7215 test 1 ch 14 (HIV)
what HIV phase is this ? occurs 2-4 weeks after the initial infection and is often accompanied by a mononucleosis-like syndrome that may be mistaken for the flu (fever, swollen lymph nodes, sore throat, HA, malaise, nausea, muscle & joint pain, diarrhea, and/or a diffuse rash); high amounts of circulating HIV
acute
if HIV is Left untreated, a diagnosis of AIDS is made about ____ years after initial HIV infection
10
badly damage immune system, opportunistic infection, survive 3 years, fever, chills, night sweats, swollen lymph nodes, weight loss, CD4 below 200 or develop infections/cancer/wasting syndrome. high viral load and very infectious
AIDS
what HIV phase is this? diagnosed when (1) CD4+ T-cell counts < 200 cells/uL; (2) opportunistic infection occurs; (3) opportunistic cancer occurs; (4) wasting syndrome (loss of 10% or more of body mass)
AIDS
meds that delay disease progression by decreasing viral replication; drugs from different classes used in combination therapy to prevent drug resistance (normally 3 or more)
ART
A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/μL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.
a
A patient has acquired immunodeficiency syndrome (AIDS) and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? The patient has the virus present and can transmit the infection to others. The patient is not able to transmit the virus to others through sexual contact. The patient will be prescribed lower doses of antiretroviral medications for 2 months. The syndrome has been cured, and the patient will be able to discontinue all medications.
a
2 lab tests for monitoring HIV progression:
CD4 viral load
HIV positive Treatment - Drug Therapy main goal is to increase ___ and decrease ____
CD4 count viral load
Immune dysfunction in HIV infection is caused by damage and destruction of______ cells
CD4+ T
HIV is an _____ virus - replicates by using its _____ as a template to produce ______, which is then integrated into the human genome
RNA RNA DNA
An older adult patient is brought to the primary health care provider by an adult child reporting confusion. What testing should the nurse anticipate obtaining from this patient? Urinalysis Sputum culture Red blood cell count White blood cell count
a
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay
a
The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. V aricella zoster immune globulin
abc
What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection (select all that apply.)? Select all that apply. Wash hands frequently. Take antibiotics as prescribed. Take the antibiotic until it is gone. Take antibiotics to prevent illnesses like colds. Save leftover antibiotics to take if needed later.
abc
Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome(AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is highand the viral load is low
abc
Emerging and reemerging infections affect health care by (select all that apply) a. reevaluating vaccine practices. b. revealing antimicrobial resistance. c. limiting antibiotics to those with life-threatening infection. d. challenging researchers to discover new antimicrobial therapies.
abd
The nurse plans a presentation for community members about how to decrease the risk for antibiotic- resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.
abe
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)
b
The patient is diagnosed with vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to others? Droplet precautions Contact precautions Airborne precautions Standard precautions
b
According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection
bc
A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.
c
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients. c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions
c
The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a patient with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications are effective? Increased viral load Decreased neutrophil count Increased CD4+ T cell count Decreased white blood cell count
c
Which types(s) of isolation precautions is (are) appropriate for a patient with tuberculosis (select all that apply)? a. contact precautions b. droplet precautions c. airborne precautions d. standard precautions e. neutropenic precautions
cd
A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What should the nurse include when teaching about preexposure prophylaxis (select all that apply.)? Select all that apply. Take fluconazole (Diflucan). Take amphotericin B (Fungizone). Use condoms for risk-reducing sexual relations. Take emtricitabine and tenofovir (Truvada) regularly. Have regular HIV testing for herself and her husband.
cde
#1 treatment is _____ on prevention of spreading the virus or acquiring it.
education
Infections disease that has recently increased in incidence or that threatens to increase in the immediate future - Ebola, Zika, etc
emerging infections
Acute HIV infection stage
first stage of HIV infection, occurs right after a person is infected when the virus quickly replicates and kills immune cells - causes fever, vomiting very high viral load highly infectious, but may not know they have HIV
Immune dysfunction is caused by damage and destruction of CD4+ T-cells > 500 CD4+ T-cells = ______ < 500 CD4+ T-cells =_______ < 200 CD4+ T-cells = ______
healthy immune problems severe problems
CD4 count normal
is 800-1200
Clinical latency of HIV
HIV = active but reproduces at low levels, may not get sick, can last a long time, ART to tx, ppl can still transmit in this stage, ppl on ART can decrease chances, viral load increase CD4 decreases
PeP
HIV post exposure prophylaxis
PrEP
HIV preventative treatment
HIV tests are typically performed on _____ or oral fluid. They may also be performed on urine
blood
A patient who is infected with human immunodeficiency virus (HIV) is being taught by the nurse about health promotion activities such as good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? Delaying disease progression Preventing disease transmission Helping to cure the HIV infection Enabling an increase in self-care activities
a
When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? "I will need to isolate any tissues I use so as not to infect my family." "I will notify all of my sexual partners so they can get tested for HIV." "Unprotected sexual contact is the most common mode of transmission." "I do not need to worry about spreading this virus to others by sweating at the gym."
a
Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation
a
What HIV phase is this? the interval between untreated HIV infection and a diagnosis of AIDS - approximately 10 years; although called asymptomatic, symptoms often occur (fatigue, HA, low-grade fever, night sweats)
asymptomatic phase
A nurse was accidently stuck with a needle used on a patient who is infected with human immunodeficiency virus (HIV). After reporting the incident, what care should this nurse first receive? Personal protective equipment Combination antiretroviral therapy Counseling to report blood exposures A negative evaluation by the manager
b
A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? There is currently no need for those older vaccines. There is a reemergence of some of the infections, such as pertussis. There is no longer an immunization available for some of those diseases. The only way to protect your child is to have the federally required vaccines.
b
A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. Avoid sexual intercourse when using injectable drugs. b. It is important to participate in a needle-exchange program. c. You should ask those who share equipment to be tested for HIV. d. I recommend cleaning drug injection equipment before each use.
b
The nurse is caring for a patient newly diagnosed with Acquired Immunodeficiency Syndrome (AIDS). What does the nurse explain to the patient the criteria for diagnosis is based on? Presence of HIV antibodies CD4+ T cell count below 200/μL Presence of oral hairy leukoplakia White blood cell count below 5000/μL
b
The nurse is teaching a group of young adults who live in a dormitory about the prevention of antibiotic-resistant infections. What should be included in the teaching plan? Save leftover antibiotics for future uses. Hand washing can prevent many infections. Antibiotics are indicated for preventing most colds. Stop taking prescribed antibiotics when symptoms improve.
b
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
c
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
c
Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/L b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs
c
A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? Cough, diarrhea, headaches, blurred vision, muscle fatigue Night sweats, fatigue, fever, and persistent generalized lymphadenopathy Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea
d
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/L. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patients social support system c. Potential medication side effects d. Patients ability to comply with ART schedule
d
is PreP recommended to be the sole prevention method of HIV
no, should be used used in conjunction with other proven prevention interactions such as condoms, risk education counseling, and regular HIV testing
The major concern related to immune suppression is the development of _______ diseases
opportunistic
HIV negative treatment/nursing goals
patient education
Pathogen that wouldn't normally cause a disease process in persons with functioning immune systems
Opportunistic infection
A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.
c
What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. "Set up" a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that the side effects of the drugs are bad but that they go away after a while. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.
d
A negative result doesn't necessarily mean the patient does not have HIV t or f
t
• Chronic HIV infection (asymptomatic) - about _____ years if untreated/undiagnosed patients. Greatest risk for _____ because patients may not know their own HIV status
10 transmitting
when do flu-like symptoms occur when infected with HIV
2-4 weeks
PeP medication is started ASAP and treatment lasts for ___ weeks. This is not 100% effective
5
HIV Diagnostic Tools 3 tests
● nucleic acid tests (NAT) ● antigen/antibody tests ● antibody tests
The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patients blood glucose level is 142 mg/dL. b. The patient complains of feeling constantly tired. c. The patient is unable to state the side effects of the medications. d. The patient states, Sometimes I miss a dose of zidovudine (AZT).
d
High risk behaviors for HIV
unprotected sex, sharing needles, breast feeding
A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What rationale for taking more than one antiretroviral medication should the nurse give to the patient to improve compliance? Viral replication will be inhibited. They will decrease CD4+ T cell counts. It will prevent interaction with other drugs. More than one drug has a better chance of curing HIV.
a
Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking lamivudine (Epivir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact
a
he nurse teaches the staff ensuring that standard precautions should be used when providing care for which type of patient? All patients regardless of diagnosis Pediatric and gerontologic patients Patients who are immunocompromised Patients with a history of infectious diseases
a
What is the most common reason for PEP for healthcare workers
accidental needle sticks
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A new onset of polycythemia Presence of mononucleosis-like symptoms A sharp decrease in the patient's CD4+ count A sudden increase in the patient's WBC count
c
What HIV phase is this occurs as the CD4+ T-cell count drops to 200-500 cells/uL and the viral load increases; symptoms seen in earlier phases tend to become worse and other problems, including infections, lymphadenopathy, and nervous system manifestations, may occur; S/S: persistent fever, frequent night sweats, chronic diarrhea, recurrent HA, severe fatigue, Kaposi sarcoma
symptomatic phase
what pt education is there to give to HIV negative ppl
● Abstinence ● Condom Use ● Do not share needles ● Prophylaxis treatment
HIV stages
Stage 1: Acute HIV Infection Stage 2: Clinical latency (HIV inactivity or dormancy) Stage 3: Acquired Immunodeficiency Syndrome (AIDS)
Who should take PreP
Those who are at risk such as those in same gender relationships or those who are in relationships with HIV+ person.
Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patients human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure
a
Components of AIDS diagnosis
● CD4 count drops below 200 ● Development of Opportunistic Infections ● Development of Opportunistic Cancers ● Wasting Syndrome
HIV treatment
•Monitor disease progression, immune function, and manage symptoms •Initiate and monitor ART •Prevent, detect and/or treat opportunistic infections •Prevent or decrease complications of therapies •Prevent further transmission of HIV
The nurse is providing postoperative care for a patient with human immunodeficiency virus (HIV) infection after an appendectomy. What type of precautions should the nurse observe to prevent the transmission of this disease? Droplet precautions Contact precautions Airborne precautions Standard precautions
d
HIV S/S- Symptomatic infection
•Symptomatic Infection •CD4+ T cells decline closer to 200 cells/μL •Symptoms become worse •HIV advances to a more active stage
OPPERTUNISTIC INFECTIONS WITH AIDS exs
● Pneumonia ● TB ● Candidiasis ● Cytomegalovirus ● Hepatitis ● Kaposi sarcoma ● Varicella ● Mycobacterium (several) ● Lymphoma
The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. c. d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis
d
Who should take PeP
Those who have been exposed to direct blood and body fluids of an individual suspected of having HIV. Used commonly in medical field when they endure a needlestick.
A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. The EIA test will need to be repeated to verify the results. b. A viral culture will be done to determine the progression of the disease. c. It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS). d. The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed.
a After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done.
Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breast feeding. d. sharing of drug-using equipment, including needles, syringes, pipes, andstraws. 4. During HIV infection a. reverse transcriptase helps HIV fuse with the CD4+ T cell. b. HIV RNA uses the CD4+ T cell's mitochondria to replicate. c. the immune system is impaired predominantly by the eventual wide spread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication
a c
A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, I am very nervous about making my baby sick. Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).
b
Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/L and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).
b
The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patients room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patients family members the reason for the use of airborne precautions.
b
Which statement(s) about metabolic side effects of ART is (are) true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients
bcd
A patient is admitted to the emergency department (ED) with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing actions will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply.)? Select all that apply. Assessment of lung sounds Assessment of sexual behavior Assessment of living conditions Assessment of drug and syringe use Assessment of exposure to an ill person
bd
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. The patient meets the criteria for a diagnosis of an acute HIV infection. b. The patient will be diagnosed with asymptomatic chronic HIV infection. c. The patient has developed acquired immunodeficiency syndrome (AIDS). d. The patient will develop symptomatic chronic HIV infection in less than a year.
c
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? "The baby will probably be infected with HIV." "Only an abortion will keep your baby from having HIV." "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
c
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, I feel obsessed with thoughts about dying. Do you think I am just being morbid? Which response by the nurse is best? a. Thinking about dying will not improve the course of AIDS. b. It is important to focus on the good things about your life now. c. Do you think that taking an antidepressant might be helpful to you? d. Can you tell me more about the kind of thoughts that you are having?
d
Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patients class schedule to help decide when the drugs should be taken.
d
Screening for HIV infection generally involves a. detecting CD8+ cytotoxic T cells in saliva. b. laboratory analysis of saliva to detect CD4+ T cells. c. analysis of lymph tissues for the presence of HIV RNA. d. laboratory analysis of blood to detect HIV antigen or antibody. 8. HIV antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease pain and symptoms in terminal disease. 9. Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.
d b c
HIV Signs/Symptoms acute phase
•Flulike symptoms •Fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, or a diffuse rash •Occurs about 2 to 4 weeks after infection •Highly infectious
HIV routes of transmission
● Sexual Transmission ● Contact with Blood and Blood products ● Perinatal Transmission blood, semen, vaginal secretions, and breast milk