WHAT DID YOU LEARN?? Immunity-HIV
A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse?
"I understand your concern. The blood is screened very carefully for different viruses as well as HIV." "If you don't have the blood transfusions, you may not make it through this episode of bleeding." "No one has gotten HIV from blood in a long time. You have to have the transfusion." "I understand what you mean, you can never be sure if the blood is tainted."
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? Sharing the diagnosis with a support group Caring for a client with an infectious terminal disease Disclosure of the client's condition Caring for a client who can kill other people
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 has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? Reverse the HIV+ status to a negative status. Bring the viral load to a virtually undetectable level Eliminate the risk of AIDS. Treat mycobacterium avium complex.
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.
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? Chronic diarrhea Nausea and vomiting Oral candida Anorexia
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 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? The client has been infected and has produced antibodies. The client cannot transmit the virus to others. The HIV infection confirms the presence of AIDS. The antibodies indicate immunity.
The client has been infected and has produced antibodies. Explanation: 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.
A client suspected of having human immunodeficiency virus (HIV) asks the nurse what causes AIDS. What is the best response by the nurse?
The human immunodeficiency virus The staphylococcal bacteria The Epstein-Barr virus The streptococcal bacteria
When preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home, the nurse should be sure to include which instruction? Avoid eating foods from serving dishes shared by other family members." Avoid sharing such articles as toothbrushes and razors." "Put on disposable gloves before bathing." "Sterilizterm-1e all plates and utensils in boiling water."
"Avoid sharing such articles as toothbrushes and razors." The human immunodeficiency virus (HIV), which causes AIDS, is most concentrated in the blood. For this reason, the client shouldn't share personal articles that may be blood-contaminated, such as toothbrushes and razors, with other family members. HIV isn't transmitted by bathing or by eating from plates, utensils, or serving dishes used by a person with AIDS.
A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse? "I understand what you mean, you can never be sure if the blood is tainted." "I understand your concern. The blood is screened very carefully for different viruses as well as HIV." "If you don't have the blood transfusions, you may not make it through this episode of bleeding." "No one has gotten HIV from blood in a long time. You have to have the transfusion."
"I understand your concern. The blood is screened very carefully for different viruses as well as HIV." Blood and blood products can transmit HIV to recipients. However, the risk associated with transfusions has been virtually eliminated as a result of voluntary self-deferral, completion of a detailed health history, extensive testing, heat treatment of clotting factor concentrates, and more effective virus inactivation methods. Donated blood is tested for antibodies to HIV-1, human immunodeficiency virus type 2 (HIV-2), and p24 antigen; in addition, since 1999, nucleic acid amplification testing (NAT) has been performed.
The nurse is discussing sexual activity with a client recently diagnosed with human immunodeficiency virus (HIV). The client states, "As long as I have sex with another person who is already infected, I will be okay." What is the best response by the nurse? "I am not sure why you would want to have sex with another person who is HIV positive. That person may have another sexually transmitted infection." "You should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner." "Yes, since you are already infected, it won't make a difference if you have sex with a person who is HIV positive." "If you have sex with another person who is HIV positive, you will develop AIDS sooner."
"You should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner." Clients, families, and friends are educated about the routes of transmission of HIV. The nurse discusses precautions the client can use to avoid transmitting HIV sexually or through sharing of body fluids, especially blood.
A client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate? "You might still go on to develop AIDS even with negative results." "Your body may not have developed antibodies yet, so we need to follow up." "Congratulations, a negative result means that you're not infected with the virus." "You're one of the lucky ones who are immune to the virus."
"Your body may not have developed antibodies yet, so we need to follow up." A negative test result means that antibodies to HIV are not in the blood at this time. The person may not be infected or the person's body may not yet have produced antibodies. (The "window" period is 3 weeks to 6 months). The client needs follow-up testing and must continue to take precautions. The negative test result does not mean that the client is immune to HIV, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet.
A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? SCID AIDS DAF CVID
AIDS AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? Limit interactions with people who are not HIV infected. Follow the same sexual precautions as someone who has been diagnosed with AIDS. Limit interactions with people who are already HIV infected. Quit their job and admit themselves to a hospital or a cancer treatment center.
Follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker will be tested for HIV at regular intervals and treated with antiretrovirals depending on the results of the tests or the potential for infection. While awaiting the results, the healthcare worker should follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker should not limit interactions with either non-HIV-infected or HIV-infected people. In addition, the healthcare worker should not quit and admit themselves to a hospital for treatment. Treatment, if required, can begin if the result of the test is positive.
The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? Greater than 500/mm3 Between 350 to 499/mm3 Less than 200/mm3 Between 200 to 350/mm3
Greater than 500/mm3 A client is classified as HIV asymptomatic when the CD4+ T lymphocyte count is greater than 500/mm3. A person is considered HIV symptomatic when the CD4+ count is 200 to 499/mm3. A person is considered to have acquired immunodeficiency syndrome (AIDS) when the CD4+ count is less than 200/mm3.
A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? HIV encephalopathy Candidiasis Distal sensory polyneuropathy (DSP) Cytomegalovirus (CMV)
HIV encephalopathy HIV encephalopathy, also called AIDS dementia complex or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.
A nurse is caring for a client diagnosed with human immunodeficiency virus (HIV). The client wants to know when medication for the disease will begin. What is the nurse's best response? If the client has a CD4 T-cell count less than 350 cells/mm3. When the client is co-infected with hepatitis C. If the client is diagnosed with HIV-associated liver disease. After the client has been cured of Kaposi's sarcoma.
If the client has a CD4 T-cell count less than 350 cells/mm3. The current guideline is to initiate treatment if the client develops an AIDS-defining illness or has a CD4 T-cell count less than 350 cells/mm3. Antiretroviral drug therapy is also warranted in infected pregnant women, in clients with HIV-associated renal disease, and in clients coinfected with hepatitis B. Options B, C, and D are therefore incorrect.
Which of these is often found in a client with AIDS? Kaposi sarcoma Carcinoma of the lung High peripheral blood CD4+ lymphocyte counts Overactive T-cell function
Kaposi sarcoma Kaposi sarcoma is an opportunistic infection with a virus that causes a tumor on the skin. It is commonly found in individuals who have a depressed immune system such as in the case of AIDS or immunosuppression therapy. An underactive T-cell function and low peripheral blood CD4+ lymphocyte counts are seen in clients with HIV/AIDS, not the opposite. A carcinoma of the lung is not a defining characteristic of HIV/AIDS, as an individual may have this carcinoma without having HIV/AIDS.
Which of the following is the most common HIV-related malignancy? Kaposi's sarcoma B-cell lymphoma Cervical carcinoma Pancreatic carcinoma
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.
What is a characteristic indicator that an individual is in the latent phase of HIV? Very high viral loads Mononucleosis-like symptoms Lack of symptoms Manifestations of opportunistic infections
Lack of symptoms The three phases experienced are primary infection phase, chronic asymptomatic or latency phase, and overt AIDS phase. Mononucleosis-like symptoms and high viral loads are seen in the primary infection phase, whereas the AIDS phase is characterized with opportunistic infections.
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? Pneumocystis pneumonia Mycobacterium avium complex (MAC) Community-acquired pneumonia Tuberculosis
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.
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? Report the incident to the supervisor. Fill out a risk management report. Call the lab to draw the nurse's blood. Obtain counseling.
Report the incident to the supervisor. Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.
A client with HIV will be started on a medication regimen of three medications. What drug will the nurse instruct the client about? Integrase inhibitors Protease inhibitor Hydroxyurea Reverse transcriptase inhibitors
Reverse transcriptase inhibitors Reverse transcriptase inhibitors are drugs that interfere with the virus' ability to make a genetic blueprint. A protease inhibitor is a drug that inhibits the ability of virus particles to leave the host cell. The integrase inhibitors are a class of drug that prevents the incorporation of viral DNA into the host cell's DNA. Hydroxyurea is a drug that is used as an adjunct therapy that tries to halt the progression of AIDS.
The mother of an infant born with profound intellectual disability and hearing loss tells the nurse that she had a viral infection in the first trimester of pregnancy. The nurse identifies which congenital infection as the cause of the fetal defects? Mumps Roseola Measles Rubella
Rubella When an infectious disease is transmitted from mother to child during gestation or birth, it is classified as a congenital infection. The most frequently observed congenital infections include toxoplasmosis (caused by the parasite Toxoplasma gondii), syphilis, rubella, cytomegalovirus infection, and HSV infections (the TORCH infections); varicella-zoster (chickenpox); parvovirus B19; group B streptococci (Streptococcus agalactiae); and HIV. The severity of congenital defects associated with these infections depends greatly on the gestational age of the fetus when transmission occurs, but most of these agents can cause profound intellectual disability and neurosensory deficits, including blindness and hearing loss.
When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? The client has not been infected with HIV. The client is immune to the AIDS virus. The body has not produced antibodies to the AIDS virus. Antibodies to the AIDS virus are in the client's blood.
The body has not produced antibodies to the AIDS virus A negative test result indicates that antibodies to the AIDS virus 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 takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk client must be encouraged. The test result does not mean that the client is immune to the virus, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.
The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse? The client has another infection present that is causing a decrease in the T4-cell count. The client has converted from HIV infection to AIDS. The client has advanced HIV infection. The client's T4-cell count has decreased due to the Pneumocystis pneumonia.
The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 200/mm3 and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.
An infant has been born to a client who is HIV positive. What is the infant's most likely prognosis for developing AIDS? The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV. The infant's immune system may or may not be able to eradicate HIV during the first few months of life. The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV. The infant will most likely have AIDS by his or her first birthday The infant's immune system possesses high immunoglobulin levels due to passive immunity and will not likely develop HIV.
The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV. Explanation: Infants born to HIV-infected women can be HIV antibody positive by ELISA for up to 18 months of age even though they are not infected with HIV. PCR testing for HIV DNA is used most often to diagnose HIV infection in infants younger than 18 months of age. Two positive PCR tests for HIV DNA are needed to diagnose a child with HIV infection. Children born to mothers with HIV infection are considered uninfected if they become HIV antibody negative after 6 months of age, have no other laboratory evidence of HIV infection, and have not met the surveillance-case-definition criteria for AIDS in children. It is possible for them to develop AIDS. Passive immunity is not likely to eradicate the virus.
A male patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows antibodies to the AIDS virus are present in the blood, this indicates what? The patient is immune to HIV. AIDS is inactive in the body. The patient may have unprotected intercourse because he is not infected with HIV. The patient has been infected with HIV.
The patient has been infected with HIV. Positive test results indicate that antibodies to the AIDS virus are present in the blood, HIV is probably active in the body, the patient does not necessarily have AIDS, the patient is not immune to AIDS, and the patient may not necessarily get AIDS in the future. The patient is not immune to HIV, and the patient may not have unprotected intercourse.
Which tests tell the physician what the viral load is in a client with HIV/AIDS? Select all that apply. T4/T8 ratio p24 antigen test polymerase chain reaction Western blot ELISA test
p24 antigen test & polymerase chain reaction It is now possible to measure a person's viral load, the number of viral particles in the blood. The p24 antigen test and polymerase chain reaction test measure viral loads. The ELISA is a screening test for HIV. The Western blot is a diagnostic test for HIV. The T4/T8 ratio determines the status of T lymphocytes.