Chapter 35: Caring for Clients with HIV/AIDS

The nurse's plan of care for a client with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to candidiasis. What nursing intervention best addresses this risk? a. Providing thorough oral care before and after meals b. Administering prophylactic antibiotics c. Promoting nutrition and adequate fluid intake d. Applying skin emollients as needed

a Thorough mouth care has the potential to prevent or limit the severity of this infection. Antibiotics are irrelevant because of the fungal etiology. The patient requires adequate food and fluids, but these do not necessarily prevent candidiasis. Skin emollients are not appropriate because candidiasis is usually oral.

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? a. Gay, bisexual, and other men who have sex with men b. Recreational drug users c. Blood transfusion recipients d. Health care providers

a Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 63% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.

A client will be starting on antiretroviral therapy, and is concerned about being able to afford the therapy. The nurse can inform the client that the largest source of public funding for HIV/AIDS care is: a. Medicaid. b. Medicare. c. Blue Cross/Blue Shield. d. AIDS Drug Assistance Program.

a Medicaid, a state-based medical assistance program for low-income clients, is the largest source of public funding for HIV/AIDS care. Medicare is for clients that are over age 65 years or disabled. Blue Cross/Blue Shield is a private insurance with a cap on coverage. AIDS Drug Assistance Program is the third largest source of funding for HIV in the United States for individuals who do not have health insurance that pays for drug therapy.

A has been diagnosed HIV positive. What will determine the initiation of antiretroviral drug therapy? a. CD (T-cell) count less than 350/mm b. CD (T-cell) count greater than 350/mm c. positive ELISA test d. positive Western blot

a The current guideline is to initiate treatment if the client develops an AIDS-defining illness or has a CD T-cell count less than 350 cells/mm.

A client will be having a hysterectomy and wants her daughter to provide directed donor blood. What factor would eliminate her daughter from donating the blood? a. The daughter is 15 years of age. b. The daughter weighs 124 lb. c. The daughter is negative for HIV. d. The physician has been notified of the procedure.

a The donor must be at least 17 years of age, weigh 110 lb. or more, and test negative for HIV; and the client's physician must be informed of the procedure.

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? a. Perianal region and oral mucosa b. Sacral region and lower abdomen c. Scalp and skin over the scapulae d. Axillae and upper thorax

a 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.

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? a. "The client probably has a case of the flu and you should give acetaminophen." b. "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." c. "This is one of the side effects from antiretroviral therapy and will require changing the medication." d. "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider."

b A fungal infection, Cryptococcus neoformans is another common opportunistic infection among clients with AIDS, and it causes neurologic disease. Cryptococcal meningitis is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.

Which blood test confirms the presence of antibodies to HIV? a. Erythrocyte sedimentation rate (ESR) b. p24 antigen c. Reverse transcriptase d. Enzyme immunoassay (EIA)

d EIA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. 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 nursing actions essential before an ELISA test is performed? a. Obtain a written consent from the client. b. Perform a Western blot test. c. Perform a polymerase chain reaction test. d. Provide the client with plenty of fluids.

a An ELISA or Western blot test helps determine whether there are sufficient HIV antibodies, and the results of the tests require strict confidentiality. Therefore, a written consent must be obtained before an ELISA is performed. The Western blot is performed if the results of the second ELISA test are positive. A polymerase chain reaction test, which measures viral loads, is used if diagnosis is confirmed as positive. While the comfort of the patient is essential, it is not necessary to provide additional fluids as it will have no implication on the test.

A client with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? a. Administer antidiarrheal medications on a scheduled basis, as prescribed. b. Encourage the client to eat three balanced meals and a snack at bedtime. c. Increase the client's oral fluid intake. d. Encourage the client to increase his or her activity level.

a 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.

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? a. Liquids b. Gluten c. Sucrose d. Iron and zinc

a The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? a. CD4+ counts b. HIV RNA c. Western blotting assay d. ELISA

a The most important consideration in decisions to initiate antiretroviral therapy is CD4+ counts.

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? a. Anorexia b. Chronic diarrhea c. Nausea and vomiting d. Oral candida

b 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 who has AIDS has been admitted for the treatment of Kaposi sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? a. Risk for Disuse Syndrome Related to Kaposi Sarcoma b. Impaired Skin Integrity Related to Kaposi Sarcoma c. Diarrhea Related to Kaposi Sarcoma d. Impaired Swallowing Related to Kaposi Sarcoma

b Kaposi sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.

When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? a. The body has not produced antibodies to the AIDS virus. b. The client has not been infected with HIV. c. The client is immune to the AIDS virus. d. Antibodies to the AIDS virus are in the client's blood.

a 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 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? a. "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." b. "Yes, since you are already infected, it won't make a difference if you have sex with a person who is HIV positive." c. "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." d. "If you have sex with another person who is HIV positive, you will develop AIDS sooner."

a 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 AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? a. Avoid fibrous foods, lactose, fat, and caffeine. b. Consume large, high-fat meals. c. Reduce food intake. d. Increase intake of iron and zinc.

a 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 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? a. HIV encephalopathy b. B-cell lymphoma c. Kaposi's sarcoma d. Wasting syndrome

a HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. The other listed complications do not normally have cognitive and behavioral manifestations.

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? a. The funding for the medications will cease if the client is not taking them correctly. b. The client is risking the development of drug resistance and drug failure. c. The client will have to take the drugs intravenously to ensure compliance.

b Clients who neglect to take antiretroviral drugs as prescribed risk development of drug resistance. When drug levels are not adequately maintained, viral replication and mutations increase. Funding will not cease for noncompliance. The medications are not all available in IV form.

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? a. 75 cells/mm3 of blood b. 200 cells/mm3 of blood c. 325 cells/mm3 of blood d. 450 cells/mm3 of blood

b When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? a. Bathing or hygiene self-care deficit b. Ineffective cerebral tissue perfusion c. Complicated grieving d. Risk for injury

d 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 client has come into contact with HIV. As a result, HIV glycoproteins have fused with the client's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? a. Integration b. Attachment c. Cleavage d. Budding

b During the process of attachment, glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors, which results in fusion of HIV with the CD4+ T-cell membrane. Integration, cleavage, and budding are steps that are subsequent to this initial phase of the HIV life cycle.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? a. Antibodies to HIV are not present in his blood. b. He has not been infected with HIV. c. He is immune to HIV. d. Antibodies to HIV are present in his blood.

a A negative test result indicates that antibodies to HIV 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 take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to HIV are detected in the blood, the test is interpreted as positive.

A patient with a recent diagnosis of HIV is soon to begin highly active antiretroviral treatment (HAART). When performing health education related to the patient's new medication regimen, the nurse should prioritize interventions relevant to which of the following nursing diagnoses? a. Ineffective adherence b. Delayed growth and development c. Risk for caregiver role strain d. Social isolation

a Adherence is vital to the success of HIV treatment. As such, interventions that maximize the patient's chance of close adherence to the prescribed regimen should be prioritized. The other listed psychosocial diagnoses may be relevant for many patients, but adherence is specific to the pharmacological treatment of HIV.

A client is in the primary infection stage of HIV. What is true of this client's current health status? a. The client's HIV antibodies are successfully, but temporarily, killing the virus. b. The client is infected with HIV but lacks HIV-specific antibodies. c. The client's risk for opportunistic infections is at its peak. d. The client may or may not develop long-standing HIV infection.

b The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection. The virus is not being eradicated and infection is certain. Opportunistic infections emerge much later in the course of the disease.

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? a. Assess the client for additional signs and symptoms of Kaposi sarcoma. b. Review the client's most recent viral load and CD4+ count. c. Place the client on respiratory isolation and inform the physician. d. Perform oral suctioning to reduce the client's risk for aspiration.

c These signs and symptoms are suggestive of tuberculosis, not Kaposi sarcoma; prompt assessment and treatment is necessary. There is no indication of a need for oral suctioning and the client's blood work will not reflect the onset of this opportunistic infection.

A client who is HIV/AIDS positive has orders for laboratory tests to be performed. What precautions should the nurse observe whenever there is a risk of exposure to the blood and body fluids of an infected client? a. Avoid any physical contact with the client. b. Avoid cleaning up spilled urine and feces. c. Wear barrier garments for as long as possible after leaving a client's room. d. Transport the specimens of body fluids in leak-proof containers.

d Whenever there is a risk of exposure to the blood and body fluids of an infected client, the nurse should transport these specimens in leak-proof containers. The nurse need not avoid physical contact with the client or cleaning the client's urine or stools. On the other hand, the nurse can use utility gloves and barrier garments, such as face shields and glasses. These objects should be removed, cleaned, and disinfected soon after leaving a client's room.

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? a. CD count <200/mm b. CD count >200/mm c. CD count <100/mm d. CD count >100/mm

a 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.

Which microorganism is known to cause retinitis in people with HIV/AIDS? a. Cytomegalovirus b. Cryptococcus neoformans c. Mycobacterium avium d. Pneumocystis carinii

a Cytomegalovirus is a species-specific herpes virus. C. neoformans is a fungus that causes an opportunistic infection in clients with HIV/AIDS. M. avium is an acid-fast bacillus that commonly causes a respiratory illness. P. carinii is an organism that is thought to be protozoan, but believed to be a fungus based on its structure.

What test will the nurse assess to determine the client's response to antiretroviral therapy? a. Western blotting b. Viral load c. Enzyme immunoassay d. Complete blood count

b 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.

The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurence) in persons with AIDS? a. Cytomegalovirus b. Legionnaire's disease c. Mycobacterium tuberculosis d. Pneumocystis pneumonia

d Pneumocystic pneumonia (PCP) is one of the first and most common opportunistic infections associated with AIDS. It may be present despite the absence of crackles. If untreated, PCP progresses to cause significant pulmonary impairment and respiratory failure.

A client is administered foscarnet to treat a case of cytomegalovirus (CMV) retinitis. Which adverse effect should the nurse closely monitor in this client? a. Electrolyte imbalances b. Hypotension c. Peripheral neuropathy d. Anemia

a Alterations in renal function, fever, nausea, electrolyte imbalances, and diarrhea are the most common adverse effects of foscarnet and should be closely monitored. The drug does not cause hypotension. On the other hand, peripheral neuropathy is an adverse effect of administering drugs such as didanosine and zalcitabine. Anemia is an adverse effect of administering zidovudine.

The period from infection with HIV to the development of antibodies to HIV is known as which of the following? a. Primary infection b. Viral load c. Viral set point d. Anergy

a Primary infection is the period from the infection with HIV to the development of antibodies to HIV. The viral load test measures plasma HIV RNA levels. Viral set point is the balance between the amount of HIV in the body and the immune response. Anergy is the absence of an immune response.

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? a. 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. b. Viral load and T4-cell counts will be performed every 2 to 3 months. c. More antiretroviral medication will be added every 2 to 3 months. d. The Western blot test will be monitored every 6 months to see if the virus is still present.

b 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 patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? a. 1 mm3 to 10 mm3 b. 10 mm3 to 20 mm3 c. 20 mm3 to 45 mm3 d. 50 mm3 to 150 mm3

d An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

A client who recently had sexual contact with a partner who is HIV+ has developed flulike symptoms such as a low grade fever, headache, and muscle pain. What does the nurse suspect this client is experiencing? a. pneumocystis pneumonia b. influenza c. AIDS d. acute retroviral syndrome

d At the time of primary HIV infection, one third to more than one half of those infected develop acute retroviral syndrome, also called acute HIV syndrome, which often is mistaken for flu or some other common illness. Some manifestations include fever; swollen and tender lymph nodes; pharyngitis; rash about the face, trunk, palms, and soles; muscle and joint pain; headache; nausea and vomiting; and diarrhea. In addition, there may be enlargement of the liver and spleen, weight loss, and neurologic symptoms such as visual changes or cognitive and motor involvement. It is too soon after exposure for the client to develop Pneumocystis pneumonia or AIDS.

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm? a. Primary infection (acute HIV infection or acute HIV syndrome) b. CDC category B: HIV symptomatic c. CDC category C: AIDS d. CDC category A: HIV asymptomatic

d More than 500 CD4+ T lymphocytes/mm3 indicates CDC category A: HIV asymptomatic. The period from infection with HIV to the development of antibodies to HIV is known as primary infection, and 200 to 499 CD4+ T lymphocytes/mm3 indicates CDC category B: HIV symptomatic. Less than 200 CD4+ T lymphocytes/mm3 indicates CDC category C: AIDS.

A client comes to the clinic to obtain HIV test results. The physician states that the client has a CD4 cell count of 300 cells/mm3 and a high viral load. What will the physician discuss with the client? a. follow-up testing to determine whether therapy is warranted at this time. b. initiation of antibiotic therapy to prevent the development of an opportunistic infection c. administration of an antifungal medication to prevent the development of an opportunistic fungal infection d. initiation of antiretroviral therapy

d The current guideline is to initiate treatment regardless of the disease stage or CD4 T-cell count.

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? a. Teach the client guided imagery. b. Give the client more control of her antiretroviral regimen. c. Increase the client's activity level. d. Collaborate with the client's physician to obtain an order for hydromorphone.

a 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 is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? a. TMP-SMZ b. Cephalexin c. Azithromycin d. Garamycin

a TMP-SMZ (Bactrim, Cotrim, Septra) is the treatment of choice for PCP; it is as effective as parenteral pentamidine isethionate (Pentacarinat) and more effective than other regimens.

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? a. Pleural b. Sweat c. Amniotic d. Symovial

b Sweat is the one body excretion that does not require skin and mucous membrane protection. However, it is recommended that Standard Precautions be used for all tissues. Refer to Box 37-3 in the text.

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. The client will be retested for HIV in 6 weeks and in 3 months b. Antiretroviral therapy will begin within 3 months c. A follow-up test will be promptly performed to confirm the result d. The client will be monitored for signs and symptoms of HIV infection to determine if treatment is necessary

c Follow-up testing is performed if the initial test result is positive to ensure a correct diagnosis.

A patient is being tested for HIV using enzyme immunoassay (EIA). The EIA shows antibodies. The nurse expects the health care provider to order what test to confirm the EIA test results? a. Another EIA test b. Viral load test c. Western blot test d. CD4:CD8 ratio

c The Western blot test detects antibodies to HIV and is used to confirm EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4:CD8 ratio test evaluates the ratio of CD4 to CD8 cells. HIV kills CD4 cells, which results in an impaired immune system, and this test is used to assess the immune system.

Which of the following indicates that a client with HIV has developed AIDS? a. Severe fatigue at night b. Pain on standing and walking c. Weight loss of 10 lb over 3 months d. Herpes simplex ulcer persisting for 2 months

d 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.

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? a. "There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV." b. "Your physician is likely the best one to ask that question." c. "If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now." d. "It's possible that your baby could contract HIV, either before, during, or after delivery."

d Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding. There is no evidence that the infant's risk is 25%. Deferral to the physician is not a substitute for responding appropriately to the client's concern. Downplaying the client's concerns is inappropriate.

The nurse teaches the client that reducing the viral load will have what effect? a. Shorter time to AIDS diagnosis b. Longer survival c. Shorter survival d. Longer immunity

b The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? a. Active substance abuse b. Depression c. Past substance abuse d. Lack of social support

c Factors associated with nonadherence include active substance abuse, depression, and lack of social support, as well as neurocognitive impairment, low health literacy, stressful life events, high levels of alcohol consumption, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? a. "You should take the drug with an antacid." b. "It doesn't matter if you take this drug with or without food." c. "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." d. "When you take this drug, eat a high-fat meal immediately afterwards."

c 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.

A client is infected with human immunodeficiency virus (HIV) after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection? a. 1 to 2 weeks b. 3 to 6 weeks c. 3 to 12 weeks d. 6 to 18 weeks

c When a person is infected with HIV, the immune system responds by producing antibodies against the virus, usually within 3 to 12 weeks after infection.

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? a. Arrange for a portable x-ray machine to be used. b. Have the client wear a mask to the x-ray department. c. Ensure that the radiology department has been disinfected prior to the test. d. Send the client to the x-ray department, and have the staff in the department wear masks.

a A client who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the client's room. This confers more protection than disinfecting the radiology department or using masks.

Which diagnostic test measures HIV RNA in the plasma? a. Viral load b. Enzyme immunoassay c. Enzyme-linked immunoassay d. Western blotting assay

a A viral load test measures the quantity of HIV RNA in the blood. Enzyme immunoassay (EIA) is a blood test that can determine the presence of antibodies to HIV in the blood or saliva; it is also referred to as an enzyme-linked immunosorbant assay (ELISA). A Western blotting assay is a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test.

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? a. The client has converted from HIV infection to AIDS. b. The client has advanced HIV infection. c. The client's T4-cell count has decreased due to the pneumocystis pneumonia. d. The client has another infection present that is causing a decrease in the T4-cell count.

a 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 1200/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.

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: a. is pregnant. b. has aches and pains. c. has the money for treatment. d. None of the options is correct.

a Antiretroviral drug therapy is warranted in infected pregnant women, in clients with HIV-associated renal disease, and in clients coinfected with hepatitis B.

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? a. "I understand what you mean, you can never be sure if the blood is tainted." b. "I understand your concern. The blood is screened very carefully for different viruses as well as HIV." c. "If you don't have the blood transfusions, you may not make it through this episode of bleeding." d. "No one has gotten HIV from blood in a long time. You have to have the transfusion."

a 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.

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? a. diarrhea and abdominal pain b. numbness in the extremities and decreased cognition c. alterations in renal function d. pancreatitis

a Common adverse effects associated with the administration of zidovudine and other NRTIs include nausea, abdominal pain and diarrhea. The drug does not cause nephropathy, decreased cognition, or pancreatitis.

A client with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? a. Utilize a pressure-reducing mattress. b. Limit the patient's physical activity. c. Apply antibiotic ointment to dependent skin surfaces. d. Avoid contact with synthetic fabrics.

a Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown. Activity should be promoted, not limited, and contact with synthetic fabrics does not necessary threaten skin integrity. Antibiotic ointments are not normally used unless there is a break in the skin surface.

A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions? a. Many older adults do not see themselves as being at risk for HIV infection. b. Many older adults are not aware of the difference between HIV and AIDS. c. Older adults tend to have more sex partners than younger adults. d. Older adults have the highest incidence of intravenous drug use.

a It is known that many older adults do not see themselves as being at risk for HIV infection. Knowledge of the relationship between HIV infection and AIDS is not known to affect the incidence of new cases. The statements about sex partners and IV drug use are untrue.

Which of the following is the first barrier method that can be controlled by the woman? a. Female condom b. IUD c. Diaphragm d. Birth control pills

a 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.

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? a. African-Americans b. Hispanics c. Asians d. No option is correct.

a The rate of HIV infection is 8 times higher in African Americans than in whites (Centers for Disease Control and Prevention [CDC], 2008).

A nurse is performing the admission assessment of a client who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. a. Current medication regimen b. Identification of client's support system c. Immune system function d. Genetic risk factors for HIV e. History of sexual practices

a, b, c, e Nursing assessment includes numerous focuses, including identification of medication use, support system, immune function, and sexual history. HIV does not have a genetic component.

A client is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? a. Promoting appropriate use of complementary therapies b. Addressing possible barriers to adherence c. Educating the client about the pathophysiology of HIV d. Teaching the client about the need for follow-up blood work

b ART is highly dependent on adherence to treatment, and the nurse should proactively address this. Blood work is necessary, but this will not have a direct bearing on the success or failure of treatment. Complementary therapies are appropriate, but are not the main factor in successful treatment. The client may or may not benefit from teaching about HIV pathophysiology.

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? a. Flush the wound site with chlorhexidine. b. Report to the emergency department or employee health department. c. Apply a hydrocolloid dressing to the wound site. d. Follow up with the nurse's primary care provider.

b After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility. Flushing is recommended, but chlorhexidine is not used for this purpose. Applying a dressing is not recommended. Following up with the nurse's own primary provider would require an unacceptable delay.

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? a. Deoxyribonucleic acid (DNA) b. Ribonucleic acid (RNA) c. Viral core d. Glycoprotein envelope

b 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.

The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick? a. Have the patient placed in restraints. b. Ask for assistance. c. Refuse to start the IV. d. Give the client a sedative prior to starting the IV.

b If a client is uncooperative, ask for assistance when starting IV therapy. Restraints can cause the client to become more agitated and less cooperative. Sedation can be considered chemical restraint and can have side effects that are undesirable. Refusing to start the IV will not allow the client to receive the care that is required.

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? a. Oral temperature of 37.2°C (99°F) b. Tachypnea and restlessness c. Frequent loose stools d. Weight loss of 0.45 kg (1 lb) since yesterday

b In prioritizing care, tachypnea and restlessness are symptoms of altered respiratory status and need immediate priority. Weight loss of 1 lb is probably fluid related; frequent loose stools would not take short-term precedence over a temperature or tachypnea and restlessness. An oral temperature of 37.2°C (99°F) is not considered a fever and would not be the first issue addressed.

A client with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? a. Appropriate use of prophylactic antibiotics b. Importance of personal hygiene c. Signs and symptoms of wasting syndrome d. Strategies for adjusting antiretroviral dosages

b Infection control is of high importance in clients living with HIV, thus personal hygiene is paramount. This is a more important topic than signs and symptoms of one specific complication (wasting syndrome). Drug dosages should never be independently adjusted. Prophylactic antibiotics are not normally prescribed unless the client's CD4+ count is below 50.

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? a. Sign a refusal of blood transfusion form so the client will not receive the transfusion. b. Bank autologous blood. c. Ask people to donate blood. d. Using volume expanders in case blood is needed.

b 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 diagnosis of HIV presents with pharyngitis, rash on the palms and soles of the feet, and diarrhea. The nurse suspects the client is suffering from: a. AIDS dementia complex (ADC). b. acute retroviral syndrome (ARS). c. distal sensory polyneuropathy (DSP). d. AIDS-related complex (ARC).

b Some manifestations of ARS include fever; swollen and tender lymph nodes; pharyngitis; rash about the face, trunk, palms, and soles; muscle and joint pain; headache; nausea and vomiting; and diarrhea. In addition, there may be enlargement of the liver and spleen, weight loss, and neurologic symptoms such as visual changes or cognitive and motor involvement. The scenario does not describe symptoms of ARC, DSP, or ADC.

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? a. Azithromycin b. Octreotide acetate c. Levofloxacin d. Clarithromycin

b Therapy with octreotide acetate, a synthetic analogue of somatostatin, has been shown to be effective in managing chronic severe diarrhea. The other listed medications are not used to treat chronic severe diarrhea.

A home care nurse is visiting a client with acquired immune deficiency syndrome (AIDS) at home. During the visit, the nurse observes the caregiver providing care. What action by the caregiver would alert the nurse to the need for additional teaching? a. Caregiver washes hands before and after providing care to the client. b. Caregiver cleans the client's anal area without wearing gloves c. Caregiver disposes of syringe and needle in a metal coffee can with lid. d. Caregiver uses a dilute bleach solution to clean up a urine spill.

b To prevent the risk of HIV transmission, standard precautions should be used. Cleaning the client's anal area without wearing gloves indicates that the nurse needs to reinstruct the caregiver in measures related to standard precautions. Handwashing before and after client care, disposing of sharps in a puncture-resistant container, and cleaning up spills with a dilute bleach solution are appropriate measures.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? a. means of transmission b. HIV-1 is more prevalent than HIV-2 subtypes c. the fact that it is a mutated virus originally thought to be bovine in nature d. cure rate

b 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.

A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention? a. Lifestyle actions that improve immune function b. Educational programs that focus on control and prevention c. Appropriate use of standard precautions d. Screening programs for youth and young adults

b Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not prevent HIV infection. Ineffective use of standard precautions applies to very few cases of HIV infection.

What intervention is a priority when treating a client with HIV/AIDS? a. Assessing neurologic status b. Monitoring skin integrity c. Assessing fluid and electrolyte balance d. Monitoring psychological status

c Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior? a. The nurse wears face protection, gloves, and a gown when irrigating a wound. b. The nurse performs hand hygiene with a waterless antiseptic agent after removing a pair of soiled gloves. c. The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. d. The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.

c Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same client. Each of the other listed actions adheres to standard precautions.

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient? a. Test for HIV without informing the patient. b. Test for HIV, requiring the patient to sign a permit. c. Inform the patient that it would be beneficial to test for HIV. d. Administer treatment for the STI and discharge the patient.

c HIV screening is recommended for all persons who seek evaluation and treatment for STIs. HIV testing must be voluntary and free of coercion. Patients must not be tested without their knowledge. HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health care settings. Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient.

A nurse is assesing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? a. Severe joint pain b. Lymphedema of the lower extremities c. Deep purple cutaneous lesions d. Venous stasis and phlebitis formation

c Localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of clients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

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? a. Psyllium b. Momordica charantia c. Megestrol d. Ranitidine

c 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 prevents ulcers.

When do most perinatal HIV infections occur? a. Through breastfeeding b. In utero c. After exposure during delivery d. Through casual contact

c Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery.

The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the client? a. "Would you like me to have the chaplain come speak with you?" b. "You'll learn much about the promise of a cure for HIV." c. "Can you tell me what concerns you most about dying?" d. "You need to maintain hope because you may live for several years."

c The nurse can help the client verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the client to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the client's expressed fears.

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? a. Less than 200/mm3 b. Between 200 to 350/mm3 c. Between 350 to 499/mm3 d. Greater than 500/mm3

d 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 aquired immunodeficiency syndrome (AIDS) when the CD4+ count is less than 200/mm3.

A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate? a. Position the client in the high Fowler position whenever possible. b. Temporarily eliminate animal protein from the client's diet. c. Make sure the client eats at least two servings of raw fruit each day. d. Obtain a stool culture to identify possible pathogens.

d 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.

Antiretroviral medications should be offered to clients with T-cell counts less than a. 50 cells/mm3. b. 150 cells/mm3. c. 250 cells/mm3. d. 350 cells/mm3.

d In general, antiretroviral medications should be offered to individuals with a T-cell count less than 350 cells/mm3 or plasma HIV RNA levels exceeding 100,000 copies/mL.

A client has come into the free clinic asking to be tested for HIV infection. The client asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? a. The client is immune to HIV. b. The client's immune system is intact. c. The client has AIDS-related complications. d. The client has been infected with HIV.

d Positive test results indicate that antibodies to the AIDS virus are present in the blood. The presence of antibodies does not imply an intact immune system or specific immunity to HIV. This finding does not indicate the presence of AIDS-related complications.

The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? a. Apply the condom prior to erection. b. A condom may be reused with the same partner if ejaculation has not occurred. c. Use skin lotion as a lubricant if alternatives are unavailable. d. Grasp the condom by the cuff after withdrawal.

d The condom should be unrolled over the hard penis before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, or cold cream should not be used with condoms because they cause latex deterioration/condom breakage. The condom should be held during withdrawal so it does not come off the penis. Condoms should never be reused.

A client has discussed therapy for HIV-positive status. The goal of antiretroviral therapy is to: a. reverse the HIV+ status to a negative status. b. treat mycobacterium avium complex. c. eliminate the risk of AIDS. d. keep the CD4 cell count above 350/mm3 and viral load undetectable.

d The goal of antiretroviral therapy is to keep the CD4 cell count above 350/mm3 and 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.