PATHO Chapter 12 HIV disease and AIDS

Which statement best describes the etiologic development and transmission of AIDS? a. AIDS is caused by a retrovirus and transmitted through body fluids. b. The mechanism of AIDS transmission is unknown; therefore, AIDS is considered to be highly contagious. c. AIDS is an autoimmune disease triggered by a homosexual lifestyle. d. AIDS is caused by a virus that can be transmitted only by sexual contact.

ANS: A AIDS is caused by an infection of HIV, which is proven to be transmitted through blood and body fluids. The mechanism of HIV transmission is known to be through blood and body fluid exposure, newborn infection from the mother, and unprotected sex with an infected partner. AIDS is not an autoimmune disease of the homosexual. HIV can be transmitted through unprotected intercourse. HIV is a virus that is transmitted through various routes, not sexual contact only.

Which type of HIV virus causes most infections in the United States and Europe? a. HIV type 1 b. HIV type 2 c. HIV type A d. HIV type B

ANS: A HIV-1 is the organism of most cases in Central Africa, the United States, Europe, and Australia. HIV-2 is found in West Africa or in countries with socioeconomic ties to West Africa. HIV type A is a subtype currently in research. HIV type B is a strain in research phases

An HIV-positive patient is hospitalized for evaluation of symptoms of progressive weakness, dyspnea, weight loss, and low-grade fever. A biopsy of lung tissue reveals Pneumocystis carinii pneumonia. This diagnosis means that the patient a. has AIDS. b. has less than 2 years to live. c. cannot be treated. d. was an intravenous drug abuser.

ANS: A Pneumocystis carinii pneumonia (PCP) is a common initial opportunistic infection in HIV and is an AIDS-defining diagnosis. A diagnosis of PCP is not associated with a life-expectancy of 2 years or less. PCP is treated with antibiotic therapy. PCP is a pulmonary manifestation of AIDS, which is not associated with intravenous drug abuse

A nurse who works in an assisted living facility is preparing to teach the residents about safe sex practices. What resident criteria should the nurse take into consideration when creating a teaching plan? (Select all that apply.) a. Age b. Ethnicity c. Culture d. Sexual preference e. Mobility status

ANS: A, B, C, D It is important that education regarding safe sex practices be tailored to appropriate age groups, ethnicity, culture, and sexual preference. Mobility status is not a consideration when teaching about safe sex practices

In which type of cells is the CD4 found? (Select all that apply.) a. T cells b. Microglial cells c. Retinal cells d. Cervical cells e. Pacemaker cells

ANS: A, B, C, D The CD4 receptor is found on many types of cells, including T cells, microglial cells, monocyte-macrophages, follicular dendritic cells, immortalized B cells, retinal cells, Langerhans cells in the skin, bone marrow stem cells, cervical cells, bone marrow-derived circulating dendritic cells, and enterochromaffin cells in the colon, duodenum, and rectum

A patient presents to the clinic with flulike symptoms and a rash. The nurse knows that the type of rash associated with HIV may include (Select all that apply.) a. maculopapular. b. vesicular. c. impetigo. d. urticarial. e. psoriasis.

ANS: A, B, D The rash in HIV is not the same in every patient and may be maculopapular, vesicular, or urticarial. Impetigo and psoriasis are not rashes linked to HIV

Which modes of transmission occur with HIV infection? (Select all that apply.) a. Sexual transmission b. Parenteral transmission c. Fomite transmission to intact skin d. Perinatal transmission to fetus e. Inhalant transmission

ANS: A, B, D Unprotected sex with infected partners is a proven method of HIV transmission. Needle and syringe sharing between intravenous drug users is a proven HIV transmission method. Transmission from an infected mother to her infant may occur in the intrauterine period or at the time of delivery. The risk of contracting HIV through the skin has only been found with a direct puncture. HIV is not known to be transmitted via aerosol routes

The CDC defines three CD4+ T-cell categories of T cell ranges. Which values are correct? (Select all that apply.) a. In category 1, the CD4+ T-cell count is greater than or equal to 500/mL. b. In category 1, the CD4+ T-cell counts range from 200 to 499/mL. c. In category 2, the CD4+ T-cell counts range from 200 to 499/mL. d. In category 3, the CD4+ T-cell count is less than 200/mL. e. In category 3, the CD4+ T-cell count is less than 300/mL.

ANS: A, C, D In category 1, the CD4+ T-cell count is greater than or equal to 500/mL. In category 2, the CD4+ T-cell counts range from 200 to 499/mL. In category 3, the CD4+ T-cell count is less than 200/mL

Which drugs are used for the management of HIV? (Select all that apply.) a. Nucleoside reverse transcriptase inhibitors b. DNA polymerase inhibitors c. Protease inhibitors d. Nonnucleoside reverse transcriptase inhibitors e. CD4 analogs

ANS: A, C, D Nucleoside reverse transcriptase inhibitors are used to prevent replication by preventing HIV DNA synthesis. Protease inhibitors attack a phase in the viral life cycle by inhibiting the enzyme protease. Nonnucleoside reverse transcriptase inhibitors are potent antiretrovirals. DNA polymerase inhibitors are not used in the management of HIV. CD4 analogs are nonexistent as a pharmacologic agent

HIV infection causes immunodeficiency because it a. directly inhibits antibody production by B cells. b. causes the destruction of T-helper cells. c. causes excessive production of cytotoxic T cells. d. blocks the ability of macrophages to present antigens.

ANS: B The hallmark of HIV infection is defective cell-mediated immunity, with a decrease in CD4 or T-helper lymphocytes. HIV infection does not directly inhibit the production of antibodies by B cells. There is not an excessive production of cytotoxic T cells with HIV infection. HIV infection does not block the ability of macrophages to produce antigens

Which statement about HIV testing is correct? a. Any patient can be tested for HIV with or without their informed consent. b. A negative HIV test ensures absence of infection. c. The false-negative rate for HIV testing is zero. d. Significant exposure to infected blood or body fluids requires HIV testing.

ANS: D After a significant exposure to HIV-infected blood or body fluids, health care workers should be treated according to post-exposure protocols. These include testing and possible prophylactic medications. Patients that need to be tested for HIV should always be given the opportunity to provide verbal or written consent according to state consent guidelines. Negative HIV tests are not always indicative of negative status. False-negative tests can occur during the period before seroconversion. Initial HIV tests are highly sensitive but should always be confirmed with a Western blot test

The HIV nurse educator teaches a newly diagnosed patient about HIV. The nurse educator tells the patient that in the United States, those at greatest risk of HIV infection include (Select all that apply.) a. infants born to infected fathers. b. heterosexual women. c. homosexual men. d. restaurant workers. e. men over age 50.

ANS: B, C In the United States, those at greatest risk of HIV infection include: men who have sex with other men (MSM), also called homosexual men; intravenous drug users who share needles or syringes; sexual partners of those in high risk groups, particularly heterosexual women; and infants born to infected mothers. Infants born to infected mothers, not infected fathers, are at greatest risk of HIV infection. Restaurant workers are not at greater risk of HIV infection solely because of their working in the restaurant industry. Using public restrooms, swimming in public swimming pools, touching or hugging someone who is HIV-positive, and eating with community utensils or in restaurants are safe practices. Approximately 10% to 11% of all HIV cases involve people over age 50, but this does not comprise the highest-risk group.

Opportunistic infections are a hallmark of HIV and AIDS. Which infections are considered opportunistic? (Select all that apply.) a. Acinetobacter b. Cytomegalovirus c. Candida albicans d. Pneumocystis carinii e. Clostridium difficile

ANS: B, C, D, E Cytomegalovirus is an opportunistic infection seen in AIDS. Candida albicans is an oropharyngeal manifestation seen in most patients with HIV. Pneumocystis carinii is a respiratory manifestation and a major source of morbidity and mortality in the AIDS patient. Clostridium difficile is a gastrointestinal manifestation of HIV. The GI tract is the major target organ in HIV infection, and malnutrition is the leading cause of death among AIDS patients worldwide. Acinetobacter is not typically associated with HIV and AIDS

Which HIV-positive patient should be given a diagnosis of AIDS? a. One who has a CD4 count of 300/µL b. One who has neuropathy c. One who has Mycobacterium tuberculosis d. One who has genital herpes

ANS: C AIDS is a syndrome that is expressed in many ways. If a person has a CD4 count less than 200/mL along with an opportunistic infection such as Mycobacterium tuberculosis, then the person is diagnosed with AIDS. A patient is not diagnosed with AIDS until the CD4 count is less than 200/mL. Neuropathy would possibly be a sign or symptom associated with an opportunistic infection, but is not used to diagnose AIDS. Genital herpes is not used to diagnose AIDS.

The immune system disorder associated with HIV is a. an overactive B-cell system. b. proliferation of immature WBCs (blasts). c. deficiency of T-helper lymphocytes. d. cancerous growth of lymph tissue.

ANS: C HIV has been identified as a type of retrovirus associated with a disorder of the T-helper lymphocytes. T cells have an interaction with B cells, but this relationship is not associated with HIV. Immature blast cells are not the deficiency that contributes to HIV. Cancerous growths of lymphatic tissue have not been found to be the source of HIV.

HIV replicates very quickly from the onset of infection. What is the major site of HIV replication? a. Vaginal mucosa b. Anal mucosa c. GI tract d. Respiratory tract

ANS: C HIV is primarily a mucosal disease that replicates very quickly from the onset of infection. The GI tract is the major site of HIV replication because the infection replicates quickly in the GI tract and overwhelms the body's defenses. The vaginal mucosa, anal mucosa, and respiratory tract may be involved in HIV replication, but these are not the initial sites of infection.

A patient receiving zidovudine and a protease inhibitor to manage HIV infection is found to have an undetectable viral load. This means that the a. dosage of both agents should be reduced. b. zidovudine can be discontinued. c. therapy is effective. d. HIV virus has been eliminated.

ANS: C Protease inhibitors attack at a phase of the viral cycle and are used in conjunction with zidovudine. The goal of treatment is to suppress the viral load. Dosage of both agents would not be reduced, because the undetectable viral load means that the therapy is effective. Zidovudine would not be discontinued, because it is deemed effective in creating an undetectable viral load in this case. The HIV virus has not been eliminated in the event of an undetectable viral load. Rather, HIV plasma is suppressed and disease progression delayed.

HIV infection of T-helper cells is facilitated by attachment of the viral envelope protein gp120 to a. CD8 proteins on suppressor cells. b. reverse transcriptase. c. CD4 proteins on helper cells. d. the macrophage lipid bilayer.

ANS: C The HIV envelope protein gp120 specifically binds to the CD4 receptor. The receptor cells of the CD4 cells are attracted to virus changes. Reverse transcriptase is not found to be attracted to the gp120 protein at this time. The macrophage lipid bilayer is not associated with the CD4 receptor

An effective HIV vaccine is difficult to produce, primarily because a. HIV is not immunogenic. b. B cells are unable to produce antibodies against HIV. c. HIV mutates frequently. d. reverse transcriptase cleaves to the vaccine.

ANS: C The variability between strains of HIV and the frequency of mutations makes it difficult to produce a vaccine. HIV infection does not overwhelm the immune system, because it is an immune deficiency. Research is still being conducted to develop a vaccine. Researchers are testing cloned T cells for response to new therapies. Reverse transcriptase is not proven to adhere to the vaccine

A patient is infected with the retrovirus HIV. The patient may have contracted HIV as it was transmitted via (Select all that apply.) a. saliva. b. tears. c. semen. d. cervical secretions. e. cerebrospinal fluid.

ANS: C, D HIV is transmitted in three ways: sexual transmission via semen or vaginal and cervical secretions through homosexual or heterosexual intercourse; parenteral transmission via blood, blood products, or blood-contaminated needles or syringes; and perinatal transmission in utero, during delivery, or in breast milk. HIV is known to be present in but has not been shown to be transmitted via urine, saliva, tears, cerebrospinal fluid, amniotic fluid, and feces. HIV is not known to be transmitted via aerosol routes

As of 2014, _____ individuals worldwide have been infected with HIV infection. a. 100,000 b. 1 million c. slightly less than 16 million d. nearly 35 million

ANS: D An estimated 36.9 million people were living with HIV worldwide as of 2014. Infection rates are calculated per 100,000 population. In the United States, more than 1 million people have been diagnosed with HIV and AIDS. Of the total number of people infected, women comprise 17.4 million.

The clinical latency period after HIV infection is a time when no a. viral replication occurs. b. decline in CD4 lymphocytes occurs. c. virus is detectable in the blood. d. significant symptoms of immunodeficiency occur.

ANS: D This latency period is the time when no significant symptoms occur, although mild symptoms of lymphadenopathy, lack of energy, weight loss, frequent fevers, and sweats may occur. Viral reproduction occurs immediately after the latency period, and can last up to 18 months. A decline in the CD4 T-cell count is taking place during the time of rapid virus production. Seroconversion usually occurs between 3 weeks and 6 months after exposure

TRUE or FALSE Cleaning dirty needles prior to use helps prevent the spread of HIV. When using bleach, the user must rinse out all the blood first and then fill the needle and syringe with full-strength bleach three times for 10 to 20 seconds.

ANS: F After rinsing all the blood first, the user fills the needle and syringe with full-strength bleach at least three times for 30 to 60 seconds