NU371 PrepU: Management of patients with HIV + AIDS (week 2)

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? a) Antibodies to HIV are not present in his blood. b) He has not been infected with HIV. c) He is immune to HIV. d) Antibodies to HIV are present in his blood.

a) Antibodies to HIV are not present in his blood. - A negative test result indicates that antibodies to HIV are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that if infected, the body has not produced antibodies (which take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to HIV are detected in the blood, the test is interpreted as positive.

A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? a) Avoid fibrous foods, lactose, fat, and caffeine. b) Consume large, high-fat meals. c) Reduce food intake. d) Increase intake of iron and zinc.

a) Avoid fibrous foods, lactose, fat, and caffeine. - Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

Which of the following is the most common HIV-related malignancy? a) Kaposi's sarcoma b) B-cell lymphoma c) Cervical carcinoma d) Pancreatic carcinoma

a) Kaposi's sarcoma - Kaposi's sarcoma is the most common HIV-related malignancy and involves the endothelial layer of blood and lymphatic vessels. Kaposi's sarcoma, certain types of B-cell lymphomas, and invasive cervical carcinoma are included in the CDC classification of AIDS-related malignancies.

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? a) Liquids b) Gluten c) Sucrose d) Iron and zinc

a) Liquids - The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.

Which of the following are common sites of visceral involvement of Kaposi's sarcoma? Select all that apply. a) Lymph nodes b) Gastrointestinal tract c) Lungs d) Brain e) Heart

a) Lymph nodes b) Gastrointestinal tract c) Lungs - The most common sites of visceral involvement are the lymph nodes, the gastrointestinal tract, and the lungs. Involvement of internal organs may eventually lead to organ failure, hemorrhage, infection, and death. The brain and the heart are not common sites.

A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in? a) Primary infection b) Secondary infection c) Tertiary infection d) Latent infection

a) Primary infection - The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection, or stage 1. Initially, there is a period during which those who are HIV positive test negative on the HIV antibody blood test, although they are infected and highly infectious, because their viral loads are very high.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? a) Urine b) semen c) blood d) breast milk

a) Urine - HIV is transmitted in body fluids that contain free virions and infected CD4+ T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. Urine is not a body fluid responsible for HIV transmission.

Which term defines the balance between the amount of HIV in the body and the immune response? a) Viral set point b) Window period c) Primary infection stage d) Viral clearance rate

a) Viral set point - The viral set point is the amount of virus in the body after the initial immune response subsides is referred to as the viral set point, which results in an equilibrium between HIV levels and the immune response that may be elicited. During the primary infection period, the window period occurs because a person is infected with HIV but negative on the HIV antibody blood test. The period from infection with HIV to the development of antibodies to HIV is known as the primary infection stage. The amount of virus in circulation and the number of infected cells equals the rate of viral clearance.

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? a) diarrhea and abdominal pain b) numbness in the extremities and decreased cognition c) alterations in renal function d) pancreatitis

a) diarrhea and abdominal pain - Common adverse effects associated with the administration of zidovudine and other NRTIs include nausea, abdominal pain and diarrhea. The drug does not cause nephropathy, decreased cognition, or pancreatitis.

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. a) semen b) urine c) breast milk d) blood e) vaginal secretions

a) semen c) breast milk d) blood e) vaginal secretions - There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.

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

b) Headache - Early manifestations of HIV encephalopathy include headache, memory deficits, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. Later stages include hyperreflexia, a vacant stare, and hallucinations.

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: a) p24 antigen test for confirmation of diagnosis. b) Western blot test for confirmation of diagnosis. c) polymerase chain reaction test for confirmation of diagnosis. d) T4-cell count for confirmation of diagnosis.

b) Western blot test for confirmation of diagnosis. - The enzyme-linked immunosorbent assay (ELISA) test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.

A client has received the results of a HIV antibody test, which is positive. What is the best explanation for the nurse to give to the client? a) The client has been infected and has produced antibodies. b) The client cannot transmit the virus to others. c) The HIV infection confirms the presence of AIDS. d) The antibodies indicate immunity.

a) The client has been infected and has produced antibodies. - A positive test result indicates HIV infection, but it does not mean that the client has AIDS. The client is not immune to HIV and can transmit the virus to others.

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? a) Active substance abuse b) Depression c) Past substance abuse d) Lack of social support

c) Past substance abuse - Factors associated with nonadherence include active substance abuse, depression, and lack of social support, as well as neurocognitive impairment, low health literacy, stressful life events, high levels of alcohol consumption, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

A client with acquired immune deficiency syndrome (AIDS) is exhibiting shortness of breath, cough, and fever. What type of infection will the nurse most likely suspect? a) Mycobacterium avium complex b) Legionella c) Cytomegalovirus d) Pneumocystis jiroveci

d) Pneumocystis jiroveci - Although mycobacterium, legionella, and cytomegalovirus may cause the signs and symptoms described, the most common infection in people with AIDS is pneumocystis pneumonia caused by pneumocystis jiroveci. It is the most common opportunistic infection associated with AIDS.

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when scheduling a return visit for viral load testing at which time? a) 6 weeks b) 12 weeks c) 18 weeks d) 24 weeks

a) 6 weeks - Viral load tests are measured immediately before initiating antiretroviral therapy and then again in 2 to 8 weeks. In most clients, adherence to a regimen of potent antiretroviral agents should result in a large decrease in the viral load by 2 to 8 weeks. Therefore, a return visit at 6 weeks would be in this time frame. By 16 to 20 weeks, the viral load should continue to decline, dropping below detectable levels.

A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? a) Severe joint pain b) Lymphedema of the lower extremities c) Deep purple cutaneous lesions d) Venous stasis and phlebitis formation

c) Deep purple cutaneous lesions - Localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of clients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS? a) Sharing the diagnosis with a support group b) Caring for a client who can kill other people c) Disclosure of the client's condition d) Caring for a client with an infectious terminal disease

c) Disclosure of the client's condition - Despite HIV-specific confidentiality laws, clients infected with AIDS fear that disclosure of their condition will affect employment, health insurance coverage, and even housing. Since healthcare providers do not share a client's diagnosis with a support group, option A is incorrect. Caring for a client with an infectious terminal illness that can be transmitted to other people is a concern for healthcare providers but it is not an ethical issue.

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? a) Sign a refusal of blood transfusion form so the client will not receive the transfusion. b) Bank autologous blood. c) Ask people to donate blood. d) Using volume expanders in case blood is needed.

b) Bank autologous blood. - Signing the refusal form does not give the client any information about the options that are available and place the client at risk. Banking autologous blood that is self-donated is the safest option for the client. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? a) Anorexia b) Chronic diarrhea c) Nausea and vomiting d) Oral candida

b) Chronic diarrhea - Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (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 end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. What client need should in the nurse focus on when planning this client's care? a) pain management b) fluid replacement c) antiretroviral therapy d) high-calorie nutrition

b) fluid replacement - The protozoal enteric infection caused by Cryptosporidium results in profuse watery diarrhea. Because diarrhea will lead to dehydration, the nurse should focus on fluid replacement. Pain management is also a concern in the care of a client with AIDS. However, with Cryptosporidium, the main concern is hydration. Antiretroviral therapy is most useful when a client with human immunodeficiency virus doesn't have opportunistic infections. With the wasting associated with AIDS, high-calorie nutrition is important, but with Cryptosporidium-related diarrhea, hydration takes precedence.

A hospital educator is reiterating the importance of Standard Precautions to a group of nursing students who will soon begin a clinical rotation on the unit. Which of the following statements best describes the application of Standard Precautions? a) Standard Precautions should be used when providing care for any patient who has a white blood cell (WBC) count of 10.8 × 109/L or greater. b) Standard Precautions should be applied in the care of any patient who has an actual or suspected primary or secondary immunodeficiency. c) Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. d) Standard Precautions should be used in the care of any patient whose diagnosis is attributable to an infectious process.

c) Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. - Standard Precautions incorporate the major features of Universal Precautions (designed to reduce the risk of transmission of bloodborne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances); they are applied to all patients in health care facilities regardless of their diagnosis or presumed infectious status.

A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? a) 1 mm3 to 10 mm3 b) 10 mm3 to 20 mm3' c) 20 mm3 to 45 mm3 d) 50 mm3 to 150 mm3

d) 50 mm3 to 150 mm3 - An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? a) Reverse the HIV+ status to a negative status. b) Treat mycobacterium avium complex. c) Eliminate the risk of AIDS. d) Bring the viral load to a virtually undetectable level

d) Bring the viral load to a virtually undetectable level - The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.

Which of the following indicates that a client with HIV has developed AIDS? a) Severe fatigue at night b) Pain on standing and walking c) Weight loss of 10 lb over 3 months d) Herpes simplex ulcer persisting for 2 months

d) Herpes simplex ulcer persisting for 2 months - A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? a) Bathing or hygiene self-care deficitIneffective cerebral tissue perfusion b) Ineffective cerebral tissue perfusion c) Complicated grieving d) Risk for injury

d) Risk for injury - In a client with AIDS, central nervous system (CNS) deterioration can lead to AIDS-related dementia. This type of dementia impairs cognition and judgment, placing the client at risk for injury. Although Bathing or hygiene self-care deficit and Complicated grieving may be relevant in AIDS, these diagnoses don't take precedence in a client with AIDS-related dementia. Because CNS deterioration results from infection, Ineffective cerebral tissue perfusion isn't applicable.

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? a) trimethoprim-sulfamethoxazole b) nystatin c) amphotericin B d) fluconazole

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

The nurse teaches the client that reducing the viral load will have what effect? a) Shorter time to AIDS diagnosis b) Longer survival c) Shorter survival d) Longer immunity

b) Longer survival - The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

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) Anorexia b) Chronic diarrhea. c) Nausea and vomiting. d) Oral candida.

b) Chronic diarrhea. - 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.

As part of HAART therapy, a client is prescribed a non-nucleoside reverse transcriptase inhibitor (NNRTI). What would be an example of a drug from this class? Select all that apply. a) Abacavir b) Delavirdine c) Amprenavir d) Efavirenz e) Stavudine

b) Delavirdine d) Efavirenz - Examples of NNRTIs are delavirdine and efavirenz. Abacavir and stavudine are nucleoside reverse transcriptase inhibitors (NRTIs). Amprenavir is a protease inhibitor.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? a) means of transmission b) HIV-1 is more prevalent than HIV-2 subtypes c) the fact that it is a mutated virus originally thought to be bovine in nature d) cure rate

b) HIV-1 is more prevalent than HIV-2 subtypes - 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 client with human immunodeficiency virus (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 client? a) Mycobacterium avium complex (MAC) b) Pneumocystis pneumonia c) Tuberculosis d) Community-acquired pneumonia

b) Pneumocystis pneumonia - The most common life-threatening infection in those living with acquired immune deficiency syndrome (AIDS) is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly P. carinii) (Durham & Lashley, 2010). Without prophylactic therapy, 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. Clients 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 clients who are breathing room air may be mildly decreased, indicating minimal hypoxemia.

Kaposi sarcoma (KS) is diagnosed through a) skin scraping. b) biopsy c) visual assessment. d) computed tomography.

b) biopsy - KS is diagnosed by biopsy of the suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count.

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

c) Assess blood urea nitrogen and creatinine. - Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urea nitrogen and creatinine for clients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the client's problem, which should be assessed before intervention are administered.

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? a) Maintain the client in a supine or side-lying position. b) Encourage client to ambulate frequently in the halls. c) Assist with chest physiotherapy every 2 to 4 hours. d) Limit fluid intake to 1 1/2 to 2 liters per day.

c) Assist with chest physiotherapy every 2 to 4 hours. - The nurse should include interventions such as assisting with and/or performing chest physiotherapy every 2 to 4 hours to prevent stasis of secretions, assist the client to attain the semi- or high Fowler's position to facilitate breathing and airway clearance, allow for frequent rest periods to prevent excessive fatigue, and maintain a fluid intake of at least 3 liters per day unless contraindicated.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses, including the steps in the process of HIV entering the host cell. What would the nurse describe as the first step? a) Cleavage b) Budding c) Attachment d) Uncoating

c) Attachment - Once HIV enters the host cell, attachment occurs in which the glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors. This is followed by uncoating, in which HIV's viral core is emptied into the CD4+ T cell. Cleavage and budding occur as the last steps.

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? a) Deficient knowledge related to the effects of the disease b) Risk for infection related to the immune system dysfunction c) Disturbed body image related to loss of fat in the face and arms d) Risk for impaired liver function related to drug therapy effects

c) Disturbed body image related to loss of fat in the face and arms - The client is experiencing lipoatrophy, which results in a localized loss of subcutaneous fat in the face (manifested as sinking of the cheeks, eyes, and temples), arms, legs, and buttocks. These changes as well as his statement about the side effects of the drug being worse than the disease indicate that he is concerned about how he appears to others. Therefore, the nursing diagnosis of disturbed body image would be the priority. Deficient knowledge, risk for infection, and risk for impaired liver function may be applicable; however, they are not concerns at this time.

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV? a) Rashes on the face, trunk, palms, and soles b) Muscle and joint pain c) Gynecologic problems d) Weight loss

c) Gynecologic problems - In women with HIV, gynecologic problems, such as abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may be the focus of a majority of complaints. Acute retroviral syndrome (viremia) may be the chief complaint in one third to more than one half of those infected, not necessarily women. Its manifestations include rashes, muscle and joint pain, and weight loss.

A patient presents to a clinic on May 1 and tells the nurse practitioner that he had a 1-month sexual relationship with a friend who did not disclose that he was HIV positive. The relationship ended last week. The nurse tells the patient that after infection with HIV, the immune system responds by making antibodies against the virus; therefore the patient should expect this to happen by: a) May 8 b) May 20 c) June 5 d) July 1

c) June 5 - An antibody response to an HIV infection usually occurs 4 to 6 weeks after exposure.

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? a) Urine specimen for culture and sensitivity b) Blood specimen for electrolyte studies c) Stool specimen for ova and parasites d) Sputum specimen for acid fast bacillus

c) Stool specimen for ova and parasites - A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.

A client taking fosamprenavir reports "getting fat." What is the nurse's best action? a) Have the client increase exercise. b) Assess the client's diet. c) Teach the client about medication side effects. d) Arrange for a psychological counseling.

c) Teach the client about medication side effects. - The client needs to be aware of the potential for fat redistribution. Exercise, diet, and counseling will not change the outcome of this side effect.

The nurse is instructing a male client about safer sexual behaviors. Which client statement indicates a need for additional instruction? a) "I will apply baby oil to lubricate the condom." b) "I should use a new condom each time I have sex." c) "My partner and I should avoid manual-anal intercourse." d) "After having sex, I should hold onto the condom when pulling out."

a) "I will apply baby oil to lubricate the condom." - The client should use only water-soluble lubricant, such as K-Y jelly or glycerin. Baby oil can cause the condom to break. The client should use a new condom for each sexual activity and hold onto the condom so that it does not come off when pulling out. Manual-anal intercourse should be avoided.

Which assessment finding(s) are likely to cause noncompliance with antiretroviral treatment? Select all that apply. a) Active substance abuse b) Depression c) Past substance abuse d) Lack of social support

a) Active substance abuse - Psychosocial barriers such as depression and other mental illnesses, neurocognitive impairment, low health literacy, low levels of social support, stressful life events, high levels of alcohol consumption and active substance use, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications affect adherence to ART. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

A nurse is preparing to administer saquinavir, which is prescribed for a client who is HIV positive. What type of drug does the nurse identify saquinavir as? a) Fusion inhibitor b) Protease inhibitor (PI) c) Non-nucleoside reverse transcriptase inhibitor (NNRTI) d) Nucleoside reverse transcriptase inhibitor (NRTI)

b) Protease inhibitor (PI) - Saquinavir is a PI. Enfuvirtide and maraviroc are examples of fusion inhibitors. NNRTIs include agents such as delavirdine and nevirapine. NRTIs include abacavir, didanosine, lamivudine, and zalcitabine.

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wart-like lesions on my vagina. This is happening quite often." What should the nurse consult with the physician regarding? a) testing the client for the presence of HIV b) instructing the client to wear cotton underwear c) having the client abstain from sexual activity for 6 weeks while the medication is working d) using a medicated douche in order to keep the vaginal pH normal

a) testing the client for the presence of HIV - Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may correlate with HIV infection. Wearing cotton underwear can help with the prevention of candidiasis but does not address the recurrent vaginal infection that may not be caused by a fungus. Abstaining from sexual intercourse does not address the recurrent vaginal infection. A medicated douche can alter the normal flora of the vaginal wall.

A client who is HIV positive has been prescribed antiretroviral drugs. The nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration, including strong emphasis about rigidly adhering to the dosage, time and frequency of the administration of the drugs. Why is it important to adhere to the schedule of drug dosing developed for this client? a) To avoid overdosing on the drugs b) To avoid resistance to the drugs c) To maintain appropriate blood levels of the drugs d) To get the most benefit from the drugs

b) To avoid resistance to the drugs - For clients with an established HIV status, the nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration. This includes strong precautions about rigidly adhering to the dosage, time, and frequency of drug administration to avoid resistance. Adhering rigidly to the developed schedule is not to preclude overdosing, or to maintain appropriate blood levels, or to get the most benefit from the drugs.

What test will the nurse assess to determine the client's response to antiretroviral therapy? a) Western blotting b) Viral load c) Enzyme immunoassay d) Complete blood count

b) Viral load - Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART. The other tests are not used in this way.

A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? a) The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. b) Viral load and T4-cell counts will be performed every 2 to 3 months. c) More antiretroviral medication will be added every 2 to 3 months. d) The Western blot test will be monitored every 6 months to see if the virus is still present.

b) Viral load and T4-cell counts will be performed every 2 to 3 months. - Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus.

A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? a) MAC b) Wasting syndrome c) Kaposi's sarcoma d) Candidiasis

d) Candidiasis - Candidiasis, a fungal infection, occurs in almost all clients with AIDS and immune depression (Durham & Lashley, 2010). Oral candidiasis is characterized by creamy-white patches in the oral cavity and, if left untreated, can progress to involve the esophagus and stomach. Associated signs and symptoms include difficult and painful swallowing and retrosternal pain.