CH 35 Clients with HIV/Aids
A nurse is working with a client who was diagnosed with HIV several months earlier. This client will be considered to have AIDS when the CD4+ T-lymphocyte cell count drops below what threshold? 1) 200 cells/mm3 of blood 2) 75 cells/mm3 of blood 3) 450 cells/mm3 of blood 4) 325 cells/mm3 of blood
200 cells/mm3 of blood Explanation: When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS.
A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? 1) "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." 2) "When you take this drug, eat a high-fat meal immediately afterwards." 3) "It doesn't matter if you take this drug with or without food." 4) "You should take the drug with an antacid."
"Be sure to take this drug about 1/2 hour before or 2 hours after you eat." Explanation: Didanosine (Videx) should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.
The nurse teaches the client that reducing the viral load will have what effect? 1) Shorter time to AIDS diagnosis 2) Shorter survival 3) Longer survival 4) Longer immunity
Longer survival Explanation: The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.
A client with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? 1) "You'll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach." 2) "Researchers have not looked at the benefits of alternative therapy for clients with HIV, so we suggest that you stay away from these therapies until there is solid research data available." 3) "Many clients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks." 4) "Complementary therapies generally have not been approved, so clients are usually discouraged from using them."
"Many clients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks." Explanation: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.
An 18-year-old client who is pregnant has tested positive for human immunodeficiency virus (HIV) and asks the nurse if her baby is going to be born with HIV. Which response by the nurse is the best? 1) "Your baby could contract HIV before, during, or after delivery." 2) "If the baby is HIV-positive, we can't do anything until after the birth, so try not to worry." 3) "Your baby has a one in four chance of being born with HIV." 4) "Your health care provider is likely the best one to answer that question."
"Your baby could contract HIV before, during, or after delivery." Explanation: Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breastfeeding. There is no evidence that the infant's risk is 25%. Deferral to the health care provider is not a substitute for responding appropriately to the client's concern. Downplaying the client's concerns is inappropriate.
A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? 1) Encourage the client to increase his or her activity level. 2) Encourage the client to eat three balanced meals and a snack at bedtime. 3) Increase the client's oral fluid intake. 4) Administer antidiarrheal medications on a scheduled basis, as prescribed.
Administer antidiarrheal medications on a scheduled basis, as prescribed. Explanation: Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the client's diarrhea is not caused by an infectious microorganism. Increased oral fluid may exacerbate diarrhea; IV fluid replacement is often indicated. Small, more frequent meals may be beneficial, and it is unrealistic to increase activity while the client has frequent diarrhea.
A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? 1) Consume large, high-fat meals. 2) Increase intake of iron and zinc. 3) Avoid fibrous foods, lactose, fat, and caffeine. 4) Reduce food intake.
Avoid fibrous foods, lactose, fat, and caffeine. Explanation: Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? 1) Ask people to donate blood. 2) Sign a refusal of blood transfusion form so the client will not receive the transfusion. 3) Using volume expanders in case blood is needed. 4) Bank autologous blood.
Bank autologous blood. Explanation: Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Banking autologous blood that is self-donated is the safest option for the client. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
A client with a history of IV drug use is HIV-positive. The client has been following an antiretroviral medication regimen faithfully and is doing well, attending college to get a social work degree, and focused on a bright future. In regular CD counts, what factor will indicate that this client has progressed from HIV to AIDS? 1) CD count <100/mm 2) CD count >100/mm 3) CD count <200/mm 4) CD count >200/mm
CD count <200/mm Explanation: A CD (T-cell) count of less than 500/mm indicates immune suppression; a CD (T-cell) count of 200/mm or less is an indicator of AIDS.
The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: 1) Nausea and vomiting. 2) Oral candida. 3) Anorexia. 4) Chronic diarrhea
Chronic diarrhea Explanation: Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.
Other than abstinence, what is the only proven method of decreasing the risk of sexual transmission of HIV infection? 1) Spermicides 2) Consistent and correct use of condoms 3) Birth control pills 4) Vaginal lubricants
Consistent and correct use of condoms Explanation: Other than abstinence, consistent and correct use of condoms is the only method proven to decrease the risk for sexual transmission of HIV infection. Vaginal lubricants, birth control pills, and spermicides are not proven means of decreasing the risk for sexual transmission of HIV infection.
The nurse is performing an admission assessment on a patient with AIDS. When assessing the patient's gastrointestinal (GI) system what is most likely to be the priority nursing diagnosis? 1) Diarrhea 2) Bowel incontinence 3) Imbalanced nutrition: more than body requirements 4) Constipation
Diarrhea Explanation: Diarrhea is a problem in 50% to 90% of all AIDS patients. In patients with AIDS, the effects of diarrhea can be devastating in terms of profound weight loss, fluid and electrolyte imbalances, perianal skin excoriation, weakness, and the inability to perform self-care activities. Although the patient may experience bowel incontinence related to the diarrhea, the priority GI-related nursing diagnosis for more than 50% of patients with AIDS is diarrhea
A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's: 1) Electrolyte levels 2) White blood cell (WBC) count 3) Oral mucus membranes 4) Abdominal girth
Electrolyte levels Explanation: Electrolyte imbalances, such as decreased serum sodium, potassium, calcium, magnesium, and chloride, typically result from profuse diarrhea. This problem does not affect the patient's abdominal girth or mucus membranes. WBC levels are not directly related to the development or complications of diarrhea
Which blood test confirms the presence of antibodies to HIV? 1) p24 antigen 2) Reverse transcriptase 3) Enzyme-linked immunosorbent assay (ELISA) 4) Erythrocyte sedimentation rate (ESR)
Enzyme-linked immunosorbent assay (ELISA) Explanation: ELISA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. The p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA
Which of the following is the first barrier method that can be controlled by the woman? 1) Birth control pills 2) Diaphragm 3) IUD 4) Female condom
Female condom Explanation: The female condom has the distinction of being the first barrier method that can be controlled by the woman. The IUD may increase the risk for HIV transmission through an inflammatory foreign body response. The female condom is as effective in preventing pregnancy as other barrier methods, such as the diaphragm and the male condom. Birth control pills are not a barrier method.
A nurse is teaching a health education class to a group of young adults and perceives that misinformation exists about the signs, symptoms, and trajectory of HIV infection. The nurse should inform participants that the first symptoms of HIV exposure include: 1) Fever, headache, and malaise 2) Pneumonia-like symptoms and increased sputum production 3) Painful lesions on the vulva or the shaft of the penis 4) Rapid weight loss and anorexia
Fever, headache, and malaise Explanation: About 3 weeks into the acute phase of HIV infection, the person may display symptoms similar to mononucleosis, such as fever, enlarged lymph nodes, rash, muscle aches, and headaches. Respiratory symptoms and weight loss do not appear at this early stage of infection. HIV does not cause genital lesions.
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? 1) cure rate 2) HIV-1 is more prevalent than HIV-2 subtypes 3) the fact that it is a mutated virus originally thought to be bovine in nature 4) means of transmission
HIV-1 is more prevalent than HIV-2 subtypes Explanation: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS; hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.
Which of the following indicates that a client with HIV has developed AIDS? 1) Herpes simplex ulcer persisting for 2 months 2) Severe fatigue at night 3) Weight loss of 10 lb over 3 months 4) Pain on standing and walking
Herpes simplex ulcer persisting for 2 months Explanation: A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.
The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, which instruction should the nurse give the attendees? 1) A condom may be reused with the same partner if ejaculation has not occurred. 2) Apply the condom prior to erection. 3) Use skin lotion as a lubricant if alternatives are unavailable. 4) Hold the condom during withdrawal so it doesn't come off.
Hold the condom during withdrawal so it doesn't come off Explanation: The condom should be held during withdrawal so it does not come off the penis. The condom should be unrolled over the hard penis, not prior to erection, before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, and cold cream should not be used with condoms because they cause latex deterioration/condom breakage. Condoms should never be reused.
A clinic nurse is caring for a client admitted with acquired immunodeficiency syndrome (AIDS). The nurse has assessed that the client is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of which complication? 1) Human immunodeficiency virus (HIV) encephalopathy 2) Kaposi sarcoma 3) Wasting syndrome 4) B-cell lymphoma
Human immunodeficiency virus (HIV) encephalopathy Explanation: HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. B-cell lymphoma is a type of non-Hodgkin lymphoma, and fatigue and weight loss are some typical signs and symptoms. Kaposi sarcoma is a malignancy that impacts clients with HIV/AIDS and involves epithelial layers of blood and lymphatic vessels. Lesions on the skin and lymphedema can cause pain and infections. Wasting syndrome is related to HIV/AIDS and involves involuntary loss of 10% of total weight with diarrhea and fevers. None of the other listed complications normally have cognitive and behavioral manifestations.
A client who has acquired immunodeficiency syndrome (AIDS) has been admitted for the treatment of Kaposi sarcoma. Which nursing diagnosis should the nurse associate with this complication of AIDS? 1) Impaired swallowing related to Kaposi sarcoma 2) Impaired skin integrity related to Kaposi sarcoma 3) Risk for disuse syndrome related to Kaposi sarcoma 4) Diarrhea related to Kaposi sarcoma
Impaired skin integrity related to Kaposi sarcoma Explanation: Kaposi sarcoma is a type of cancer caused by human herpesvirus-8 that involves the epithelial layer of blood and lymphatic vessels. It exhibits a variable and aggressive course, ranging from localized cutaneous lesions to disseminated disease involving multiple organ systems. Cutaneous signs, which may be the first manifestation of HIV, can appear anywhere on the body and are usually brownish pink to deep purple. They may be flat or raised and surrounded by ecchymosis (hemorrhagic patches) and edema. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.
A nurse is planning the care of a client with acquired immunodeficiency syndrome (AIDS) who is admitted to the unit with Pneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this client? 1) Ineffective airway clearance 2) Impaired oral mucous membranes 3) Imbalanced nutrition: Less than body requirements 4) Activity intolerance
Ineffective airway clearance Explanation: Although all these nursing diagnoses are appropriate for a client with AIDS, Ineffective Airway Clearance is the priority nursing diagnosis for the client with PCP. Airway and breathing take top priority over the other listed concerns because of the immediacy of the health consequences.
Since the emergence of the human immunodeficiency virus (HIV), there have been significant changes in epidemiologic trends. At present, members of which group are most affected by new cases of HIV? 1) People 25 to 29 years of age 2) Male-to-male sexual contact with injection drug use 3) Male-to-male sexual contact 4) Heterosexual contact
Male-to-male sexual contact Explanation: In the United States from 2012 to 2016, male-to-male sexual contact accounted for approximately 67% of new cases, male-to-male contact with injection use 3%, heterosexual contact 24%, and people 25 to 29 years of age 32.9%.
A client with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in clients with AIDS, by increasing body fat stores? 1) Psyllium 2) Megestrol 3) Ranitidine 4) Momordica charantia
Megestrol Explanation: Megestrol acetate, a synthetic oral progesterone preparation, promotes significant weight gain. In clients with HIV infection, it increases body weight primarily by increasing body fat stores. Psyllium is a fiber source. Momordica charantia (bitter melon) is given as an enema and is part of alternative treatment for HIV/AIDS. Ranitidine was previously used to prevent ulcers but was removed from the market in April 2020.
A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate? 1) Make sure the client eats at least two servings of raw fruit each day. 2) Obtain a stool culture to identify possible pathogens. 3) Temporarily eliminate animal protein from the client's diet. 4) Position the client in the high Fowler position whenever possible.
Obtain a stool culture to identify possible pathogens Explanation: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Clients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the bed.
A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? 1) Perianal region and oral mucosa 2) Scalp and skin over the scapulae 3) Axillae and upper thorax 4) Sacral region and lower abdomen
Perianal region and oral mucosa Explanation: The nurse should inspect all the client's skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection.
During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? 1) Salmonella infection 2) Pneumocystis pneumonia 3) Clostridium difficile 4) Mycobacterium tuberculosis
Pneumocystis pneumonia Explanation: There are a number of opportunistic infections that can infect individuals with AIDS. The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly carinii). Other opportunistic infections may involve Salmonella, Mycobacterium tuberculosis, and Clostridium difficile.
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? 1) Viral core 2) Ribonucleic acid (RNA) 3) Glycoprotein envelope 4) Deoxyribonucleic acid (DNA)
Ribonucleic acid (RNA) Explanation: HIV is a retrovirus that carries its genetic material in the form of RNA rather than DNA. HIV consists of a viral core containing the viral RNA, surrounded by an envelope consisting of protruding glycoproteins.
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? 1) Bathing or hygiene self-care deficit 2) Complicated grieving 3) Risk for injury 4) Ineffective cerebral tissue perfusion
Risk for injury Explanation: In a client with AIDS, central nervous system (CNS) deterioration can lead to AIDS-related dementia. This type of dementia impairs cognition and judgment, placing the client at risk for injury. Although Bathing or hygiene self-care deficit and Complicated grieving may be relevant in AIDS, these diagnoses don't take precedence in a client with AIDS-related dementia. Because CNS deterioration results from infection, Ineffective cerebral tissue perfusion isn't applicable.
A nurse is providing ongoing care for a client who is positive for human immunodeficiency virus (HIV), and assessment reveals a client with a newly delayed and shortened speech pattern. The client, who previously had no neurological or motor deficits, has forgotten that they are in the hospital and has trouble getting out of bed. Which problem is the client most likely experiencing related to these signs and symptoms? 1) Subcortical neurodegenerative disease 2) Cytomegalovirus retinitis 3) Peripheral neuropathy 4) Cryptococcal meningitis
Subcortical neurodegenerative disease Explanation: Subcortical neurodegenerative disease is known as HIV-associated neurocognitive disorder (HAND). Signs can be subtle and include changes in language, memory, and problem solving, as well as slowing psychomotor skills. Early identification is important as HAND can be treated by changing antiretroviral medications. Cryptococcal meningitis is a form of subacute meningitis. Signs include fever, malaise, and headache. Retinitis caused by cytomegalovirus retinitis is the leading cause of blindness in clients with acquired immunodeficiency syndrome. Peripheral neuropathy is a common neurological symptom at any stage of HIV infection. Signs and symptoms are pain in the feet and functional impairment.
A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? 1) Collaborate with the client's physician to obtain an order for hydromorphone. 2) Give the client more control of her antiretroviral regimen. 3) Teach the client guided imagery. 4) Increase the client's activity level.
Teach the client guided imagery Explanation: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other clients this may exacerbate feelings of anxiety or loss. Granting the client control has the potential to reduce anxiety, but the client is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety
A client's antibody test for HIV showed no antibodies. For which reason would the client need to have a nucleic acid test completed before being told that testing for HIV is negative? 1) Two tests need to be done for every client 2) The antibody test for HIV is not sensitive 3) The client engages in high risk behavior 4) The client may be in stage 0 of the disease
The client may be in stage 0 of the disease Explanation: There are three types of HIV diagnostic tests: antibody tests, antigen/antibody tests, and nucleic acid (RNA) tests. Antibody tests detect antibodies, not HIV itself, while antigen and RNA tests directly detect HIV. The CDC recommends tests for HIV antigens and HIV nucleic acid because studies from high risk populations found that antibody testing alone might miss a considerable percentage of HIV infections detectable by virologic tests, especially during stage 0. The antibody test for HIV is sensitive and specific to antibodies but other tests should be performed for a definitive diagnosis. The client does not need an additional test because of engaging in high risk behavior. Two tests are not mandatory for every client.
What test will the nurse assess to determine the client's response to antiretroviral therapy? 1) Enzyme immunoassay 2) Complete blood count 3) Viral load 4) Western blotting
Viral load Explanation: Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART. The other tests are not used in this way.
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? 1) Viral load and T4-cell counts will be performed every 2 to 3 months. 2) The Western blot test will be monitored every 6 months to see if the virus is still present. 3) The client will be required to stop medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. 4) More antiretroviral medication will be added every 2 to 3 months.
Viral load and T4-cell counts will be performed every 2 to 3 months. Explanation: Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus
A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? 1) Western blot assay 2) Nucleic acid sequence-based amplification 3) p24 antigen capture assay 4) OraSure test
Western blot assay Explanation: A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. The OraSure test uses saliva to perform an EIA test. The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load and evaluate response to treatment. However, the reverse transcriptase-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based tests have replaced the p24 antigen test. The RT-PCR tests may be used to confirm a positive EIA result.
A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effects should the nurse closely monitor in the client? 1) emboli 2) dyspnea 3) numbness in extremities 4) hypotension
numbness in extremities Explanation: Alterations in renal function, fever, nausea, anemia, numbness in extremities, and diarrhea are the most common adverse effects of foscarnet and should be closely monitored.
The lower the client's viral load 1) the longer the time immunity. 2) the shorter the time to AIDS diagnosis. 3) the longer the survival time. 4) the shorter the survival time.
the longer the survival time. Explanation: The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretroviral therapy is to achieve and maintain durable viral suppression
A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? 1) amphotericin B 2) nystatin 3) trimethoprim-sulfamethoxazole 4) fluconazole
trimethoprim-sulfamethoxazole Explanation: To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.
