Chapter 17: Concepts of Care for Patients with HIV Disease

A client with HIV-III is hospitalized and has weeping Kaposi sarcoma lesions. The nurse dresses them with sterile gauze. When changing these dressings, which action is most important for the nurse's safety? a. Adhering to Standard Precautions b. Assessing tolerance to dressing changes c. Performing hand hygiene before and after care d. Disposing of soiled dressings properly

ANS: A All of the actions are important, but due to the infectious nature of this illness, the nurse would ensure he or she is following Standard Precautions (and Transmission-Based Precautions when necessary) to avoid a potential exposure.

A nurse begins a job at a Veterans Administration Hospital and asks why so much emphasis is on HIV testing for the veterans. What reasons is this nurse given? (Select all that apply) A. Veterans have a high prevalence of substance abuse B. Many veterans may engage in high risk behaviors C. Many older veterans may not know their risks D. Everyone should know their HIV status E. Belief that the VA has tested then and would notify them if positive

ANS: A, B, C, D, E All options are correct for the veteran population. The nurse interacting with veteran would ensure they know about the HIV testing offered by the VA.

The nurse is educating a client with HIV -II and the partner on self-care measure to prevent infection when blood counts are low. What information does the nurse provide? (Select all that apply) A. Do not work in the garden or with houseplants B. Do not empty the kitty litter boxes C. Clean your toothbrush in the dishwasher daily D. Bathe daily using antimicrobial soap E. Avoid people who are sick and large crowds F. Make sure meat, fish, and eggs are cooked well

ANS: A, B, D, E, F Ways to avoid infection when immunocompromised include not working in the garden or with houseplants; not emptying litter boxes; running the toothbrush through the dishwasher at least weekly; bathing daily using antimicrobial soap; avoiding sick people and large crowds; and making sure meat, fish, and eggs are cooked well prior to eating them.

Which findings are AIDS-defining characteristics ? (Select All that Apply) A. CD4+ cell count less than 200/mm3 (0.2 x 10(9)/L) or less than 14 % B. Infection with P. jiroveci C. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) D. Presence of HIV wasting syndrome E. Taking antiretroviral medications F. Confusion, dementia, or memory loss

ANS: A, B, D, F A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 (0.2 109/L) or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as P. jiroveci and HIV wasting syndrome. Confusion, dementia, and memory loss are central nervous system indications. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.

The nurse is teaching a client about medications for HIV-II treatment. What drugs are paired with the correct information? (Select All that Apply) A. Abacavir: avoid fatty and fried foods B. Efavirenz: take 1 hour before or 2 hours after antacids C. Atazanavir: check pulse daily and report pulse greater than 100 beats/minute D. Dolutegravir: do not take this medication if you become pregnant E. Enfuvirtide: teach client how to operate syringe infusion pump for administration F. All drugs: you must adhere to the drug schedule at least 90% of the time for effectiveness

ANS: A, B, F Abacavir is a nucleoside reverse transcriptase inhibitor and clients are taught to avoid fried and fatty foods because they can lead to digestive upsets and even pancreatitis. Efavirenz is a nonnucleoside reverse transcriptase inhibitor and clients are taught to take them (doraverene) all except spaced 1 hour before or 2 hours after antacids to avoid inhibiting drug absorption. Atazanavir is a protease inhibitor and can cause bradycardia which should be reported. Dolutegravir is an integrase inhibitor and can cause birth defects. Enfuvirtide is a fusion inhibitor and is given subcutaneously. All drugs must be taken as scheduled 90% of the time in order to remain effective.

A nurse is providing education about HIV risks at a health fair. What groups would the nurse include as needing to be tested for HIV on an annual basis? (Select all that apply) A. Anyone who received blood product in 1989 B. Couples planning on getting married C. Those who are sexually active with multiple partners D. Injection drugs users E. Sex workers and their customers F. Adults over the age of 65 years

ANS: B, C, D, E The CDC recommends that HIV testing would be performed on those who received a transfusion between 1978 and 1985 only. People planning on getting married should be tested and all sexually active people should know their HIV status. Those engaged in sex work and their customers should also be tested, as well as injection drug users. Those over the age of 65 years need a one-time screen.

A client with HIV-III has oral thrush and difficulty eating. What action does the nurse delegate to the assistive personnel (AP)? (Select all that apply) A. Apply oral anesthesia gels before meals B. Assist the client with oral care every 2 hours C. Offer the client frequent sips of cool drinks D. Provide the client with alcohol-based mouthwash E. Remind the client to use only a soft toothbrush F. Offer the client soft foods like gelatin or pudding

ANS: B, C, E, F The AP can help the client with oral care, offer fluids, and remind the client of things the nurse (or other professional) has already taught. Soft foods and liquids are tolerated better than harder foods. Applying medications is performed by the nurse. Alcohol-based mouthwashes are harsh and drying and would not be used.

A nurse is caring for a client with HIV-III who was admitted with HIV-associated neurocognitive disorder (HAND). What sign or symptom would be most important for the nurse to report to the primary health care provider? A. Nausea B. Change in pupil size C. Weeping open lesion D. Cough

B. Change in pupil size HIV-associated neurocognitive disorder (HAND) is a sign of neurologic involvement. The nurse would report any sign of increasing intracranial pressure immediately, including change in pupil size, level of consciousness, vital signs, or limb strength. The other signs and symptoms are not life threatening and would be documented and reported appropriately.

A client with HIV-III is admitted to the hospital with Toxoplasma gondii infection. Which action by the nurse is most appropriate? A. Initiate Contact Precautions B. Conduct frequent neurologic assessments C. Conduct frequent respiratory assessments D. Initiate Protective Precautions

B. Conduct frequent neurologic assessments Toxoplasma gondii infection is an opportunistic infection that causes an encephalitis but poses only a rare threat to immunocompetent individuals The nurse would perform ongoing neurologic assessments. Contact and Protective Precautions are not needed. Good respiratory assessments are important to the client, but toxoplasmosis will demonstrate neurologic signs and symptoms.