Chapter 35: Caring for Clients with HIV/AIDS
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?
CD count
A client was tested for HIV as part of a screening process and has just been told that the results were positive. What anticipatory guidance should the nurse provide to the client?
A follow-up test will be promptly performed to confirm the result
An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response?
"It's possible that your baby could contract HIV, either before, during, or after delivery."
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?
Bank autologous blood.
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:
Chronic diarrhea.
Which condition is an early manifestation of HIV encephalopathy?
Headache
While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?
Kaposi's sarcoma
The nurse care plan for a client with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care?
Keep the client's bed linens free of wrinkles.
A hospital educator is reiterating the importance of Standard Precautions to a group of nursing students who will soon begin a clinical rotation on the unit. Which of the following statements best describes the application of Standard Precautions?
Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status.
When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means?
The body has not produced antibodies to the AIDS virus.
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior?
The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure.
The lower the client's viral load,
the longer the survival time.
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?
trimethoprim-sulfamethoxazole
A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?
AIDS dementia complex (ADC)
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
CD4+ counts
A home care nurse is visiting a client with AIDS at home. During the visit, the nurse observes the caregiver providing care. Which of the following would alert the nurse to the need for additional teaching for the caregiver?
Caregiver cleans the client's anal area without wearing gloves
Which microorganism is known to cause retinitis in people with HIV/AIDS?
Cytomegalovirus
Which blood test confirms the presence of antibodies to HIV?
Enzyme-linked immunosorbent assay (ELISA)
A client who has AIDS has been admitted for the treatment of Kaposi sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS?
Impaired Skin Integrity Related to Kaposi Sarcoma
A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education?
Importance of personal hygiene
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?
Megestrol
A client with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this client should expect the health care provider to prescribe what medication for the management of the client's diarrhea?
Octreotide acetate
Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment?
Past substance abuse
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?
Perianal region and oral mucosa
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 containing the genetic viral material?
Ribonucleic acid (RNA)
A young mother of two has been diagnosed as being HIV positive. Her HIV specialist has started her on antiretroviral therapy without a CD (T-cell) count because she:
is pregnant.
A client has discussed therapy for HIV-positive status. The goal of antiretroviral therapy is to:
keep the CD4 cell count above 350/mm3 and viral load undetectable.
Traditionally, HIV infection has been a danger for specific population groups who engaged in risky behaviors. Recently, incidence has spread to groups who are not typically thought to be in danger of contracting HIV. Which population group in the United States has HIV infection rates eight times higher than whites?
African-Americans
Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?
Primary infection
A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission?
Urine
The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action?
Place the client on respiratory isolation and inform the physician.
A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results?
Western blot test
A client requires a blood transfusion for anemia and is concerned about the risk of contracting acquired immune deficiency syndrome (AIDS). What is the best response by the nurse?
"The blood is screened very carefully; the risk is 1 in 2,000,000."
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?
200 cells/mm3 of blood
A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea?
Administer antidiarrheal medications on a scheduled basis, as prescribed.
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?
Avoid fibrous foods, lactose, fat, and caffeine.
Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV?
Gay, bisexual, and other men who have sex with men
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
Which of the following indicates that a client with HIV has developed AIDS?
Herpes simplex ulcer persisting for 2 months
As a result of a needlestick inury, a hospital nurse has experienced percutaneous exposure to the blood of a client who is HIV-positive. The nurse has informed the supervisor and identified the client. What action should the nurse take next?
Report to the emergency department or employee health department.
The nurse knows to follow the CDC's guidelines for Standard Precautions while caring for patients regardless of known or unknown infectious status. The nurse is aware that barrier protection is not necessary for which body fluid?
Sweat
A nurse is assessing a client with HIV who has been admitted with pneumonia. In assessing the client, which of the following observations takes immediate priority?
Tachypnea and restlessness
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 has been infected with HIV.
A client with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond?
"Many clients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks."
A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.)
-Active substance abuse -Depression -Lack of social support
A hospital client is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test?
Arrange for a portable x-ray machine to be used.
A clinic nurse is caring for a client admitted with 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 what complication?
HIV encephalopathy
A client on antiretroviral drug therapy admits to skipping medication doses, sometimes for days at a time. What can occur when medications are not taken as prescribed?
The client is risking the development of drug resistance and drug failure.
