Patho 15

The nurse is teaching a pregnant patient about the use of antiretroviral medications. Which statement by the patient indicates to the nurse that teaching was successful?

"Following the medication regimen can reduce the risk of transmission of HIV to my baby by 90%." Adherence to current recommendations—including administration of antiretroviral medications to HIV-positive mothers during pregnancy, during delivery, and during breastfeeding—can reduce the risk of vertical transmission by 90%. The risk to the baby is much lower, and therefore the baby will not necessarily be infected. Birth defects are uncommon with the use of antiretroviral medications. The medication regimen is recommended for use throughout the entire pregnancy.

The nurse teaches a patient with primary immunodeficiency disease about the risk of tuberculosis. Which statement by the patient indicates that the teaching has been effective?

"HIV infection can increase the risk of latent tuberculosis."

The nurse reviews the role of body fluids in the transmission of HIV with a group of new nurses. Which statement by a new nurse reflects accurate understanding of HIV transmission?

"HIV is not known to be transmitted through tears and saliva." HIV is not known to be transmitted in tears or saliva. HIV can be transmitted by way of sexual intercourse, blood products, and maternal-fetal contact (vertical transmission). Additional Learning HIV has been isolated in the following: Blood Semen Cervicovaginal secretions Cerebrospinal fluid Saliva Tears Breast milk

Which of the following statements made by a client in HAART therapy indicates understanding of the regimen?

"I need to take these medications exactly as prescribed."

The nurse teaches a patient who has just been given a diagnosis of HIV about antiretroviral treatment. Which statement should the nurse make that best describes the goal of antiretroviral treatment?

"It suppresses plasma HIV RNA to an undetectable level." The purpose of antiretroviral treatment is to suppress the plasma HIV level. Although drug-resistant forms of HIV are becoming more prevalent, the goal of treatment is to suppress the plasma HIV level. HIV cannot be killed. The viral load of HIV should be undetectable in a patient on antiretroviral treatment; it should not increase. Additional Learning There are five requirements for HIV to be transmitted to an uninfected individual: There must be an infected host. There must be infectious viral particles in a body fluid. There must be a bolus of infectious particles. Infectious particles must encounter target cells in an uninfected individual. Infected cells must escape clearance from the immune system.

The nurse teaches about HIV transmission. Which patient response describes why HIV is less commonly transmitted during sexual intercourse by infected women than by infected men?

"The concentration of HIV in cervicovaginal secretions is lower."

The nursing instructor is teaching about the CD4+ lymphocyte count. Which reason should the nurse explain why the CD4+ T-lymphocyte count exhibits a marked decrease right after the initial infection with HIV?

"There are high concentrations of HIV." The high level of HIV contributes to a marked decreased in the CD4+ T-lymphocyte count as the body is acutely fighting the infection. The viral count is high, not reduced, during the primary infection. Erythropoietin is not affected during the initial infection. Lymphadenopathy worsens during the primary infection. The image below illustrates the changes in the CD4+ lymphocyte count in HIV infection.

The nurse teaches patients about transmission of HIV through blood transfusions. Which statement should the nurse make that is the most accurate regarding the transmission of HIV through a blood transfusion?

"Transmission of HIV has been reduced by nucleic acid testing of blood products." Since the introduction of nucleic acid testing of all donated blood products in the 1990s, the risk of transfusion-related infection has been reduced to 1 in 1 million to 1.5 million units transfused. Transmission is not increased by way of blood products. Transmission has not been eradicated, but it has decreased. HIV is transmitted through sexual intercourse, in blood products, and vertically (from mother to fetus).

The nursing instructor is teaching about needlestick transmission of HIV. Which value is the most accurate description of the rate of HIV needlestick transmission?

0.3%. The risk of needlestick HIV transmission has been shown to be approximately 0.3%. Needlestick transmission is most likely to occur if the wound is deep, if there is visible blood on the instrument, and if the person in whom the contaminated needle was first used has a high viral titer. The 30%, 3%, and 7% values are all incorrect.

A nurse is teaching a patient with HIV infection about the average time frame for the progression to chronic disease. Which time frame given by the patient indicates that the nurse's teaching was effective?

10 years. Once the acute infection subsides, most individuals show no clinical manifestations of HIV infection for several years, even in the absence of treatment. However, during this prolonged asymptomatic period, HIV actively replicates, and there is an intense reduction in the half-life of circulating CD4+ T-lymphocytes. The average duration of this asymptomatic period is 10 years (although it varies considerably), not as little as 1 to 2 years or as long as 20 years. Additional Learning Several host factors can influence the duration of the asymptomatic period: Increased age is associated with accelerated progression to AIDS; heterozygotes for the CCR5 32-bp deletion show delayed progression. Behavioral factors such as smoking, poor nutrition, depression, and unprotected anal intercourse have been correlated with more rapid progression to AIDS. Genetic variations in CD8+ T-lymphocytes, which are involved in the immune response to HIV, are also believed to affect the rate of progression from acute HIV infection to AIDS.

Which is the window of time during which a patient may have a false-negative result on HIV testing?

2 weeks to 3 months

The nurse is teaching a client with HIV infection about the disease. Which test result cited by the client confirms the​ client's understanding of the laboratory test that is used to diagnose​ AIDS?

A CD4​+ count of less than 200 ​cells/mm3 supports a diagnosis of AIDS. A viral load of 0 or CD4​+ count greater than 800 ​cells/mm3 reflects HIV disease that is well controlled through the use of highly active antiretroviral therapy​ (HAART). A reactive Western blot result is confirmatory for a diagnosis of HIV infection.

HIV-associated lipodystrophy syndrome (HALS)

A collection of morphologic and metabolic abnormalities associated with HIV, including insulin resistance, glucose intolerance, dyslipidemia, and fat redistribution.

Cytomegalovirus (CMV)

A double-stranded DNA virus that is carried by the majority of the general population but replication of which is normally inhibited by the immune system; found in blood, saliva, semen, cervical secretions, and urine.

Lentiviruses

A family of viruses that infect cells of the immune system and cause immunodeficiency; includes HIV.

Heterozygous

A genetic term used to describe a pair of genes that are present at corresponding loci of homologous chromosomes.

AIDS-related lymphoma

A heterogenous collection of B-cell malignancies that occur in extra nodal sites, including the central nervous system, gastrointestinal tract, and liver.

Primary immunodeficiencies (PIs)

A heterogenous group of genetic disorders affecting all components of immune system function, including phagocytic and complement activity as well as B-lymphocyte, T-lymphocyte, and natural killer cell function.

Which of the following would the nurse expect when caring for an infant with SCID?

A life-threatening infection

Granuloma

A mass of fused macrophages that sequester persistent infectious agents and prevent their activation and dissemination.

Tuberculosis

A pulmonary infection caused by Mycobacterium tuberculosis, an acid-fast bacillus that is transmitted through aerosolized droplets; hallmarks of this disorder include formation of granulomas in the alveolar macrophages.

Human immunodeficiency virus (HIV)

A retrovirus that infects key cells in the immune system and induces defects in cellular and humoral immunity; the causative agent of AIDS.

Reverse transcriptase

A viral polymerase that generates two copies of DNA using the viral RNA as template.

15.3

AIDS-related lymphomas is a group of B-cell malignancies that involves extranodal sites, such as the central nervous system, GI tract, and liver. It is caused by infection with the Epstein-Barr virus.

Which is a clinical manifestation of a primary infection with​ HIV? (Select all that​ apply.)

Acute or primary HIV infection includes these​ manifestations: fever,​ fatigue, headache,​ lymphadenopathy, arthralgia, and maculopapular rash. Symptomatic disease is marked by​ headache, fatigue, night​ sweats, diarrhea, and mucocutaneous abnormalities.

Integrase

An enzyme that facilitates integration of viral DNA into the nuclear DNA of a host cell.

Opportunistic infection (OI)

An infection that occurs with increased frequency or greater severity as a result of the host's weakened or compromised immune response.

Dendritic cells

Antigen-presenting cells, such as Langerhans cells, involved in the early phase of adaptive host defense that engulf or phagocytose microbial antigen.

Retrovirus

Any category of viruses for which replication involves insertion of a DNA copy of the viral genome into the host cell; for example, HIV.

15.2

Approximately 6 months after infection, the plasma viral load stabilizes at a level known as the viral set point. The viral set point is prognostically significant and correlates with rate of CD4+ T-lymphocytes depletion and disease progression.

While teaching a community education​ class, the nurse includes which accurate statistic about the estimated new HIV syndrome diagnoses in the United States for the most affected​ populations?

Based on data reported by the Centers for Disease Control in​ 2016, Black men who have sex with men have the highest estimated new HIV diagnoses. Hispanic men who have sex with men have the third highest estimated new HIV diagnoses.​ Hispanic/Latina heterosexual women have the second lowest estimated new HIV​ diagnoses; White heterosexual women have the lowest estimated new HIV diagnoses. Black heterosexual women have the fourth highest estimated new HIV​ diagnoses, surpassed by Black men who have sex with​ men, White men who have sex with​ men, and​ Hispanic/Latina men who have sex with men.

The nurse teaches about testing required for patients with HIV infection. Which blood test should the nurse emphasize that predicts the classification of HIV disease in an individual?

CD4+ lymphocyte count

The nurse is assessing an infant with DiGeorge syndrome with 22q11.2 deletion. Which of the following is the nurse most likely to observe?

Cleft palate

A client with a positive ELISA is scheduled for a Western blot analysis. The nurse explains which of the following to the client?

Clumping of viral antigens can result in a falsely positive ELISA.

Long terminal repeat (LTRs)

Control centers for gene expression; structures that contain binding sites for viral proteins that regulate replication.

15.3

Cytomegalovirus (CMV) retinitis is the most common CMV infection in HIV/AIDS. CMV infections are treated with valganciclovir therapy; the optimal duration of treatment has not yet been established.

The nurse is teaching a patient with HIV about illnesses that define AIDS. Which illness identified by the patient indicates that the nurse's teaching was effective?

Cytomegalovirus infection

Which is considered an opportunistic illness that supports a diagnosis of​ AIDS? (Select all that​ apply.)

Cytomegalovirus, Kaposi​ sarcoma, and distal symmetric polyneuropathy are opportunistic​ and/or AIDS-defining illnesses. Rhinosinusitis and atopic asthma are not​ AIDS-defining illnesses.

15.3

Distal symmetric polyneuropathy (DSP) is a sensory axonal neuropathy that affects up to 50% of HIV-infected individuals. It can be the direct results of HIV infection or a complication of antiretrovial therapy.

The nurse is assessing a client with primary HIV infection. Which of the following is the nurse most likely to observe?

Fever

Chemokine receptors

G-protein-coupled receptors whose activation mediates leukocyte extravasation and migration.

15.3

HIV infection increases the risk of activation of latent TB and dissemination. All HIV-infected individuals should undergo annual tuberculin testing.

15.2

HIV is characterized by genetic heterogeneity, thus limiting vaccine development.

Which type of virus is​ HIV?

HIV is considered a retrovirus. Coronaviruses and rhinoviruses are cold​ viruses, and rotavirus is a gastrointestinal​ virus; all three of these viruses produce illnesses that are acute and​ self-limiting.

The nurse provides care for a client with HIV infection. When the client asks how the disease might have been​ contracted, which factor does the nurse list as a contributor to the transmission of​ HIV? (Select all that​ apply.)

HIV is transmitted through body fluids-it has been isolated in​ most, including​ blood, semen, cervicovaginal​ secretions, cerebrospinal​ fluid, saliva,​ tears, and breast milk-as well as through the placenta from a mother to a fetus. HIV is not known to be transmitted through tears or saliva.

15.2

HIV is transmitted through exchange of body fluids

Which laboratory test is used to monitor HIV​ infection?

HIV targets the​ CD4+ lymphocyte, so the CD4​+ count is monitored.​ Urinalysis, C-reactive​ protein, and complete blood count​ (CBC) are not adequate measures for monitoring HIV status.

Which part of the cell does the HIV use to​ reproduce?

HIV uses RNA to copy DNA and uses the human cell to​ replicate; mRNA is used for protein​ synthesis; tRNA is used to bridge mRNA and amino​ acids; and qRNA​ doesn't exist.

15.2

HIV uses the chemokine receptors CCR5 and CXCR4 as coreceptors to gain entry into target cells.

15.2

HIV-induced mechanisms of CD4+ T-lymphocytes depletion include direct cytopathic effects, syncytia formation, reduced thymic production of new cells, and activation of apoptotic pathways.

15.3

HIV-related lipodystrophy is a collection of morphologic and metabolic abnormalities. It includes insulin resistance, glucose intolerance, and fat redistribution.

The CD4+ T-lymphocyte count for a client with AIDS is 150 cells/mm^3. The nurse understands that this client:

Has opportunistic infections.

The nurse teaches a patient with newly diagnosed HIV infection about CD4+ lymphocytes and how it progresses to a chronic period of the disease. Which topic should the nurse include in this teaching?

How CD4+ decreases and HIV replicates

15.1

Immunodeficiency can adversely affect all facets of life and every body system. The concepts related to immunodeficiency include immunity, infection, perfusion, oxygenation, mobility, metabolism, tissue integrity, cognition, and cellular regulation.

15.1

Immunodeficiency disorders affect both innate and adaptive immunity, maintenance or self-tolerance, and cancer cell surveillance.

15.1

Immunodeficiency disorders may be primary or secondary and include a heterogeneous group of abnormalities of B-lymphocyte (humoral or antibody-mediated), T-lymphocyte (cell-mediated), phagocytic, and complement-related immune function.

Viral set point

In reference to HIV, the stabilized amount of virus remaining in the body after the initial immune response.

15.2

Inadequate adherence to HIV medications (<90-95% adherence) in a major factor in the emergence of viral mutants.

15.4

Individuals with PI are at increased risk for a variety of autoimmune or inflammatory disease and malignancies.

15.2

Initiation of HAART is recommended for all individuals who are infected with HIV.

15.3

Kaposi sacroma (KS), the most common AIDS-associated malignancy, is caused by infection with human herpesvirus 8.

The nurse assesses a patient with HIV infection. Which term should the nurse use to document this patient's manifestation?

Kaposi sarcoma

Antiretroviral therapy (ART)

Medications used in the treatment of HIV to suppress viral replication.

Which stage of the HIV lifecycle do nucleoside reverse transcriptase inhibitors​ (NTRIs) disrupt?

NRTIs were the first class of antiretroviral medications approved for use in the United States. After undergoing intracellular​ phosphorylation, NRTIs are structural analogs of the cellular nucleotides that make up the DNA strands copied from viral RNA. They compete with cellular nucleotides for reverse transcriptasedashmediated incorporation into growing DNA chains. By blocking reverse​ transcriptase, NRTIs inhibit HIV replication.

Which individual is likely to have an​ AIDS-defining illness within 1 year of an HIV infection​ diagnosis?

Older age is associated with accelerated progression to AIDS. Behavioral​ factors, such as​ smoking, poor​ nutrition, depression, and unprotected anal intercourse have been shown to correlate with more rapid progression to AIDS.​ Infant, adolescents, and​ middle-aged adults may avoid​ AIDS-defining illnesses with treatment that includes highly active antiretroviral therapy​ (HAART).

Distal symmetric polyneuropathy (DSP)

One of the most common forms of HIV-associated peripheral neuropathy; a sensory axonal neuropathy that typically involves thetas and soles of the feet, although the fingers and hands may become involved over time.

The nurse is caring for a client diagnosed with AIDS is most likely to assess which of the following conditions?

Opportunistic infections

15.4

Over 250 primary immunodeficiencies (PI's) have been identified, but the overall incidence and prevalence are low.

15.1

Primary immunodeficiencies (PI's) comprise more than 250 diseases, most of which are proven to be or suspected of being the result of genetic mutations; the majority of these are inherited.

15.4

Primary immunodeficiencies are primary hereditary and are often diagnoses in infancy and childhood. However, better diagnosis and treatment have led to a significant increase in the number of adults living with PI.

The nurse is teaching about protease inhibitors to a group of clients with HIV and their families. Which statement by a participant indicates that teaching was​ effective?

Protease inhibitors act at a late stage in the viral lifecycle. They bind to the active site of HIV protease and block the proteolytic cleavage of viral polyproteins that occurs immediately after budding. The resulting viral particles are immature and incapable of infecting new cells. Protease inhibitors are among the most potent inhibitors of HIV replication.

15.2

Resistance testing can be used to select optimal HAART regimens in treatment-experienced individuals.

The nurse is teaching about opportunistic infections. Which part of the human body should the nurse emphasize as being the most often affected by cytomegalovirus (CMV) infection?

Retinas

The nurse is caring for client with HIV and CMV. Which of the following signs is the nurse most likely to assess?

Retinitis

By which process does HIV use RNA to copy DNA and​ replicate?

Reverse transcription is the process by which HIV uses RNA to copy DNA and replicate. Tropism is the capacity to infect target cells. Budding is when HIV pushes out of the CD4 cell. Assembly is the process by which HIV releases protease to cut up the long chains of HIV proteins.

Which is the primary mode of transmission for​ HIV?

Sexual contact is the primary mode of transmission. HIV is not known to be transmitted through kissing. Transplacental transmission has markedly decreased as a result of the administration of highly active antiretroviral therapy​ (HAART) to pregnant women. Screening of blood products has also decreased transmission through blood transfusion.

CD4 receptor

Site for the major histocompatibility complex class II molecule on antigen-presenting cells.

The nurse is teaching clients with HIV about the purpose of the laboratory tests done to monitor their health. Which statement is​ accurate?

The CD4​+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with HIV. CD4​+ cells are a type of white blood cell. White blood cells are important in fighting infections. CD4​+ cells are also called T lymphocytes. The HIV load detects how rapidly the virus is replicating or multiplying. A complete blood count measures the number of red blood​ cells, white blood​ cells, hemoglobin,​ hematocrit, and platelets. A complete blood count​ (CBC) is a blood test used to evaluate your overall health and detect a wide range of​ disorders, including​ anemia, infection, and leukemia. The basic blood chemistry measures the levels of​ sodium, potassium,​ chloride, bicarbonate, blood urea​ nitrogen, and​ creatinine, which tell how well the kidneys are​ functioning, and​ glucose, which indicates whether there is a normal amount of sugar in the blood.

15.2

The HIV enzyme reverse transcriptase generates two copies of DNA using the viral RNA as a template.

Which is the confirmatory test for a diagnosis of HIV​ infection?

The Western blot is the confirmatory test.​ Enzyme-linked immunosorbent assay​ (ELISA) is the first blood test performed to detect HIV in the body. HIV RNA is the viral load count in the body. CD4​+ count is used to stage HIV disease.

Identify the order for the steps in the HIV lifecycle.

The correct order of steps in the lifecycle of HIV is​ binding, fusion, reverse​ transcription, integration, transcription and​ translation, assembly, and budding.

Tropism

The degree to which a potential host is susceptible to infection by a specific pathogen. The preference of a virus to bind to specific targets or host cells.

Which is the resultant effect of seroconversion in HIV infection?

The development of neutralizing antibodies

15.2

The goal of HAART is to achieve suppression of HIV replication to undetectable levels.

15.2

The major targets of HIV infection are CD4+T lymphocytes, monocytes/macrophages, and dendritic cells.

Acquired immunodeficiency syndrome (AIDS)

The most advance stage of HIV infection; characterized by severe immunodeficiency (i.e., CD 4+ T-lymphocyte count <200 cells/mm3), opportunistic infections, and/or malignancies

Kaposi sarcoma

The most common AIDS-associated malignancy; caused by human herpesvirus 8, this disorder most commonly produces skin tumors but may also produce tumors in the oral cavity, gut, lymph nodes, brain, and visceral organs.

15.1

The most common life-threatening cause of secondary immunodeficiency, especially in developing nations, is acquired immunodeficiency syndrome (AIDS).

15.4

The most common manifestations of PIs are recurrent, severe, and/or persistent/ unresponsive bacterial and viral infections involving both common and opportunistic pathogens or infections with unexpected or severe complications.

15.4

The most commonly identified primary immunodeficiencies are selective IgA deficiency and IgG subclass deficiency (both B-cell deficiencies) as well as common variable immunodeficiency (CVID) (both T-cell and B-cell deficiency).

Window period

The period between infection with HIV and the appearance of neutralizing antibodies.

Seroconversion

The point in time at which a particular antibody becomes detectable in the plasma.

The nurse is teaching the client with HIV syndrome about highly active antiretroviral therapy​ (HAART). Which primary benefit of early rather than delayed HAART treatment should the nurse​ include?

The primary benefits of early highly active antiretroviral therapy​ (HAART) include preservation of the immune​ system, a decrease in the risk of HIV​ transmission, and earlier suppression of viral replication. Potential risks of early therapy include drug​ toxicities, possible development of​ drug-resistant mutants that will limit treatment options in symptomatic​ disease, and the risk of transmitting​ drug-resistant mutants to uninfected​ individuals, thus limiting their treatment options.

15.2

The primary modes of transmission are sexual contact, injection drug use, and mother-to-child (vertical) transmission.

The nurse teaches a client about the early treatment of HIV infection with HAART therapy. Which client comment indicates that the teaching was​ effective?

The purpose of highly active antiretroviral therapy​ (HAART) is to decrease viral replication. The medication must be taken daily. The medicine does not kill HIV and is used early after HIV infection diagnosis to help prevent the development of AIDS.

Transmitted drug resistance (TDR)

The transmission of drug-resistant forms of HIV.

Highly active antiretroviral therapy (HAART)

The use of a combination of antiretroviral medications to suppress replication of HIV while simultaneously helping to prevent the occurrence of viral resistance to the medications.

15.2

The viral DNA in incorporated into the host cell's chromosomes; thus, viral genes replicate each time the infected cell replicates.

15.2

There are two tropic strains of HIV: macrophage tropic (M tropic), which preferentially infect macrophages and establish the initial infection, and T-cell tropic (T tropic), which infect T lymphocytes.

Which is expected to occur during primary HIV​ infection?

There is a marked decrease in CD4 count in HIV infection. During this period of high​ viremia, high concentrations of HIV are present in plasma and genital​ secretions; as a​ result, infected individuals are highly contagious.​ Also, during this viremic​ period, a transient decrease in​ CD4+ T-lymphocyte count occurs.

In which phase of the HIV lifecycle is there creation of HIV proteins that contribute to the building of new HIV virus?

Transcription and translation

Provirus

Viral DNA that is integrated into the genetic material of a host cell; may be transmitted from one cell generation to the next without causing cellular death.

The nurse is teaching a client about highly active antiretroviral therapy​ (HAART) and drug resistance. Which statement by the client indicates that teaching was​ effective?

​"Several drugs are used to prevent resistant forms of​ HIV." As a means of guiding the choice of​ medications, treatment of individuals who have​ early-stage HIV infection should be preceded by genotypic antiviral resistance testing. Exposure to HAART medications may yield HIV mutations and subsequent development of​ drug-resistant strains of the​ virus, rendering previously effective HIV medications ineffective. Transmission of​ drug-resistant forms of​ HIV, known as transmitted drug resistance​ (TDR), has emerged as a significant public health threat. TDR may be more prevalent among individuals with acute HIV infection than among those with chronic HIV infection.