Decreased white blood cell count

c. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

The nurse is caring for clients on a medical floor. Which client should be assessed first? 1. The client diagnosed with SLE who is complaining of chest pain. 2. The client diagnosed with MS who is complaining of pain at a "10." 3. The client diagnosed with myasthenia gravis who has dysphagia. 4. The client diagnosed with GB syndrome who can barely move his toes.

*1. Chest pain should be considered a priority regardless of the admitting diagnosis. Clients diagnosed with SLE can develop cardiac complications.* 2. Pain at a "10" is a priority but not above chest pain. 3. Dysphagia is expected in clients diagnosed with MG. 4. Clients diagnosed with GB syndrome have ascending muscle weakness or paralysis, which could eventually result in the client being placed on a ventilator, but the problem currently is in the distal extremities (the feet) and is not priority over chest pain. TEST-TAKING HINT: When the test taker is deciding on which client has priority, a potentially life-threatening condition is always top priority.

The client on a medical floor is diagnosed with HIV encephalopathy. Which client problem is priority? 1. Altered nutrition, less than body requirements. 2. Anticipatory grieving. 3. Knowledge deficit, procedures and prognosis. 4. Risk for injury.

1. Altered nutrition may be a priority for a client with malnutrition, but HIV encephalopathy is a cognitive deficit. 2. The client might grieve if the client still has enough cognitive ability to understand the loss is occurring, but this is not the most important consideration. 3. A client diagnosed with encephalopathy may not have the ability to understand instructions. The nurse should teach the significant others. *4. Safety is always an issue with a client with diminished mental capacity.* TEST-TAKING HINT: The test taker must have a basis for deciding priority. Maslow's hierarchy of needs lists safety as a high priority.

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus? (Select all that apply.) A. Perinatal exposure B. Pregnancy C. Monogamous sex partner D. Older adult woman E. Occupational exposure

A. CORRECT: Perinatal exposure is a risk factor associated with HIV. Women who are pregnant should take cautionary measures to prevent HIV exposure. B. INCORRECT: Women who are pregnant should be tested for HIV, but pregnancy is not a risk factor associated with this virus. C. INCORRECT: Having a monogamous sex partner is not a risk factor associated with the HIV virus. D. CORRECT: Being an older adult woman is a risk factor associated with the HIV virus due vaginal dryness and the thinning of the vaginal wall. E. CORRECT: Occupational exposure, such as being a health care worker, is a risk factor associated with the HIV virus.

A nurse is caring for a client who is suspected of having HIV. Which of the following diagnostic tests and laboratory values are used to confirm HIV infection? (Select all that apply.) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-lymphocyte count D. CD4+ T-lymphocyte percentage of total lymphocytes E. Cerebrospinal fluid (CSF) analysis

A. CORRECT: Positive results of a Western blot test confirm the presence of HIV infection. B. CORRECT: Positive results of an indirect immunofluorescence assay confirm the presence of HIV infection. C. INCORRECT: CD4+ T-lymphocyte count assists with classifying the stage of HIV infection. D. INCORRECT: CD4+ T-lymphocyte percentage of total lymphocytes assists with classifying the stage of HIV infection. E. INCORRECT: CSF analysis can be used to confirm meningitis.

A nurse working in an outpatient clinic is assessing a client who reports night sweats and fatigue. He states he has had a cough along with nausea and diarrhea. His temperature is 38.1° C (100.6° F) orally. The client is afraid he has HIV. Which of the following actions should the nurse take? (Select all that apply.) A. Perform a physical assessment. B. Determine when current symptoms began. C. Teach the client about HIV transmission. D. Draw blood for HIV testing. E. Obtain a sexual history.

A. CORRECT: The nurse should perform a physical assessment to gather data about the client's condition. This is an appropriate action by the nurse. B. CORRECT: The nurse should gather more data to determine whether the clinical manifestations are acute or chronic. This is an appropriate action by the nurse. C. INCORRECT: Teaching the client about HIV transmission is not an appropriate action by the nurse at this time. This is not a priority action for the nurse to include at this time. D. INCORRECT: Drawing blood for HIV testing is not an appropriate action by nurse at this time. This is not a priority action for the nurse to include at this time. E. CORRECT: The nurse should obtain a sexual history to determine how the virus was transmitted. This is an appropriate action by the nurse.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities

A nurse is completing discharge instructions with a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear gloves while changing the pet litter box." B. "I will rinse raw fruits with water before eating them." C. "I will wear a mask when around family members who are ill." D. "I will cook vegetables before eating them."

A. INCORRECT: A client who has AIDS should avoid changing the pet litter box to prevent acquiring toxoplasmosis. B. INCORRECT: A client who has AIDS should avoid consuming raw fruits due to the presence of bacteria that can cause opportunistic infections. C. INCORRECT: Due to compromised immune response, a client who has AIDS should avoid contact with family members who are ill. D. CORRECT: A client who has AIDS should cook vegetables before eating to kill bacteria that cause opportunistic infections.

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.

The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? A. Assessment of lung sounds B. Assessment of sexual behavior C. Assessment of living conditions D. Assessment of drug and syringe use E. Assessment of exposure to an ill person

B. Assessment of sexual behavior D. Assessment of drug and syringe use With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count below 200/µL C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µL

B. CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager

B. Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs

B. Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.

C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection.

A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/µL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

Correct answer: a Rationale: AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.

Which statement about metabolic side effects of ART is true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include central fat accumulation and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients

Correct answers: b, c, d Rationale: Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? a. The patient has the virus present and can transmit the infection to others. b. The patient is not able to transmit the virus to others through sexual contact. c. The patient will be prescribed lower doses of antiretroviral medications for 2 months. d. The syndrome has been cured, and the patient will be able to discontinue all medications.

a. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.

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? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT.

The nurse has just taken a report and is preparing for the day's activities. Which client with AIDS should be seen first? A. The client with Kaposi's sarcoma B. The client with oral leukoplakia C. The client with vaginal candidiasis D. The client with Pneumocystis carinii pneumonia

Answer D is correct. Answer A is incorrect because Kaposi's sarcoma is a cancer of the connective tissue. The multifocal lesions are purplish in color and somewhat painful; however, there is no indication that this client is unstable. Answer B is incorrect because oral leukoplakia is a precancerous lesion that is not life-threatening. Answer C is incorrect because vaginal candidiasis or yeast is also not life threatening. Answer D is correct because Pneumocystis carinii pneumonia often causes airway closure and alterations in oxygen perfusion.

The client infected with HIV might be prescribed several medications to control replication of the AIDS virus. The combination of drug therapy is known by the abbreviation: A. ELISA B. RIPA C. IFA D. HAART

Answer D is correct. HAART stands for Highly Active Retroviral Therapy. This therapy combines two or three different categories of drugs to combat HIV. Answer A is incorrect because ELISA stands for Enzyme Linked Immunosuppressant Assay. Answer B is incorrect because RIPA stands for Radiommunoprecipitation Assay, a screening test. Answer C is incorrect because IFA stands for Immunofluoruescence Assay, another screening test.

The nurse is assessing a client with cutaneous lupus erythematosus. Which intervention should be implemented? 1. Use astringent lotion on the face and skin. 2. Inspect the skin weekly for open areas or rashes. 3. Dry the skin thoroughly by patting. 4. Apply anti-itch medication between the toes.

Moisturizing lotions, not astringents, are applied. Astringent lotions have analcohol base, which is drying to the client's skin. 2. The skin should be inspected daily for any breakdown or rashes. *3. The skin should be washed with mild soap, rinsed, and patted dry. Rubbing can cause abrasions and skin breakdown.* 4. The stem does not tell the test taker the client is itching, and SLE does not have itching as a symptom. Lotions are not usually applied between the toes because this fosters the development of a fungal infection between the toes. TEST-TAKING HINT: If the test taker did not know what "astringent" meant, then the test taker should skip this option and continue looking for a correct answer. In option "2," the time frame of weekly makes this option wrong.

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? a. Cough, diarrhea, headaches, blurred vision, muscle fatigue d. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

d. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? a. Droplet precautions b. Contact precautions c. Airborne precautions d. Standard precautions

d. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.

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? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

ANS: B It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day

The nurse on a medical floor is caring for clients diagnosed with AIDS. Which client should be seen first? 1. The client who has flushed, warm skin with tented turgor. 2. The client who states the staff ignores the call light. 3. The client whose vital signs are T 99.9˚F, P 101, R 26, and BP 110/68. 4. The client who is unable to provide a sputum specimen.

*1. Flushed warm skin with tented turgor indicates dehydration. The HCP should be notified immediately for fluid orders or other orders to correct the reason for the dehydration.* 2. This is a concern but it can be taken care of after the client with the physical problem. 3. The temperature is slightly elevated and the pulse is one (1) beat higher than normal. This client could wait to be seen. 4. Many clients who have had sputum specimens ordered are unable to produce sputum, but it does not warrant immediate intervention. TEST-TAKING HINT: This is an "except" question asking the test taker to identify abnormal data indicating a life-threatening situation or a complication.

The client has a viral load of 1500 copies per mL. The nurse recognizes that this finding indicates the client is: A. At risk for opportunistic infections B. Relatively free of HIV infection C. In remission with his HIV infection D. Within the normal limits for viral load results

Answer A is correct. A viral load greater than 400 copies/mL indicates the client is at risk for development of opportunistic infections. Answers B, C, and D are incorrect because they are untrue statements.

The client has been prescribed metronidazole (Flagyl) for Pneumocystis carinii pneumonia and candida. Which instruction should be given to the client taking Flagyl? A. Take the medication with water only. B. Arise slowly after taking the medication. C. Abstain from drinking alcohol while taking the medication. D. Remain supine for 30 minutes after taking the medication

Answer C is correct. Alcohol taken with Flagyl can cause extreme nausea; therefore, it should not be consumed by this client. Answer A is incorrect because Flagyl can be taken with juice or other liquids. Answers B and D are incorrect because Flagyl is not affected by position.

The client is seen in the clinic requesting screening for HIV. Which of the following is a screening test for HIV? A. Viral load B. Viral culture C. ELISA D. CD4/CD8 count

Answer C is correct. Answers A, B, and D are incorrect because these tests are used to track the progression of the illness, not to screen for the presence of HIV. Answer C is correct because the ELISA test is done on two occasions; if they are positive, a Western Blot assay is done to confirm the diagnosis.

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact

Correct answer: a Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment.

Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including needles, syringes, pipes, and straws

Correct answer: a Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner

Which medication is usually prescribed for the pregnant client with AIDS to prevent transmission of the virus from mother to infant? A. Acyclovir (Zovirax) B. Sulfamethaxazole (Bactrim) C. Zidovudine (AZT) D. Fluconazole (Diflucan)

Answer C is correct. The pregnant client with AIDS is treated with zivovudine (AZT) during pregnancy, and the infant is treated after delivery. Acyclovir, sulfamethazole, and fluconazole are not used to prevent transmission of the virus from mother to baby, so Answers A, B, and D are incorrect.

The nurse is describing the HIV virus infection to a client who has been told he is HIV positive. Which information regarding the virus is important to teach? 1. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in. 2. The HIV virus can be eradicated from the host body with the correct medical regimen. 3. It is difficult for the HIV virus to replicate in humans because it is a monkey virus. 4. The HIV virus uses the client's own red blood cells to reproduce the virus in the body.

*1. Retroviruses never die; the virus may become dormant, only to be reactivated at a later time.* 2. "Eradicated" means to be completely cured or done away with. HIV cannot be eradicated. 3. The HIV virus originated in the green monkey, in whom it is not deadly. HIV in humans replicates readily using the CD4 cells as reservoirs. 4. The HIV virus uses the CD4 cells of the immune system as reservoirs to replicate itself. TEST-TAKING HINT: If the test taker is not aware of the definition of a word, the individual monitoring the test may be able to define the word, but this is not possible on the NCLEX-RN examination. Of the answer options, option "1" has the most important information regarding prognosis and potential spread to noninfected individuals.

The nurse is admitting a client diagnosed with R/O SLE. Which assessment data observed by the nurse support the diagnosis of SLE? 1. Pericardial friction rub and crackles in the lungs. 2. Muscle spasticity and bradykinesia. 3. Hirsutism and clubbing of the fingers. 4. Somnolence and weight gain.

*1. SLE can affect any organ. It can cause pericarditis and myocardial ischemia as well as pneumonia or pleural effusions.* 2. Muscle spasticity occurs in MS, and bradykinesia occurs in Parkinson's disease. 3. Hirsutism is an overgrowth of hair. Spotty areas of alopecia occur in SLE, and clubbing of the fingers occurs in chronic pulmonary or cardiac diseases. 4. Weight loss and fatigue are experienced by clients diagnosed with SLE. TEST-TAKING HINT: The test taker must know the signs and symptoms of disease processes.

The client diagnosed with AIDS is angry and yells at everyone entering the room, and none of the staff members wants to care for the client. Which intervention is most appropriate for the nurse manager to use in resolving this situation? 1. Assign a different nurse every shift to the client. 2. Ask the HCP to tell the client not to yell at the staff. 3. Call a team meeting and discuss options with the staff. 4. Tell one (1) staff member to care for the client a week at a time.

1. This does not provide continuity of care for the client. It does recognize the nurse's position, but it is not the best care for the client. 2. The HCP should be asked to attend the care plan meeting to assist in deciding how to work with the client, but asking the HCP to "tell" the client to behave is not the best way to handle the situation. The client can always refuse to behave as requested. *3. The health-care team should meet to discuss ways to best help the client deal with the anger being expressed, and the staff should be consistent in working with the client.* 4. Telling a staff member to care for the client for a week could result in a buildup of animosity and make the situation worse. TEST-TAKING HINT: The test taker is being asked for the most appropriate method. Option "4" can be discarded because of the word "tell." Option "3" gives the option for multiple individuals to work together toward an outcome.

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

ANS: B Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.

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? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART

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? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.

ANS: D The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

Antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease.

Correct answer: b Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

During HIV infection a. the virus replicates mainly in B-cells before spreading to CD4+ T cells. b. infection of monocytes may occur, but antibodies quickly destroy these cells. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication

Correct answer: c Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

Correct answer: c Rationale: Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (see Table 15-10).

Screening for HIV infection generally involves a. laboratory analysis of blood to detect HIV antigen. b. electrophoretic analysis for HIV antigen in plasma. c. laboratory analysis of blood to detect HIV antibodies. d. analysis of lymph tissues for the presence of HIV RNA.

Correct answer: c Rationale: The most useful screening tests for HIV detect HIV-specific antibodies

What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

Correct answer: d Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.

Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low

Correct answers: a, b, c Rationale: The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.