Chapter 56 Care of the Patient with HIV/AIDS

What does the nurse teach a patient about condom use to prevent sexually transmitted diseases? 1. "Use only natural-membrane condoms." 2. "Do not use oil-based lubricants for lubrication." 3. "Do not leave any space at the tip of the condom." 4. "Unroll the condom and place it on the erect penis."

"Do not use oil-based lubricants for lubrication." The nurse should teach patients not to use oil-based lubricants, such as petroleum jelly, for lubrication, because they can damage the condom. Water-based lubricants are safe to use. Latex or polyurethane condoms should be used rather than natural-membrane condoms, because they are more durable. The condom must be unrolled onto the erect penis by holding the tip of the condom, and space should be left at the tip to collect the semen.

The nurse is educating a patient with human immunodeficiency virus (HIV) on methods to reduce the risk of infection transmission. What should the nurse include in the teaching? Select all that apply. 1. "You should not share a razor." 2. "You should use a condom for safe sex." 3. "You should never donate blood to others." 4. "You can donate liver or kidneys if required." 5. "You can donate semen for artificial insemination."

"You should not share a razor." "You should use a condom for safe sex." "You should never donate blood to others." Patients should be encouraged to use a condom in order to practice safe sex and avoid the transmission of HIV. Patients with HIV should be instructed to not donate blood. Patients with HIV should be instructed not to share razors, as razors may contain blood and could spread the disease. HIV-infected patients should be instructed not to donate organs or semen for artificial insemination, as they are routes for passing on the infection on to others.

A pregnant woman with human immunodeficiency virus (HIV) requests information on ways to prevent transmission of the virus to her baby. The nurse should respond with which information? 1. "Zidovudine (azidothymidine or AZT) therapy can reduce vertical transmission to 2%." 2. "Zidovudine (azidothymidine or AZT) therapy can eliminate vertical transmission of the virus." 3. "Zidovudine (azidothymidine or AZT) can be used after the first trimester to reduce vertical transmission." 4. "Although zidovudine (azidothymidine or AZT) therapy is effective at reducing viral transmission, it causes serious birth defects.

"Zidovudine (azidothymidine or AZT) therapy can reduce vertical transmission to 2%." Zidovudine (azidothymidine or AZT) therapy administered to the mother can reduce vertical transmission to 2% without causing serious defects in the baby. It does not eliminate the transmission, but it drastically decreases it.

A nurse who is caring for a patient with human immunodeficiency virus (HIV) is splashed in the face and eyes with blood while inserting an intravenous (IV) line. The nurse immediately notifies occupational health and is told that the risk for contracting HIV is what percentage? 1. 9% 2. 3% 3. 0.3% 4. 0.09%

0.09% An individual who has infected blood or secretions come in contact with his or her mucous membranes has a 0.09% chance of contracting HIV. An injury from a needle contaminated with HIV-positive blood leads to a 0.3% chance of contracting HIV. The values 3% and 9% are not associated with contracting HIV.

The nurse is caring for a patient with acquired immune deficiency syndrome (AIDS). What opportunistic fungal infection would the nurse expect to observe in this patient? 1. Tuberculosis 2. Toxoplasmosis 3. Histoplasmosis 4. Cryptosporidiosis

Histoplasmosis. Histoplasmosis is an opportunistic fungal infection that can be observed in a patient with AIDS. Tuberculosis is an opportunistic bacterial infection that can be observed in a patient with AIDS; it is caused by Mycobacterium tuberculosis. Toxoplasmosis and cryptosporidiosis are opportunistic protozoal infections that can be observed in a patient with AIDS.

An adult patient comes to the clinic with white patches in the mouth that are diagnosed as oral thrush (candidiasis). The nurse knows this patient should be tested for which disease? 1. Hepatitis C virus (HCV) 2. Herpes simplex virus (HSV) 3. Haemophilus influenzae type B (HIB) 4. Human immunodeficiency virus (HIV)

Human immunodeficiency virus (HIV). Oral thrush is not an infection that occurs in patients with healthy immune systems. The patient should be tested for HIV. Testing for HSV, HIB, and HCV is not necessary.

Which factors have been linked to increased mortality and morbidity from human immunodeficiency virus (HIV)? 1. Higher socioeconomic status 2. Lack of access to adequate care 3. Receiving care in a hospital with extensive experience in caring for HIV-infected patients 4. Being treated by a primary health care provider with extensive experience in caring for HIV-infected patients

Lack of access to adequate care. The course of HIV disease varies from person to person and can be influenced by several factors. One factor that has been linked to increased mortality and morbidity from HIV is lack of access to adequate care. Other factors for increased mortality and morbidity from HIV are receiving care in a hospital that has little experience in caring for HIV-infected patients; being from a lower socioeconomic status; and receiving treatment from a primary health care provider who has had little experience in caring for HIV-infected patients.

A nurse is caring for a patient with advanced human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) who is experiencing wasting. The nurse anticipates the patient's body will exhibit which change? 1. Loss of muscle 2. Increase in fatty tissue 3. Decrease in bone density 4. Thinning of the dermis and epidermis

Loss of muscle. Wasting is the loss of lean muscle while fatty tissue is maintained. It is not an increase in fatty tissue, decrease in bone density, or thinning of the dermis and epidermis.

Which cells may inhibit leukocyte migration inhuman immunodeficiency virus (HIV)? 1. B cells 2. Mast cells 3. Neutrophils 4. Natural killer (NK) cells

Mast cells Mast cells may inhibit leukocyte migration in HIV. B cells are involved in the humoral response to HIV and produce a variety of antibodies against the virus. HIV affects neutrophils and causes neutropenia. HIV affects NK cells, making them functionally defective.

The nurse is caring for a patient who is on postexposure prophylaxis (PEP) regimen for human immunodeficiency virus (HIV). What side effects should the nurse monitor in the patient? Select all that apply. 1. Onset of pancreatitis 2. Onset of kidney stones 3. Onset of hypoglycemia 4. Onset of hyperglycemia 5. Onset of bile duct stones

Onset of pancreatitis Onset of kidney stones Onset of hyperglycemia Antiretroviral PEP regimen might prevent or inhibit systemic infection. The use of PEP regimens has been associated with the onset of pancreatitis, kidney stones, and hyperglycemia as a side effect. Hypoglycemia and bile duct stones are not reported in patients who are on postexposure prophylaxis (PEP) regimen for HIV.

A patient with advanced acquired immune deficiency syndrome (AIDS) requests information from the nurse regarding palliative care options. The nurse should respond with which information about palliative care? 1. Palliative care can hasten death. 2. Palliative care is only for patients with cancer. 3. Palliative care can improve the patient's life expectancy. 4. Palliative care can improve the quality of the patient's remaining time.

Palliative care can improve the quality of the patient's remaining time. The goal of palliative care is to improve the quality of the patient's remaining life. Palliative care does not hasten death or improve the patient's life expectancy and is not only for patients with cancer.

The nurse is conducting a study to compare the characteristics of the patients who have contracted zoonotic infections. Which patient should the nurse include in the study? 1. Patient with rabies infection 2. Patient with salmonella infection 3. Patient with enterococcal infection 4. Patient with streptococcal infection

Patient with rabies infection. A zoonotic organism is able to cross from an animal species to humans. Rabies is an infection that is usually acquired from infected dogs and cats and therefore it is a zoonotic infection. Enterococcal and salmonella infection are food borne infection. Streptococcal infection is usually an air borne infection.

A nurse is caring for a patient with human immunodeficiency virus (HIV) who will begin highly active antiretroviral therapy (HAART). The nurse anticipates administering medications from which class(es)? Select all that apply. 1. Fusion inhibitor 2. Protease inhibitor 3. Integrase Inhibitor 4. Nucleotide reverse transcriptase inhibitor (NRTI) 5. Non-nucleoside reverse transcriptase inhibitor (NNRTI)

Protease inhibitor Nucleotide reverse transcriptase inhibitor (NRTI) Non-nucleoside reverse transcriptase inhibitor (NNRTI) HAART includes a protease inhibitor and two NNRTIs or NRTIs. Fusion inhibitors and integrase inhibitors are also medications used to treat HIV, but they are not included in HAART.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which nursing intervention would help promote good nutrition in the patient? 1. Provide a high-protein diet. 2. Provide a high-residue diet. 3. Provide raw fruits in the diet. 4. Provide raw meats in the diet.

Provide a high-protein diet. A protein-rich diet helps develop the immune system and promote cell and tissue repair. Therefore, to promote good nutrition for patients with HIV, patients should be advised to consume a protein-rich diet. Patients should not be advised to follow a high-residue diet, as the digestive function is reduced. Patients should not consume raw fruits and meats, as these foods may cause food poisoning due to the patient's low immunity levels.

After observing the urine screening test reports of a patient, the primary health care provider (PHP) decides to perform another test to confirm the presence of human immunodeficiency virus (HIV). Which test would the nurse expect the PHP to prescribe for this patient? 1. Radioimmunoprecipitation assay (RIPA) 2. Agglutination assay of the blood specimen 3. Western blotting technique for antibodies 4. Oral fluid test (swabbing of the cheek and gum)

Radioimmunoprecipitation assay (RIPA) RIPA is the confirmatory test performed for the detection of antibodies in response to HIV in a patient. Agglutination assay of the blood specimen, Western blotting technique for antibodies, and oral fluid test (swabbing of the cheek and gum) are screening tests done for the presence of HIV, but are not confirmatory tests.

The nurse is caring for a patient with human immunodeficiency virus (HIV). While observing the diagnostic reports, the nurse finds that the patient has anemia. Which food items should the nurse include in the patient's diet to increase red blood cell (RBC) count? Select all that apply. 1. Raisins 2. Cereals 3. Bananas 4. Organ meats 5. Apricot nectar

Raisins Organ meats Patients with anemia should be encouraged to consume foods rich in iron, such as raisins and organ meats, in order to increase their RBC count. Patients with constipation are encouraged to eat cereals, as cereals contain fiber, which helps relieve constipation. Patients with diarrhea should be encouraged to eat bananas and apricot nectar, as these foods have high potassium content, which replenishes the patient's potassium levels after experiencing diarrhea.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which findings suggest that the patient has early symptomatic disease? Select all that apply. 1. Recurrent infections 2. No reactivity to skin tests 3. CD4+ cell count of 400/mm3 4. Generalized lymphadenopathy

Recurrent infections CD4+ cell count of 400/mm3 Generalized lymphadenopathy Early symptoms include recurrent infections and generalized lymphadenopathy due to compromised immunity.The early symptomatic phase of HIV occurs when the CD4+ cell count drops below 500/mm3. No reactivity to skin tests and the presence of more CD4+ cells than CD8+ cells indicate acquired immunodeficiency syndrome (AIDS).

The nurse is educating the family members of a patient with human immunodeficiency virus (HIV) about the risk of HIV transmission. Which routes of HIV transmission does the nurse discuss with the family members? Select all that apply. 1. Handshake 2. Air or water 3. Sharing needles 4. Sexual intercourse 5. Saliva, tears, or sweat

Sharing needles. Sexual intercourse. Sharing needles with a patient who has HIV can spread the HIV, as the virus is transmitted through blood. HIV also spreads through unprotected sex with a patient who has HIV, so the use of condoms is recommended. HIV cannot reproduce outside the human body. Therefore, it cannot be transmitted while shaking hands. Similarly, breathing the same air and sharing water with someone with HIV will also not transmit the disease.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which nursing interventions help prevent atelectasis? Select all that apply. 1. Include yogurt in the patient's diet. 2. Recommend daily showering or bathing. 3. Provide the patient with a protein-rich diet. 4. Teach the patient routine coughing exercises. 5. Encourage the patient to perform deep-breathing exercises.

Teach the patient routine coughing exercises. Encourage the patient to perform deep-breathing exercises. Atelectasis is defined as the collapse or closure of the lung, resulting in a reduced or absent gas exchange. This condition occurs in patients with HIV. Encouraging the patient to perform deep-breathing and coughing exercises to promote airway clearance can prevent atelectasis. The patient with dysphagia is encouraged to consume yogurt to promote good nutrition. Showering or using a basin bath on a daily basis is recommended to promote good patient hygiene, but does not prevent atelectasis. A protein-rich diet is recommended to increase immunity and provide strength to a patient; however, itis not particularly given to prevent atelectasis.

The primary health care provider (PHP) prescribes an iron supplement to a patient with human immunodeficiency virus (HIV) to treat anemia. The nurse advises the patient to drink orange juice while taking the iron supplement. What could be the reason for this advice? 1. To increase the immunity of the patient 2. To facilitate absorption of the iron supplement 3. To maintain the blood sugar level of the patient 4. To prevent side effects from the iron supplement

To facilitate absorption of the iron supplement. The patient has been prescribed an iron supplement to treat anemia. Orange juice facilitates the absorption of iron supplements, resulting in an increased absorption of iron in the body. Therefore, the nurse advises the patient to drink orange juice when taking the iron supplement. Orange juice does not have immunomodulator activity, so it does not increase the immunity of the patient. Orange juice does not interact with iron supplements, so it does not prevent the side effects of the iron supplements. Orange juice does not have any effect on insulin function, so it does not help maintain blood sugar levels.

A nurse is teaching a group in the community about the history of the human immunodeficiency virus (HIV). A student indicates an understanding of the virus by stating which route as its mode of transmission? 1. Using the same toilet as an infected individual. 2. Using the same toothbrush as an infected individual. 3. Drinking from the same straw as an infected individual. 4. Using the same hypodermic needle as an infected individual.

Using the same hypodermic needle as an infected individual. HIV is transmitted through infected blood, semen, vaginal secretions, and breast milk. Therefore the virus is transmitted when using the same hypodermic needle as an infected individual. Although HIV has been found in saliva, no evidence of transmission has occurred unless the saliva has visible blood. Therefore, using the same toilet, toothbrush, and straw as an infected individual does not lead to transmission.

A nurse is providing education to a group of high school students about human immunodeficiency virus (HIV). The students would demonstrate an understanding of the modes of transmission by identifying which route(s)? Select all that apply. 1. Vaginal sex 2. Being sneezed on 3. Using the same toilet 4. From mother to fetus 5. Sharing eating utensils 6. Sharing needles and syringes

Vaginal sex From mother to fetus Sharing needles and syringes HIV is transmitted through blood, cervicovaginal secretions, and semen. It can be transmitted through vaginal sex, vertically from mother to fetus, and when needles and syringes are shared. HIV is not transmitted from a sneeze, use of the same toilet, or shared eating utensils.

A pregnant patient learns she has human immunodeficiency virus (HIV) and asks the nurse if she can transmit the virus to her fetus. The nurse should base her response on an understanding of which mechanism of transmission? 1. Vertical transmission 2. Transient transmission 3. Incidental transmission 4. Accidental transmission

Vertical transmission. Vertical transmission is the transmission of the virus from the mother to the fetus. Horizontal transmission would be the transmission of the virus through sexual contact. Incidental and transient transmission do not exist.

A patient with human immunodeficiency virus (HIV) comes to the clinic because of frequent pneumocystitis. The nurse suspects that the patient's CD4 cell count will be below which level? 1. 500/mm³ 2. 800/mm³ 3. 5000/mm³ 4. 10,000/mm³

500/mm³ When the patient's CD4 count falls below 500/mm³, the patient's immune system starts to fail and chronic infections are noted.

A person reports of having unwanted sexual intercourse with a patient who has human immunodeficiency virus (HIV). Two days after the intercourse, the patient approaches the primary health care provider (PHP) for treatment. What does the nurse expect the PHP to prescribe? 1. A 21-day supply of antiretroviral therapy 2. A 24-day supply of antiretroviral therapy 3. A 25-day supply of antiretroviral therapy 4. A 28-day supply of antiretroviral therapy

A 28-day supply of antiretroviral therapy. When a person is exposed to body fluids from a patient with HIV during a high-risk activity less than 72 hours before seeking treatment, the exposed person should receive a 28-day supply of antiretroviral therapy. A 21-, 24-, or a 25-day supply of antiretroviral therapy is not advised for this person, as the supply would not be sufficient because the packages do not provide enough drugs to act against the HIV.

How long does the initial stage of an HIV infection usually last? a. 2 to 4 weeks b. 4 to 8 weeks c. 8 to 12 weeks d. 12 to 16 weeks

ANS: B The initial phase of an HIV infection lasts from 4 to 8 weeks. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2 TOP: Initial Phase of HIV Infection KEY: Nursing Process Step: Implementation

Which of the following are early signs and symptoms of an HIV infection? (Select all that apply.) a. Dry mouth b. Weight loss c. Sore throat d. Vaginal dryness e. Nausea f. Dyspnea

ANS: B, C, F Signs and symptoms of HIV infection include weight loss, sore throat, and dyspnea. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1980, Box 55-1 OBJ: 8 TOP: HIV infection KEY: Nursing Process Step: Assessment

A nurse is providing education to a patient newly diagnosed with human immunodeficiency virus (HIV). The patient demonstrates an understanding of the disease by stating the disease progression will be monitored with which laboratory value? 1. CD4 cells 2. HIV antibodies 3. T lymphocytes 4. B lymphocytes

CD4 cells. HIV disease progression is tracked by the number of CD4 cells left in the body. HIV antibodies, T lymphocytes, and B lymphocytes are not used.

Which statement is true regarding pharmacologic therapy for human immunodeficiency virus (HIV)? 1. Combination drug therapy is now the standard of care. 2. Zidovudine (AZT) is the only medication approved to treat HIV disease. 3. Antiretroviral medications and prophylactic interventions have demonstrated limited success in treating opportunistic infections. 4. When a medication for treatment of HIV is prescribed to be taken three times a day, it is acceptable for the patient to be flexible with the schedule, as long as three doses are taken during waking hours.

Combination drug therapy is now the standard of care. Combination drug therapy is now the standard of care. A single dose (monotherapy) is no longer recommended because of the likelihood of the development of viral and therapeutic resistance. "Cocktails" are more effective than single-drug therapy. This is referred to as highly active antiretroviral therapy (HAART). A number of opportunistic diseases and debilitating problems associated with HIV can be delayed or prevented through the use of antiretroviral medications and prophylactic interventions. Prophylactic medications have contributed to the decreased morbidity and mortality associated with HIV infection during the past several years. A medication that is prescribed three times a day (tid) should be given as close to every 8 hours as possible, not three times while the patient is awake. When medications are not given regularly, the drug levels in the blood fall low enough to allow HIV to develop resistance. Zidovudine was the first drug approved to treat HIV but is no longer the only approved medication. Today there are 18 approved anti-HIV medications available, and many more are being developed and researched.

The primary health care provider prescribes a human immunodeficiency virus (HIV) diagnostic test for a patient. After observing the test results, the nurse suspects that the patient has an acute HIV infection. What findings in the report are consistent with the nurse's suspicion? 1. Decreased levels of CD4+cells 2. Decreased levels of neopterin 3. Decreased levels of cytotoxic T cells 4. Decreased levels of natural killer (NK) cells

Decreased levels of CD4+cells CD4+ cells are the major target of HIV. Progressive infection gradually destroys the available pool of CD4+ cells. So, the overall CD4+ cell count drops. Lower CD4+ cell counts leads to immunodeficiency in the patient. Increased levels of neopterin, cytotoxic T cells, and NK cells are observed in patients with HIV.

The nurse is aware that when caring for the client who is human immunodeficiency virus (HIV) positive, once initial treatment for acute cryptococcal meningitis is completed, interventions should include: a. avoiding fresh juice and fruit b. being reevaluated every 2 to 4 weeks for reoccurrence c. recognizing the signs and symptoms of meningitis, so any reoccurrence can be identified soon d. beginning lifelong suppressive therapy

ANS: D Interventions for acute cryptococcal meningitis would include initial IV drug therapy followed by lifelong suppressive drug therapy.

According to the Centers for Disease Control and Prevention (CDC), in 2010 what percentage of men who have sex with men (MSM) accounted for the total number of human immunodeficiency virus (HIV) infections in males 13 years old and older? 1. 23% 2. 56% 3. 78% 4. 95%

78% In 2010 the CDC reported that MSM constitute the biggest proportion of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) patients, accounting for 78% of the total number of HIV infections in males 13 years old and older. The category labeled as men who have sex with men still accounts for the largest number of individuals with HIV and AIDS.

Which of the following is a CDC criterion for the progression of HIV infection to AIDS? a. Increase in viral load b. Decreased ratio of CD8 to CD4 c. Increase in white blood cells d. Increased reactivity to skin tests

ANS: A AIDS is the end stage of an HIV infection. The CDC has developed criteria for the diagnosis of AIDS, which are: increase in viral load even with pharmacologic interventions, increase in the ratio of CD8 to CD4, decline in the WBCs, and a decreased reactivity to skin tests. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1989 OBJ: 7 TOP: AIDS diagnostic criteria KEY: Nursing Process Step: Implementation

What should a patient with HIV avoid to prevent bacillary angiomatosis (BA)? a. Cats b. Large crowds of people c. Consuming unwashed fruits d. Exposure to mosquito bites

ANS: A Cats and their fleas are thought to transmit BA. DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4 TOP: Prevention KEY: Nursing Process Step: Implementation

The patient, age 21, has been treated for chlamydia and has a history of recurrent herpes. What should the nurse counsel this patient about? a. Sexual history, risk reduction measures, and testing for HIV b. Getting an appointment at a family planning clinic c. Testing for HIV and what the test results mean d. Abstinence and a monogamous relationship

ANS: A Chlamydia is considered a sexually transmitted disease (STD). As such it requires further testing and a sexual history to advise the sexual partners. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2008 OBJ: 6 TOP: Risk for infection KEY: Nursing Process Step: Planning

Which of these statements about the medical treatment for cryptosporidiosis is TRUE? a. It is aimed at palliative treatment. b. It consists of antibiotic therapy such as penicillin G IV over a period of 14 to 21 days. c. It consists of antifungal therapy IV for a period of 6 weeks. d. It consists of radiation therapy for the gastrointestinal (GI)tract.

ANS: A Cryptosporidiosis is a protozoan that infects epithelial cells of the GI tract. It is transmitted by the fecal-oral route and through contaminated water or food. Interventions include a focus on symptoms (palliative care), including antidiarrheals given on programmed schedule, not PRN; fluid/electrolyte replacements; maintaining nutritional status with low residue, high protein, calories; and careful attention to skin care.

The nurse is caring for a client who is human immunodeficiency virus (HIV) positive with a diagnosis of toxoplasmosis. Confirmation the diagnosis of toxoplasmosis in the client is made by which of these signs? a. recent onset of neurological abnormality b. presence of CD4 T cells c. presence of white patches on tongue or oral mucosa d. evidence of elevated protein level in cerebrospinal fluid

ANS: A Diagnosis is confirmed by a recent onset of neurological abnormalities such as headache, lethargy, poor coordination, seizures, and coma.

Which nursing diagnosis should take priority in the care of an outpatient with AIDS? a. Ineffective therapeutic regimen management b. Impaired physical mobility c. Impaired skin integrity d. Social isolation

ANS: A Failure to take anti-HIV drugs as scheduled can encourage resistant strains of HIV. DIF: Cognitive Level: Analysis REF: p. 676 OBJ: 7 TOP: Nursing Diagnosis: AIDS KEY: Nursing Process Step: Nursing Diagnosis

When assigned to a newly admitted patient with AIDS, the nurse says, "I'm pregnant. It is not safe for me or my baby if I am assigned to his case." Which is the most appropriate response by the charge nurse? a. "This patient would not be a risk for your baby if you use standard precautions and avoid direct contact with blood or body fluids." b. "You should ask for a transfer to another unit because contact with this patient would put you and your baby at risk for AIDS." c. "Wear a mask, gown, and gloves every time you go into his room and use disposable trays, plates, and utensils to serve his meals." d. "We should recommend that this patient be transferred to an isolation unit."

ANS: A HIV is transmitted from human to human through infected blood, semen, cervicovaginal secretions, and breast milk. The use of Standard Precautions by all staff members for all patients all the time simplifies this issue. PTS: 1 DIF: Cognitive Level: Application REF: Pages 1996, Box 55-6 OBJ: 6 TOP: Transmission of AIDS KEY: Nursing Process Step: Implementation

What indicates that a patient has entered the third stage of HIV infection? a. T-helper CD4 cell count of 500 b. Rise in antibody count c. Drop in viral load d. Increase in T4 helper cells

ANS: A In the third stage of HIV infection, T-helper CD4 cells drop to approximately 500. Antibodies are always high throughout the infection but are ineffective. The viral count is high. DIF: Cognitive Level: Comprehension REF: p. 668 OBJ: 5 TOP: Third Stage of HIV Infection KEY: Nursing Process Step: Assessment

A nurse is caring for a patient with HIV infection who has been prescribed highly active antiretroviral therapy (HAART). What should the nurse warn the patient that inconsistent administration of the drug can result in? a. HIV strain becoming resistant to the drug b. Decrease in antibodies in the circulating volume c. Addition of another antiretroviral agent to the protocol d. Rapid increase in the symptoms of AIDS

ANS: A Inconsistent administration of HAART drugs can cause the HIV strain to become resistant to the drug. DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 6 TOP: HAART KEY: Nursing Process Step: Implementation

What is the name of the vascular malignancy that can occur anywhere in the body, but whose first lesions often appear on the face or oral cavity in clients with acquired immunodeficiency syndrome (AIDS)? a. Kaposi's sarcoma b. oral candidiasis c. oral hairy leukoplakia d. non-Hodgkin's lymphoma

ANS: A Kaposi's sarcoma is cancer of the cells of the lymph system. It may occur anywhere in the body, but the first lesions usually appear on the face or in the oral cavity. It may develop in a person with a normal immune system, but spreads more rapidly in the immunosuppressed person.

While teaching community groups about AIDS, what should the nurse indicate as the most common method of transmission of the HIV virus? a. Sexual contact with an HIV-infected partner b. Perinatal transmission c. Exposure to contaminated blood d. Nonsexual exposure to saliva and tears

ANS: A Modes of transmission have remained constant throughout the course of the HIV pandemic. It is also important for health care providers to remember that transmission of HIV occurs through sexual practices, not sexual preferences. Worldwide, sexual intercourse is by far the most common mode of HIV transmission. PTS: 1 DIF: Cognitive Level: Application REF: Page 2000, Box 55-11 OBJ: 7 TOP: Transmission of disease KEY: Nursing Process Step: Implementation

A male patient is concerned about telling others he has HIV infection. What should the nurse stress when discussing his concerns? a. Care providers and sexual partners should be told about his diagnosis. b. There is no reason to hide his disease. c. Secrecy is a poor idea because it will lower his self-esteem. d. His diagnosis will be obvious to most people with whom he will come into contact.

ANS: A Nurses have a responsibility to assess each patient's risk for HIV infection and counsel those at risk about HIV testing and the behaviors that put them at risk, and about how to reduce or eliminate those risks. The diagnosis needs to be carefully protected and shared only with caregivers who need to know for the purpose of assessment and treatment. PTS: 1 DIF: Cognitive Level: Application REF: Page 2000 OBJ: 13 TOP: Coping KEY: Nursing Process Step: Implementation

The majority of clients who have oral hairy leukoplakia receive which kind of treatment? a. none b. acyclovir sodium c. nystatin suspension d. oral fluconazole

ANS: A Oral hairy leukoplakia appears as white patches on side of tongue, irregular surface of lesions, resembles hair, and can not be scraped off. Interventions are not necessary in most cases as it is usually not bothersome and may regress spontaneously.

A nurse is clarifying information for a client whose ELISA test is negative. After reviewing the test results with the client, which aspect should be included? a. Assess the client's risk behavior and strategies for reducing risk. b. Make a follow-up appointment for further testing. c. Review the symptoms of disease progression. d. Discuss the medication regimen.

ANS: A Posttest counseling should include reviewing transmission, prevention, and risk reduction with the client. The client's test was negative and does not require medications or knowledge of symptoms. In addition, there is no need for further follow-up.

A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms, because "they don't work." Which is the most appropriate response? a. "Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted diseases." b. "You are correct. Condoms don't always work, so your best protection is to limit your number of partners." c. "Condoms do not provide 100% protection, so you should always discuss with your sexual partners their HIV status or ask if they have any STD." d. "Condoms do not provide 100% protection, but when used with a spermicide you can be assured of complete protection against HIV and other STDs."

ANS: A Risk-reducing sexual activities decrease the risk of contact with HIV through the use of barriers. The most commonly used barrier is the male condom. Although not 100% effective, when used correctly and consistently, male condoms are very effective in the prevention of HIV transmission. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2010 OBJ: 5 TOP: Transmission of disease KEY: Nursing Process Step: Implementation

When is a health care worker at greatest risk of being exposed to tuberculosis (TB)? a. during and after procedures that induce coughing in clients with TB b. when handling blood products of a client with HIV c. when caring for clients at risk for developing TB, such as clients who are HIV-positive d. when caring for clients who have come to the United States from other countries

ANS: A TB involves an acid-fast aerobic bacilli that is transmitted through inhalation. Clients should be placed in negative pressure precautions to avoid transmission.

A nurse is preparing a teaching plan for a patient with HIV who has been diagnosed with microsporidiosis. Which implementation should be included? a. Drink 3 quarts of fluid a day to combat dehydration. b. Include milk products with every meal. c. Consume liberal amounts of fat for increased energy. d. Limit protein intake to reduce serum ammonia levels.

ANS: A The patients need plenty of fluids to combat the diarrhea and proteins for calories. They should avoid milk products and fat. DIF: Cognitive Level: Application REF: p. 670 OBJ: 7 TOP: Microsporidiosis KEY: Nursing Process Step: Implementation

A 21-year-old male who has been an IV heroin user has been experiencing fever, weight loss, and diarrhea and has been diagnosed as having AIDS. At this time, he has a low-grade fever, severe diarrhea, and a productive cough. He is admitted with Pneumocystis jiroveci. What should the nurse do when caring for the patient? a. Use a gown, mask, and gloves when assisting the patient with his bath b. Wear a gown when assisting the patient to use the bedpan c. Use a gown, mask, and gloves to administer oral medications d. Use a mask when taking the patient's temperature

ANS: A The use of Standard Precautions and body substance isolation has been shown not only to reduce the risk of blood-borne pathogens, but also to reduce the risk of transmission of other disease between the patient and the health care worker. PTS: 1 DIF: Cognitive Level: Application REF: Page 2011 OBJ: 16 TOP: Transmission of disease KEY: Nursing Process Step: Implementation

Which statement by a patient diagnosed with AIDS should lead a nurse to suspect an infection by CMV? a. "I need to get glasses; I can't see as well as I did a few months ago." b. "I need to drink more water. This diarrhea has really dehydrated me." c. "I need to get smaller clothes. I have lost 10 lb in the past 6 weeks." d. "I need to take some pep pills. I don't have any energy."

ANS: A Visual changes indicate the presence of CMV retinitis, which will eventually lead to blindness. Diarrhea is indicative of a fungal infection, and decreases in weight and energy are expected manifestations of AIDS. DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4 TOP: Assessing CMV KEY: Nursing Process Step: Assessment

Which opportunistic fungal diseases threaten patients with HIV? (Select all that apply.) a. Aspergillosis b. Pneumocystis jiroveci c. Herpes simplex d. Oral hairy leukoplakia e. Tuberculosis

ANS: A, B Aspergillosis and P. jiroveci are caused by fungi. Herpes simplex and leukoplakia are caused by viruses. Tuberculosis is caused by bacteria. DIF: Cognitive Level: Knowledge REF: p. 670 OBJ: 7 TOP: Fungal Infections KEY: Nursing Process Step: Implementation

How does the HIV-2 virus compare to the HIV-1 virus? (Select all that apply.) a. It has lower mortality risks in the older adult b. It is less virulent c. It is less infectious in the initial stage of infection d. It predisposes the HIV-infected person to a normal life span e. It develops high viral loads

ANS: A, B, C, D Persons who are infected with the HIV-2 are less infectious during the initial stage because the virus is less virulent than HIV-1. These persons tend to live a normal life span and the mortality in the later years is less. PTS: 1 DIF: Cognitive Level: Application REF: Page 1978 OBJ: 7 TOP: HIV-2 KEY: Nursing Process Step: Planning

Which of the following are methods in which children with AIDS could have contracted their disease? (Select all that apply.) a. During intrauterine life with an HIV-positive mother b. During the birth process of an HIV-positive mother c. From other children who are HIV positive d. From receiving a transfusion contaminated with the HIV virus e. From breastfeeding by an HIV-positive mother

ANS: A, B, D, E In the United States, transfusion of infected blood and blood products and transplantation of infected tissues account for 1% of the total adult and adolescent AIDS cases and 2% of the total pediatric AIDS cases. HIV infection can be transmitted from a mother to her infant during pregnancy, at the time of delivery, or after birth, through breastfeeding. In the United States, it is estimated that approximately 30% of infected mothers will transmit HIV to their infants, with approximately 50% to 70% of the transmissions occurring late in utero or intrapartum. In the United States, among children who are less than 13 years old and have AIDS, 93% were infected at birth. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1983 OBJ: 5 TOP: Transmission of disease KEY: Nursing Process Step: Assessment

Which populations are at the highest risks of contracting HIV? (Select all that apply.) a. Health care workers who mishandle infected sharps b. Breastfed infants of HIV-infected mothers c. Persons sharing living quarters with an HIV-infected person d. Heterosexual partners of an HIV-infected person e. Newborns of an HIV-infected mother

ANS: A, B, D, E Sharing living quarters without intimate contact does not expose a person to HIV infection. DIF: Cognitive Level: Comprehension REF: p. 664 OBJ: 2 TOP: Prevalence of HIV KEY: Nursing Process Step: Implementation

During the incubation period following exposure to HIV, some individuals will experience which of the following symptoms? (Select all that apply.) a. fever b. night sweats c. herpes simplex d. rash e. headache f. myalgia g. neuralgia h. candidiasis

ANS: A, B, D, E, F, G Following exposure to HIV and an incubation period of 2 to 4 weeks, some individuals, but not all, will experience flulike symptoms such as fever, night sweats, malaise, rash, headache, myalgia, neuralgia, sore throat, GI distress, loss of appetite, and photophobia.

Health care workers are at risk for contracting HIV due to exposure to which of the following? (Select all that apply.) a. blood b. semen c. urine d. tears e. vaginal fluids f. placentas g. stool

ANS: A, B, E, F Health care workers are at risk for contracting HIV because of being near blood, semen, vaginal fluids, and placentas. The health care worker needs to follow standard precautions and wear gloves at all times when in contact with these fluids. The health care worker should wear goggles and a gown if there is potential of HIV contaminated fluids spraying or splashing into their eyes or on their clothes.

Which factors explain the increase in HIV infections in persons over the age of 50 years? (Select all that apply.) a. Older persons are usually not questioned by health professionals about sex or drug abuse. b. Older persons are more promiscuous in earlier years. c. Older persons are less likely to seek HIV screening. d. Older persons mistake HIV symptoms as part of the discomforts of increased age. e. Older persons tend to use hormonal forms of contraception.

ANS: A, C, D Individuals older than 50 years of age are less likely to be questioned by health care professionals relative to sex activities or illicit drug use. Older adults are less likely to seek HIV screening and frequently accept the symptoms of HIV as part of increasing age. DIF: Cognitive Level: Comprehension REF: p. 674 OBJ: 7 TOP: Older Persons with HIV KEY: Nursing Process Step: N/A

Which foods would a nurse recommend for a person with debilitating diarrhea as a result of HIV infection? (Select all that apply.) a. Bananas b. Ensure c. Fresh broccoli d. Cooked fruits and vegetables e. Red meat f. Apricot nectar

ANS: A, D, F Avoid dairy products, red meat, margarine, butter, eggs, dried beans, peas, and raw fruits and vegetables. Cooked or canned fruits and vegetables will provide needed vitamins. Eat potassium-rich foods, such as bananas and apricot nectar. Discontinue foods, nutritional supplements, and medications that may make diarrhea worse (Ensure, antacids, stool softeners). Avoid gas-producing foods. Serve warm, not hot, foods. Plan small, frequent meals. Drink plenty of fluids between meals. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000, Table 55-6 OBJ: 15 TOP: Weight loss KEY: Nursing Process Step: Implementation

A nurse is designing a teaching plan for a patient with AIDS. What should be included relative to food preparation precautions? (Select all that apply.) a. Check expiration dates on frozen foods. b. Leave produce unwashed to preserve protective spray. c. Drink a small glass of red wine before each meal to stimulate the appetite. d. Eat three large, well-balanced meals daily. e. Avoid leftovers.

ANS: A, E Using food before the expiration date and avoiding leftovers reduce the risk of food contamination. Individuals with AIDS should wash all fresh produce to get rid of contaminants, eat several small meals daily, and avoid alcohol and caffeine. DIF: Cognitive Level: Application REF: p. 678 OBJ: 7 TOP: Nutritional Precautions KEY: Nursing Process Step: Implementation

What should the nurse look for when reviewing a patient's chart to determine whether she has progressed from HIV disease to AIDS? a. CD4+ count below 500, chronic fatigue, night sweats b. HIV-positive test result, CD4+ count below 200, history of opportunistic disease c. Weight loss, persistent generalized lymphadenopathy, chronic diarrhea d. Fever, chills, CD4+ count below 200

ANS: B Patients who have progressed from HIV disease to AIDS will have the condition in which the CD4+ cell count drops to less than 200 cells/mm3 and have a history of opportunistic diseases. PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 1986, Table 55-1 OBJ: 9 TOP: Progression of disease KEY: Nursing Process Step: Assessment

The HIV-infected patient who has just seroconverted says he just cannot take all those confusing, expensive antiretroviral (ART) medications. He says he still feels fine, anyway. What should the nurse keep in mind when counseling this patient? a. Resumption of the ART later in the disease is just as effective b. Adherence to the ART protocol is essential to the success of the treatment c. Cessation of the ART may prevent the emergence of a resistant strain of HIV d. Once ART is initiated it cannot be restarted in the same patient

ANS: B Compliance and adherence to the ART protocol is essential to its success. Cessation of the medication may stimulate the emergence of a resistant strain of HIV virus. ART can be restarted, but the optimum time to start is soon after seroconversion. PTS: 1 DIF: Cognitive Level: Application REF: Page 2001 OBJ: 5 TOP: Adherence to ART KEY: Nursing Process Step: Assessment

The nurse caring for a client with human immunodeficiency virus (HIV) understands that a client is considered to have acquired immunodeficiency syndrome (AIDS) when which of the following occurs? a. appearance of flulike symptoms b. CD4 T cell count of less than 200 cells/mm3 and one defined clinical condition c. enlarged lymph nodes for more than 3 months d. one positive enzyme-linked immunosorbent assay (ELISA) test

ANS: B Diagnosis of AIDS is made when the client's CD4 T cell count is of less than 200 cells/mm3 and there is one defined clinical condition. Flu-like symptoms appear with the acute phase of HIV. Enlarged lymph nodes for more than 3 months can be associated with opportunistic infections. The diagnosis of HIV requires two positive enzyme-linked immunosorbent assay (ELISA) tests and a confirmatory Western blot.

Why should interventions such as promotion of nutrition, exercise, and stress reduction be undertaken by the nurse for patients who have HIV infection? a. They will promote a feeling of well-being in the patient. b. They will improve immune function. c. They will prevent transmission of the virus to others. d. They will increase the patient's strength and ability to care for himself or herself.

ANS: B HIV disease progression may be delayed by promoting a healthy immune system. Useful interventions for HIV-infected patients include the following: nutritional changes that maintain lean body mass, regular exercise, and stress reduction. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2001 OBJ: 15 TOP: Immune function improvement KEY: Nursing Process Step: Implementation

A very anxious young man comes to the clinic believing that he may have HIV infection because of his persistent influenza-like symptoms and his risky sexual behavior. What should the nurse anticipate that a positive blood analysis would show? a. High levels of CD8 cells b. High levels of HIV-infected cells c. Low levels of T cells d. Low levels of antibodies

ANS: B In the initial phase of HIV infection, high levels of HIV-infected cells, high levels of T cells, and high levels of antibodies are present as the body attempts to rid the body of the virus through the immune response. DIF: Cognitive Level: Comprehension REF: p. 668-669 OBJ: 2 TOP: Diagnosis of AIDS KEY: Nursing Process Step: Assessment

A young man at the HIV clinic tells the nurse how relieved he is that he does not have HIV because he now has no symptoms at all when just a few weeks ago he felt awful. What is the most appropriate nursing response? a. "Flulike symptoms frequently are misdiagnosed as HIV." b. "In the latent stage, the physical symptoms are reduced, but the HIV is still present in the lymph nodes." c. "A high antibody count can overwhelm HIV infection in the early stage." d. "Antiretroviral drugs are very effective in the first stage in reducing symptoms."

ANS: B In the latent stage, the symptoms are reduced as the virus enters the lymph nodes. DIF: Cognitive Level: Application REF: p. 668 OBJ: 2 TOP: Stages of HIV Infection KEY: Nursing Process Step: Implementation

Which of these conditions belongs to the herpes virus group and lies dormant in tissues waiting to be reactivated in the immunocompromised client? a. cryptosporidium enteritis b. cytomegalovirus c. Pneumocystis carinii pneumonia d. tuberculosis

ANS: B Most people have been exposed to cytomegalovirus (active/latent), but it becomes a problem when the client becomes immunosuppressed. Exposure occurs during preschool (congenital infection, child to child, vaginal delivery, breast milk) and the sexually active years (intercourse, kissing).

Which population, according to statistics from the Centers for Disease Control and Prevention (CDC), has the greatest incidence of human immunodeficiency viral (HIV) infection in the United States? a. Asian Americans b. African Americans c. Latinos d. Whites

ANS: B Of those with HIV infection in the United States, African Americans make up 49%, whites 27%, and Latinos 12%. Asian Americans were not reported. DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3 TOP: Human Immunodeficiency Virus (HIV) Incidence in the United States KEY: Nursing Process Step: Implementation

A client has received testing for human immunodeficiency virus (HIV). The client's results of two enzyme-linked immunosorbent assay (ELISA) tests have been positive. In explaining the next step, the nurse's response is based on the understanding that: a. the client will have a bone marrow biopsy to confirm the diagnosis b. a Western blot test will be done to confirm the diagnosis c. a CD4+ cell count will be obtained to measure T-helper lymphocytes d. the client will be diagnosed as HIV-positive and begin medical treatment

ANS: B Once the results of two ELISA tests are positive, the Western blot test is done to confirm the diagnosis. If the result of the Western blot test is positive, the client is diagnosed as positive for HIV.

After what period of time would the home health nurse make a mental health appointment for a patient with an HIV infection after assessing a diminished ability to attend to daily functioning? a. 1 week b. 2 weeks c. 3 weeks d. 1 month

ANS: B Patients with HIV infection have a great deal of anxiety and guilt, which may interfere with the daily functions of maintaining relationships and making decisions. When this apathy is assessed for a period of 2 weeks, the nurse should refer the patient for a mental health consult. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000 OBJ: 13 TOP: Coping KEY: Nursing Process Step: Assessment

For most people who are HIV-positive, marker antibodies are usually present 10 to 12 weeks after exposure. What is the development of these antibodies called? a. Immunocompetence b. Seroconversion c. Opportunistic infection d. Immunodeficiency

ANS: B Seroconversion is the development of antibodies from HIV, which takes place approximately 5 days to 3 months after exposure, generally within 1 to 3 weeks. Although the conversion has taken place, the patient is not yet immunodeficient. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1987 OBJ: 10 TOP: Progression of disease KEY: Nursing Process Step: Assessment

The anxious male patient is fearful that he has been exposed to a person with an HIV infection. He states he does not want to go to a laboratory for the ELISA tests because he does not want to be identified. What would be the nurse's most helpful response? a. "There really is not an option, you will need to get the Western blot test first." b. "There is an FDA-approved home test called OraQuick." c. "The rapid test Reveal can identify all the HIV strains." d. "You can be tested anonymously for ELISA. If you are seronegative, your concerns are over."

ANS: B The OraQuick is a home OTC test approved by the FDA. One seronegative on the ELISA is not evidence because seroconversion may not have taken place. The Western blot test follows if the ELISA is positive. PTS: 1 DIF: Cognitive Level: Application REF: Page 2008 OBJ: 6 TOP: HIV testing KEY: Nursing Process Step: Implementation

What should the nurse emphasize when counseling an anxious HIV-positive mother about the care of her HIV-positive infant? a. The baby will develop AIDS and refer her to a local AIDS support group. The baby will remain HIV-positive for the rest of its life. b. Although infants of HIV-infected mothers may test positive for HIV antibodies, not all infants are infected with the virus. c. She has not yet developed AIDS, and that it is possible the baby will not develop AIDS for many years. d. If the infant is started on zidovudine (AZT) within the first month after delivery, AIDS can be prevented.

ANS: B The decline in pediatric AIDS incidence is associated with the increased compliance with universal counseling and testing of pregnant women and the use of zidovudine by HIV-infected pregnant women and their newborn infants. Infants born to HIV-infected mothers will have positive HIV antibody results as long as 15 to 18 months after birth. This is caused by maternal antibodies that cross the placenta during gestation and remain in the infant's circulatory system. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1983-1984 OBJ: 5 TOP: Transmission of disease KEY: Nursing Process Step: Planning

A male patient is advised to receive HIV antibody testing because of his multiple sexual partners and injectable drug use. What should the nurse inform the patient to ensure understanding? a. The blood is tested with the highly sensitive test called the Western blot. b. The blood is tested with an ELISA; if positive, it is tested again with an ELISA, followed by a Western blot if the second ELISA is positive. c. A series of HIV tests is performed to confirm if the patient has AIDS. d. If the HIV tests are seronegative, the patient can be assured that he is not infected.

ANS: B The individual's blood is tested with ELISA or enzyme immunoassay (ELA), antibody tests that detect the presence of HIV antibodies. If the ELA is positive for HIV, then the same blood is tested a second time. If the second ELA is positive, a more specific confirming test such as the Western blot is done. Blood that is reactive or positive in all three steps is reported to be HIV-positive. A seronegative is not an assurance that the individual is free of infection since seroconversion may not have yet occurred. PTS: 1 DIF: Cognitive Level: Application REF: Page 1990, Box 55-2 OBJ: 9 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

The home health nurse designing a teaching plan for a person with HIV disease that would support weight gain would include information pertaining to (Select all that apply.) a. Limit fluid intake b. Eating high-protein/high-calorie diet c. Drinking nutritional supplements (Boost, Sustacal, etc.) d. Eating several small meals during the day e. Providing referrals to dietitians f. Resistance weight training

ANS: B, C, D, E, F Increase protein, calorie, and fat intake. Offer nutritional supplements. Eat several small meals per day instead of three large meals. Provide for referrals. Weigh the patient daily. Weight training maintains muscle tone and improves appetite. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2011 OBJ: 15 TOP: Weight loss KEY: Nursing Process Step: Implementation

When is a patient with HIV considered to have progressed to AIDS? a. Two or more opportunistic infections are diagnosed. b. Kaposi sarcoma appears. c. CD4 cell level drops to 200. d. Patient tested positive for enzyme-linked immunosorbent assay (ELISA).

ANS: C A person with an HIV infection is not diagnosed with AIDS until the CD4 count falls to 200. Other AIDS markers exist as well. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 5 TOP: AIDS KEY: Nursing Process Step: Implementation

What sign should a nurse report when caring for the patient with AIDS who has cutaneous Kaposi sarcoma? a. Nausea b. Fatigue c. Abdominal pain d. Weight loss

ANS: C Abdominal pain may be an indication of organ involvement from Kaposi sarcoma. DIF: Cognitive Level: Comprehension REF: p. 673 OBJ: 2 TOP: Kaposi Sarcoma KEY: Nursing Process Step: Assessment

What medication times should the nurse use in writing out a schedule for taking antiretroviral medication three times a day? a. 8 AM - 2 PM - 8 PM b. 8AM - 4PM - 12 AM c. 8AM - 5PM - 1 AM d. Be given with meals

ANS: C Antivirals should be given around the clock to keep the therapeutic level of the ART at a constant level. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1993 OBJ: 15 TOP: Antiretroviral therapy (ART) KEY: Nursing Process Step: Implementation

Why are snacks high in potassium, such as bananas and apricot nectar, recommended? a. Electrolytes are lost through diaphoresis. b. Sodium is lost through frequent diarrhea. c. Potassium will support weight gain. d. Potassium helps fight infection.

ANS: C HIV disease progression may be delayed by promoting a healthy immune system. Nutritional changes that maintain lean body mass, increase weight, and ensure appropriate levels of vitamins and micronutrients are helpful. Eat potassium-rich foods, such as bananas and apricot nectar. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000, Box 55-6 OBJ: 15 TOP: Nutrition KEY: Nursing Process Step: Implementation

The nurse caring for a client who is HIV positive notes the client is experiencing an explained weight loss of more than 10% of body weight that is associated with chronic diarrhea or fever. The nurse plans care, knowing that this condition is: a. anorexia b. histoplasmosis c. HIV-wasting syndrome d. malabsorption syndrome

ANS: C HIV-wasting syndrome is associated with a weight loss of greater than 10% body weight and one of the following for more than 30 days: weakness, diarrhea, or fever. Causes are related to poor intake, malabsorption, metabolic changes, and medication side effects.

What should a nurse anticipate will happen when a patient's first ELISA result is positive? a. The diagnosis of AIDS is confirmed. b. The test is repeated in 6 to 8 months. c. Another blood sample must be obtained for testing. d. A Western blot test is performed on the same sample.

ANS: C If the ELISA result is positive, the ELISA is repeated. If the second ELISA result is positive, a Western blot test is performed. DIF: Cognitive Level: Application REF: p. 673 OBJ: 5 TOP: HIV Laboratory Tests KEY: Nursing Process Step: Planning

A 28-year-old married attorney with one child is in the first trimester of her second pregnancy. The patient states that she is at no risk for HIV, so she would not need to be counseled about testing for HIV. Which is the most appropriate response? a. "She's a professional woman in a monogamous relationship. She obviously is not at risk." b. "Women are not at great risk. The greatest risk is with gay men." c. "The fastest-growing segment of the population with AIDS is women and children. We need to assess her risks." d. "We need to review her chart to determine if her first child was infected."

ANS: C Increases in AIDS cases in women and heterosexuals and a slowing of cases in the men who have sex with men (MSM) category are a direct reflection of early educational efforts directed at the MSM population, who were believed to be the only population at risk. Women need to be assessed for different manifestations of HIV infection. It is the current recommendation for voluntary HIV testing for all pregnant women. PTS: 1 DIF: Cognitive Level: Application REF: Page 2008 OBJ: 6 TOP: Risk for infection KEY: Nursing Process Step: Implementation

The nurse is caring for a client with a diagnosis of human immunodeficiency virus (HIV). The nurse understands that the therapeutic management of the client does NOT include: a. using antiretrovirals to prolong the HIV stage b. preventing opportunistic infections from occurring c. radiation to inhibit HIV replication d. medications to treat opportunistic infections

ANS: C Medical management of clients who have HIV/AIDS focuses on minimizing disease progression by keeping the viral load as low as possible for as long as possible, thus preventing opportunistic infections from occurring.

When educating a client who has human immunodeficiency virus (HIV), the nurse should include the information that it is possible to remain asymptomatic for: a. up to 2 years b. up to 5 years c. 8 to 10 years d. 10 or more years

ANS: C Most individuals will remain symptom free for years (8 to 10), but some may begin to have symptoms in a few months. During this "asymptomatic" period, HIV is multiplying, infecting, and killing the CD4 T-cells of the immune system.

What oral fungal infection produces symptoms such as creamy, white intraoral lesions; mucosal tenderness; and painful swallowing in clients who are immunocompromised? a. cryptosporidium colitis b. Epstein-Barr virus c. oral candidiasis d. oral hairy leukoplakia

ANS: C Oral candidiasis appears as white plaques on the tongue, gums, or other mucous membranes. It may appear as flat, bright red areas on the hard palate, buccal mucosa, or tongue. Data collection includes: dysphagia, dry mouth, unpleasant taste, tender gums, painful swallowing, and white cheesy lesions, which if wiped away leave erythematous or even bleeding mucosal lesions.

A nurse is caring for a patient with HIV infection taking Retrovir, a nucleoside antiviral that is a reverse transcriptase inhibitor. For what should the nurse be especially observant? a. Decreased urine output b. Hypertensive episodes c. Jaundice d. Edema of the face

ANS: C Retrovir has the potential of causing a fatal hepatotoxic reaction. Jaundice is a possible sign of hepatic impairment. DIF: Cognitive Level: Comprehension REF: p. 675 OBJ: 6 TOP: Drug Side Effects KEY: Nursing Process Step: Assessment

The depressed patient with AIDS says, "I don't understand why I am going to be getting doses of testosterone. What good will that do me now?" What should the nurse keep in mind about testosterone when responding? a. It can lower viral load b. It can lighten depression c. It can increase lean body mass d. It can increase appetite

ANS: C Testosterone can increase body mass and lean weight. PTS: 1 DIF: Cognitive Level: Application REF: Page 2005 OBJ: 16 TOP: Transmission of disease KEY: Nursing Process Step: Implementation

The nurse is usually responsible for which of the following actions prior to a client being tested for human immunodeficiency virus (HIV)? a. explaining venipuncture to client and obtaining specimen for testing b. obtaining a signed consent only c. pretest counseling and ensuring a signed consent is completed d. pretest counseling only

ANS: C The nurse provides pretest and posttest counseling to the client regarding transmission, preventions, and risk reduction. Testing for HIV requires that an informed consent be signed prior to testing. The nurse will ensure the consent has been signed prior to the testing.

The HIV patient asks the nurse about what to expect in terms of disease progression. The nurse tells this patient that although the disease can vary greatly among individuals, the usual pattern of progression includes: a. viremia, clinical latency, opportunistic diseases, and death. b. asymptomatic phase, clinical latency, ARC, and AIDS. c. acute retroviral syndrome, early infection, early symptomatic disease, and AIDS. d. transitional viral syndrome, inactive disease, early symptomatic infection, and opportunistic diseases.

ANS: C The progression from HIV to AIDS includes initial exposure, primary HIV infection, asymptomatic HIV infection, early HIV disease, and AIDS. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1980, Figure 55-3 OBJ: 4 TOP: Progression of disease KEY: Nursing Process Step: Implementation

Which of the following are examples of the AIDS wasting syndrome in a patient with an HIV infection? (Select all that apply.) a. Episodes of vomiting for 20 days b. Appearance of Kaposi sarcoma c. Loss of 10% of body mass d. Marked hair loss e. Episodes of diarrhea for 30 days f. Episodes of hypotension

ANS: C, E The AIDS wasting syndrome is due to disturbances in metabolism involving lean body mass. The wasting syndrome is signaled by 10% loss of body weight, 30 days of diarrhea, weakness, and fever. The person who has the wasting syndrome is considered to have AIDS. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2001 OBJ: 4 TOP: Wasting syndrome KEY: Nursing Process Step: Assessment

A patient states that he feels terrific, but a blood test shows that he is HIV-positive. It is important for the nurse to discuss with him that HIV may remain dormant for several years. What is true of the patient during this time? a. He is not dangerous to anyone. b. He experiences minor symptoms only. c. He experiences decreased immunity. d. He is contagious.

ANS: D A prolonged period in which HIV is not readily detectable in the blood follows within a few weeks or months of the initial infection. This titer, or viral load, falls dramatically as the immune system responds and controls the HIV infection, and it may last 10 to 12 years. During this period, there are few clinical symptoms of HIV infection, although an individual is still capable of transmitting HIV to others. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1988 OBJ: 15 TOP: Progression of disease KEY: Nursing Process Step: Implementation

The nurse is caring for a patient with human immunodeficiency virus (HIV) who is experiencing bouts of diarrhea. Which dietary instruction does the nurse give to the patient to prevent complications? Select all that apply. 1. Increase the intake of peas. 2. Increase the intake of bananas. 3. Increase the intake of dried beans. 4. Increase the intake of apricot nectar. 5. Increase the intake of margarine foods.

Increase the intake of bananas. Increase the intake of apricot nectar. Diarrhea causes loss of electrolytes in the body. Therefore, the nurse should instruct the patient to increase the intake of bananas and apricot nectar. Both are rich sources of potassium and help maintain potassium levels in the body. The nurse should not instruct the patient to increase the intake of peas, dried beans, and margarine foods because these foods worsen the symptoms of diarrhea.

Which drug does the primary health care provider prescribe for a patient with human immunodeficiency virus (HIV)? 1. Dronabinol (Marinol) 2. Zidovudine (Retrovir) 3. Pravastatin (Pravachol) 4. Rosiglitazone (Avandia)

Zidovudine (Retrovir) Zidovudine (Retrovir) is used to treat HIV. Dronabinol (Marinol) is given to stimulate appetite in patients who have anorexia. Pravastatin (Pravachol) is an anticholesterol drug that is given to treat hyperlipidemia. Rosiglitazone (Avandia) is an oral hypoglycemic agent given to treat diabetes.

A group of nursing students are discussing the transmission of the human immune deficiency (HIV) virus. Which statement about the transmission of the human immune deficiency (HIV) virus indicates effective learning? 1. "HIV is not present in tears." 2. "HIV can be spread by mosquitoes and insects." 3. "HIV can be transmitted via the parenteral route." 4. "The highest concentrations of HIV are in blood and vaginal fluids."

"HIV can be transmitted via the parenteral route." HIV can be spread via parenteral routes, such as the sharing of needles contaminated with infected blood, or by receiving contaminated blood products. HIV has been found in body fluids, such as the tears of infected patients, but there is no evidence that it transmits through tears. HIV cannot be transmitted by mosquitoes or other insects. The highest concentrations of HIV are found in blood and semen. Though vaginal fluids also have HIV, concentrations are less than blood and semen.

An occupational health nurse is providing education to an employee who has been exposed to human immunodeficiency virus (HIV) and will begin postexposure antiviral therapy. Which statement, if made by the employee, indicates a need for further teaching regarding healthy practices during postexposure antiviral therapy? 1. "I should be sure to drink plenty of fluids each day." 2. "I should eat a balanced diet and exercise regularly." 3. "I should practice universal precautions at all times." 4. "I should use only acetaminophen (Tylenol) for minor aches."

"I should use only acetaminophen (Tylenol) for minor aches." Postexposure antiviral therapy is hepatotoxic, so the employee should avoid medications such as Tylenol, which are also hepatotoxic. The patient would be correct to eat a balanced diet, exercise regularly, drink plenty of fluids, and practice universal precautions at all times.

What statement is most accurate concerning acquired immunodeficiency syndrome (AIDS)? 1. The median time from AIDS diagnosis to death, without treatment, is 5 years. 2. As HIV disease progresses, there are more T-helper cells (CD4+) than T-suppressor cells (CD8+). 3. AIDS is used to describe the end stage, or terminal phase, of human immunodeficiency virus (HIV) infection. 4. A patient with AIDS usually has a normal white blood cell (WBC) count and purified protein derivative (PPD) test result.

AIDS is used to describe the end stage, or terminal phase, of human immunodeficiency virus (HIV) infection. AIDS is used to describe the end stage, or terminal phase, of HIV infection. Earlier phases of the disease include early infection (sometimes called the asymptomatic phase) and early symptomatic disease, when the patient begins to have the symptoms of fevers, night sweats, diarrhea, headaches, fatigue, and persistent generalized lymphadenopathy (PGL). The median time from AIDS diagnosis to death, without treatment, is 1.3 years. With treatment, however, the life span is unpredictable, and the disease can resemble a chronic illness in some patients. The normal ratio of T-helper (CD4+) to T-suppressor (CD8+) cells is 2:1. As HIV disease progresses, there is a gradual shift in this ratio, whereby there are more T-suppressor cells (CD8+) than T-helper cells (CD4+), because of the reduction in the T-helper cells. A patient with AIDS often has a decrease in the number of white blood cells. The person's reactivity to skin tests, such as PPD tuberculin, is decreased or absent. An individual is said to be anergic if no skin response is noted.

When caring for a client with a diagnosis of human immunodeficiency virus (HIV), the nurse understands that HIV is transmitted by: a. airborne droplets b. exchange of body fluids c. exposure to infected animals or their waste products d. sexual activity only

ANS: B HIV infection can be transmitted by blood, semen, vaginal secretions, and breast milk. High-risk behaviors that contribute to the spread of human immunodeficiency virus (HIV) include engaging in unprotected sexual intercourse, having multiple sex partners, withholding information about HIV status, and sharing needles or syringes. Transmission of HIV to health care professionals is possible, but the risk can be reduced with the use of Standard Precautions.

The nurse is educating the client with histoplasmosis about prevention methods for future exposure. The nurse evaluates that the client needs future instruction if the client states that the possible sources include which of the following? a. cleaning bird cages b. chicken coops c. fruit trees d. mushroom cellars

ANS: C Histoplasmosis is a fungal infection caused from bird droppings, chicken coops, soil in the Mississippi, and in caves. It may have been dormant in the body following exposure and becomes prevalent when a client becomes immunosuppressed.

What do the activated monocytes and macrophages produce in the presence of an inflammatory process? a. Reduction of red cells b. Increase in WBCs c. Neopterin d. Increase in T-helper cells increase natural killer (NK) cells

ANS: C Neopterin is produced in the presence of an inflammatory reaction and is increased in HIV disease. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1990, Box 55-2 OBJ: 5 TOP: Neopterin KEY: Nursing Process Step: Intervention

What should a patient be encouraged to do before the initiation of any anti-HIV drug protocol? a. Give up sexual activity for several months. b. Follow the strict dietary guidelines. c. Comply with the drug protocol. d. Involve the partner in a support program.

ANS: C Patients with HIV are assessed for their willingness to comply with the drug protocol because nonadherence causes the HIV organisms to become resistant to the drug. DIF: Cognitive Level: Application REF: p. 676 OBJ: 7 TOP: Compliance KEY: Nursing Process Step: Implementation

What does enzyme reverse transcriptase transcribe? a. DNA to mimic CD4 cells b. T4-helper cells to RNA c. HIV RNA to HIV DNA d. T4 cells to HIV virions

ANS: C Reverse transcriptase reverses the normal process and allows the RNA to be transcribed to the DNA rather than the DNA to be transcribed to the RNA. DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2 TOP: Pathophysiology KEY: Nursing Process Step: Implementation

A patient has just been diagnosed as HIV-positive. He asks the nurse, "Does this mean I have AIDS?" Which response would be most informative? a. "Most people get AIDS within 3 to 12 weeks after they are infected with HIV." b. "Don't worry. You may never get AIDS if you eat properly, exercise, and get plenty of rest." c. "It varies with every individual, but the average time is 8 to 10 years from the time a person is infected, and some go much longer." d. "You can expect to develop signs and symptoms of AIDS within 6 months."

ANS: C Typical progress of HIV includes a period of relative clinical latency, occurring immediately after the primary infection, which can last for several years. Long-term nonprogressors remain symptom-free for 8 to10 years. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1988 OBJ: 4 TOP: Progression of disease KEY: Nursing Process Step: Implementation

As the disease progresses, symptoms of human immunodeficiency virus (HIV) become evident when which of the cells of the immune system decrease? a. B cells b. macrophages c. neutrophils d. CD4 T cells

ANS: D CD4 T cells are the immune response for cellular immunity. HIV attach to the T cells, causing depletion. B cells are the humoral immune response system.

A nurse is educating patients about the progression of HIV infections. Which statement by the patient in the latent stage indicates that teaching has been effective? a. "I had better get my affairs in order. I don't have a lot of time left." b. "Whew! I thought when I got AIDS that I was a 'goner.'" c. "Now I won't have to take all those expensive drugs that I have been using." d. "I can still enjoy life and live pretty much as I want for the next several years."

ANS: D The latent stage may last as long as 12 years without developing into AIDS. Medications will be continued. DIF: Cognitive Level: Application REF: p. 668 OBJ: 7 TOP: Latent Stage of HIV Infection KEY: Nursing Process Step: Evaluation

A nurse in the community is providing education to a group of individuals in a homeless shelter who use intravenous (IV) drugs. Which instruction would be most effective at reducing the group members' risk for contracting human immunodeficiency virus (HIV)? 1. Abstain from the use of IV drugs immediately 2. Never share needles and syringes with another person 3. Always use a new syringe and needle for each injection 4. Before each use, fill each syringe with bleach twice, then with water twice

Always use a new syringe and needle for each injection. The most effective technique is to instruct patients to use a new syringe each time they inject. Ideally, these individuals would abstain from IV drug use, always use a new syringe and needle, or never share syringes and needles with another person. A group of individuals in a homeless shelter who already use IV drugs are not likely to be able to quit without treatment or to afford their own needles and syringes. It is suggested that if they can't obtain these, then they can be instructed to, at the very least, properly clean each syringe and needle before each use. This is harm-reduction education, and it has not been shown to rid the syringes of infectious organisms.

The nurse is caring for a postpartum patient with human immunodeficiency virus (HIV). What should the nurse suggest to the patient to prevent the spread of infection to the newborn? 1. Avoid kissing the newborn. 2. Avoid hugging the newborn. 3. Avoid breastfeeding the newborn. 4. Avoid providing kangaroo care to the newborn.

Avoid breastfeeding the newborn. HIV is transmitted through blood, semen, cervicovaginal secretion, and breast milk. Therefore, to prevent the transmission of infection to the newborn, the nurse should suggest that the patient avoids breastfeeding the newborn. HIV does not spread through saliva, urine, or feces. Therefore, the nurse need not advise the patient to avoid kissing the newborn. HIV is not transmitted through skin-to-skin contact. Therefore, the nurse should not tell the patient to avoid hugging and providing kangaroo care to the newborn.

A nurse is providing education to a patient recently diagnosed with human immunodeficiency virus (HIV). Which instruction would the nurse include to help the patient delay the progress of the disease? 1. Conserve energy by avoiding exercise 2. Report any changes to the oral mucosa 3. Consume a diet that promotes lean muscle mass and an ideal body weight 4. Take double the recommended daily allowance of all vitamins and minerals

Consume a diet that promotes lean muscle mass and an ideal body weight. In general, the patient who has just learned that he or she is HIV positive still feels well, and education should focus on improving and maintaining the health of the immune system. The nurse should instruct the patient to consume a diet that will promote lean muscle mass and an ideal body weight. The patient should maintain a regular exercise regimen and consume the recommended daily allowance of vitamins and minerals. Although the patient should report any changes to the oral mucosa, this is not an intervention to slow the progress of the disease.

The nurse is caring for a male patient with human immunodeficiency virus (HIV). While checking the patient's body weight, the nurse finds that the body weight has decreased from 150 to 100 lb. What could be the reason behind this? 1. Decreased levels of activin 2. Decreased levels of neopterin 3. Decreased levels of testosterone 4. Decreased levels of cytotoxic T cells

Decreased levels of testosterone. Men with HIV have decreased levels of testosterone. Testosterone has two distinct biologic properties: virilizing activity (androgenic effect) and protein-building ability (anabolic effect). As testosterone is an anabolic hormone, a testosterone deficiency may cause a loss of body mass. Decreased levels of activin may not be observed in this patient. Increased levels of neopterin and cytotoxic T cells are observed in a patient with HIV.

The nurse knows which action is the correct way to prevent exposure to human immunodeficiency virus (HIV) while working in the health care industry? 1. Report all needle sticks to the occupational health department 2. Recap needles before disposing of them in appropriate receptacles 3. Employ universal precautions when coming in contact with all patients 4. Wear a gown, gloves, and mask when caring for a patient infected with HIV

Employ universal precautions when coming in contact with all patients. Universal precautions are designed to prevent the transmission of blood-borne diseases in the health care setting. It is not necessary to wear a gown, gloves, and mask when caring for a patient infected with HIV. Although one should report all accidental needle sticks to the occupational health department, this is not the most important action. Needles should never be recapped before disposal.

Which nursing interventions would be helpful to delay the progression of disease in a patient with human immunodeficiency virus (HIV)? Select all that apply. 1. Encourage the patient to quit smoking. 2. Encourage the patient to eat vegetables. 3. Encourage the patient to exercise regularly. 4. Support the patient in reducing stress levels. 5. Encourage the patient to be on a low-protein diet.

Encourage the patient to quit smoking. Encourage the patient to exercise regularly. Support the patient in reducing stress levels. Maintaining health and promoting immunity may delay the progression of HIV. The patient should be encouraged to stop smoking, as smoking may worsen pulmonary complications. Regular exercise helps maintain the patient's muscle mass. Stress levels may disturb the patient's metabolic functions. In a patient with HIV, stress levels should be reduced to promote well-being. The patient should be advised to not eat vegetables, as vegetables can cause gastroenteritis. A patient with HIV should be encouraged to maintain a high-protein diet to promote cell repair.

After observing the diagnostic reports of a patient infected with human immunodeficiency virus (HIV), the primary health care provider prescribes fluvastatin (Lescol). What reason does the nurse expect behind the prescription? 1. Increased glucose levels 2. Decreased protein levels 3. Increased cholesterol levels 4. Decreased triglyceride levels

Increased cholesterol levels. Fluvastatin (Lescol) is a statin drug prescribed to prevent cardiovascular disease in patients with HIV who have elevated cholesterol levels.Increased glucose levels may occur due to diabetes. Decreased protein or triglyceride levels may occur due to malnutrition. Fluvastatin (Lescol) is neither prescribed for increased glucose levels nor for decreased protein levels. It is also not prescribed for decreased levels of triglycerides.

A nurse works in a clinic that has a patient population composed largely of individuals with or at risk for human immunodeficiency virus (HIV). The nurse knows which characteristic of HIV promotes the transmission of the virus? 1. The virus affects the individual's ability to make sound decisions. 2. Many individuals do not experience symptoms of the disease for years. 3. Individuals with HIV are not contagious until they begin to experience symptoms. 4. The type of individuals with HIV are not concerned about preventing transmission.

Many individuals do not experience symptoms of the disease for years. HIV transmission is promoted by the fact that many individuals do not realize they have HIV because they do not experience symptoms. Although HIV can cause dementia in the late stages, it does not affect the individual's ability to make sound decisions. Individuals with HIV are contagious immediately. There is no certain "type" of individual with HIV.

The nurse is caring for a patient with a human immune deficiency (HIV) viral infection who has been prescribed stavudine (Zerit). What action does the nurse perform when caring for the patient? 1. Check the patient's serum phosphate levels. 2. Ensure HLA B5701 allele testing is performed. 3. Administer the drug 30 minutes before meals. 4. Monitor for numbness and tingling in toes or feet.

Monitor for numbness and tingling in toes or feet. The nurse should check for numbness and tingling in the patient's toes or feet, as peripheral neuropathy is a common side effect of stavudine. Patients taking didanosine (Videx EC) are given the drug 30 minutes before meals, because gastric acid destroys the drug's activity. Patients taking tenofovir (Viread) are checked for serum phosphate levels, because hypophosphatemia is a common side effect of the drug. HLA B5701 allele testing is performed in patients taking abacavir (Ziagen); patients who have a specific variation of the B5701 gene allele are at high risk for hypersensitivity reactions.

The nurse is teaching safe and effective sex methods to a couple. The nurse finds that the couple participates in anal sex and uses a diaphragm for contraception. The male partner is circumcised and refrains from having oral sex. Which of the couple's actions would increase the risk of sexually transmitted infections (STIs)? 1. Using a diaphragm 2. Refraining from oral sex 3. Undergoing circumcision 4. Participating in anal sex

Participating in anal sex. Most couples participate in anal intercourse instead of vaginal intercourse to prevent conception. Practicing anal sex increases the risk of human immunodeficiency virus and STIs, as the rectal mucosa is less lubricated and may be easily worn out. Therefore, the nurse should advise the couple to avoid participating in anal sex. Using a diaphragm and condoms helps prevent the risk of infections, as it prevents the contact of semen with other body fluids. Oral sex increases the risk of STIs, as a virus may be transmitted if the partner's oral mucosa is damaged. Therefore, refraining from oral sex is a good method. According to research, circumcision reduces the risk of STIs.

A patient with human immunodeficiency virus (HIV) who is administered stavudine (Zerit) reports numbness and impaired proprioception. The nurse finds that the patient also has hypesthesia. What could be the reason behind the onset of these symptoms? 1. Hypoglycemia 2. Hyperlipidemia 3. Stress due to HIV 4. Peripheral neuropathy

Peripheral neuropathy. Peripheral neuropathy can be related to HIV itself or, more frequently, the side effects of many anti-HIV medications, such as stavudine (Zerit). Symptoms include numbness, hypesthesia (diminished sensitivity to stimulation), or anesthesia, and loss of sense of vibration and position (proprioception). Hypoglycemia, hyperlipidemia, and stress due to HIV do not cause these symptoms in patients with HIV who have been administered stavudine (Zerit).

What is the most common mode of transmission of human immunodeficiency virus (HIV)? 1. Injection drug use 2. Sexual transmission 3. Occupational exposure 4. Receiving blood or blood products

Sexual transmission. Sexual transmission remains the most common mode of HIV transmission in the world today and is responsible for the majority of the world's total acquired immune deficiency syndrome (AIDS) cases. Sexual activity provides the potential for exchange of semen, cervicovaginal secretions, and blood. Although the majority of HIV transmissions in the United States occur in men who have sex with me (MSM) via receptive anal intercourse, heterosexual transmission via anal intercourse is becoming increasingly prevalent. HIV transmission may occur by exposure to contaminated blood through the accidental or intentional sharing of injection equipment and paraphernalia. Such equipment includes syringes, needles, filters, and cooking devices. Injection drug users represent the second highest exposure category. In the United States, transfusion of infected blood and blood components and transplantation of infected tissues accounts for 1% of total adult and adolescent AIDS cases and 2% of pediatric AIDS cases. The risk of contracting HIV from a blood transfusion is estimated to be 1 in 400,000. In 1985, blood banks implemented procedures to screen all donated units of blood and blood products for HIV and to screen donors who might be at risk for HIV infection. As of December 2000, there had been 58 documented cases of occupationally acquired HIV or AIDS infection, with another 138 cases of possible occupational transmission (by the end of 2003, the total cumulative number of cases of AIDS in the United States was listed at 929,985). The overall risk of acquiring HIV after a percutaneous exposure is approximately 0.3%

Dysregulation and dysfunction of which cells contribute to the immune dysfunction in human immunodeficiency virus (HIV) disease? Select all that apply. 1. B cells 2. Platelets 3. Red cells 4. T-helper cells 5. CD4+ lymphocytes

T-helper cells CD4+ lymphocytes Immune dysfunction in HIV disease results primarily from dysregulation and dysfunction of the T-helper cells, also known as CD4+ lymphocytes. These cells are targeted because they have more CD4+ receptors on their surfaces than other cells. The CD4+ lymphocytes play a pivotal role in the ability of the immune system to recognize and defend against foreign invaders. CD4+ lymphocytes is another name for T-helper cells. The B cells actually function well during HIV infection. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. Platelets and red cells do not contribute to the process.

A patient who recently learned she was infected with human immunodeficiency virus (HIV) demands that the nurse keep her status a secret. What is the best way for the nurse to respond? 1. "I promise I will keep your status a secret until you are ready to tell people." 2. "Your partners and your family deserve to know so they can protect themselves." 3. "You seem embarrassed. Why don't you want your partners and family to know?" 4. "Although I respect your need for privacy, I am required to share this information with my coworkers and with necessary health agencies."

"Although I respect your need for privacy, I am required to share this information with my coworkers and with necessary health agencies." The nurse should be honest about who will be told of the patient's HIV status while creating open lines of therapeutic communication. The nurse should not make promises he or she cannot keep. Telling the patient that her partners and family deserve to know is not therapeutic. The nurse should not presume the patient is embarrassed. Asking, "Why don't you want your partners and family to know?" does not create open lines of communication.

The nurse is educating a male teenager about the prevention of human immunodeficiency virus (HIV).Which instructions given by the nurse would help promote safe sex? Select all that apply. 1. "Use oil-based lubricants when using condoms." 2. "Put on the condom as soon as erection occurs." 3. "Pull the condom snug against the tip of the penis." 4. "Limit the number of partners for sexual intercourse." 5. "Avoid sexual contact that involves the exchange of semen."

"Put on the condom as soon as erection occurs." "Limit the number of partners for sexual intercourse." "Avoid sexual contact that involves the exchange of semen." HIV is a sexually transmitted virus. To avoid contracting HIV, it is necessary to practice safe sex. This can be achieved by putting on the condom as soon as erection occurs. In order to prevent HIV, it is advised to limit the number of sexual partners, as well as avoid sexual contact that involves the exchange of semen. Not leaving space at the tip of the condom may cause the condom to break and increase the risk of HIV transmission. Water-based lubricants should be used for the condom.

The historical progress of the HIV infection began to be tracked in 1979. Arrange the historical events in sequence of their discovery. (Separate letters by a comma and space as follows: A, B, C, D) a. Infection in heterosexual men and women b. Infection in hemophiliacs c. Infection in injection drug users d. Increased incidence of Kaposi carcinoma in young homosexual men e. Increased incidence of Pneumocystis jiroveci (previously PCP)

ANS: E, D, C, B, A The history of the incidence of HIV infection was slow in being recognized. The first observation was an increase in incidence of Pneumocystis jiroveci, followed by increasing incidence of Kaposi carcinoma in the homosexual population. The infection began to be seen in injection drug users, hemophiliacs, then into the heterosexual population. PTS: 1 DIF: Cognitive Level: Application REF: Page 1977 OBJ: 1 | 12 TOP: History of incidence of HIV infection KEY: Nursing Process Step: N/A

A nurse explains that HIV is introduced to the systemic circulation by the _____, which is found in the mucous membranes.

ANS: macrophage The macrophage introduces HIV into the system. DIF: Cognitive Level: Knowledge REF: p. 667 OBJ: 2 TOP: Macrophage KEY: Nursing Process Step: Implementation

A patient is considering antiretroviral therapy (ART) for human immunodeficiency virus (HIV). What is the most important consideration about the patient when the primary health care provider is making a treatment choice? 1. Ability of the patient to pay for therapy 2. Ability of the patient to adhere to therapy 3. Ability of the patient to tolerate the side effects of therapy 4. Incompatibilities of the ART therapy with drugs the patient already takes

Ability of the patient to adhere to therapy. The most important consideration for whether or not to begin ART therapy is whether or not the patient will adhere to the treatment plan. If not, treatment failure and drug resistant organisms occur. Although side effects of therapy and the patient's ability to pay for therapy are important, they are not the most important considerations. The patient's current prescriptions can be changed to accommodate ART therapy.

The nurse is caring for a patient with human immunodeficiency virus (HIV) who reports diarrhea due to gastrointestinal infection. Which nursing interventions would help prevent complications related to diarrhea? Select all that apply. 1. Encourage high-fiber foods. 2. Assess for skin impairment. 3. Encourage a high-protein diet. 4. Discourage the intake of fruit juices. 5. Advise the patient to drink Gatorade.

Assess for skin impairment. Encourage a high-protein diet. Advise the patient to drink Gatorade. A patient with HIV who is suffering from diarrhea may have impaired skin integrity due to dehydration and malnutrition. So, the nurse should assess the patient for skin impairments. A high-protein diet helps replenish the nutrition lost from the body caused by the diarrhea. A patient with diarrhea is at risk for fluid and electrolyte imbalance. Therefore, the nurse should advise the patient to drink Gatorade, which provides energy and prevents dehydration. High-fiber foods are encouraged for patients with constipation. The intake of fruit juices should be encouraged for the patient with diarrhea.

A nurse is assisting with the delivery of a baby born to a human immunodeficiency virus (HIV)-positive mother. The mother received zidovudine early in pregnancy and had good prenatal care. The nurse knows that which intervention should be employed to ensure the safety of the baby? 1. Initiating contact precautions until the baby's viral load is known 2. Bathing the baby before administering the routine vitamin K injection 3. Wearing gloves while handling the baby until the baby has been bathed 4. Inserting an intravenous (IV) line immediately to administer zidovudine within 2 hours of birth

Bathing the baby before administering the routine vitamin K injection. Because the mother received zidovudine early in pregnancy and had good prenatal care, it is possible that the virus has not yet been transmitted to the baby. The baby should be bathed well with soap and water before the skin is pierced to avoid introducing the virus into the baby's system. Gloves are always worn when caring for a baby before the baby is bathed for the first time; this protects the health care worker, not the baby. Contact precautions are not necessary for patients with HIV. Although zidovudine should be administered within 2 hours of birth, the baby should be bathed before an IV line is inserted.

The nurse is counseling a group of patients before human immunodeficiency virus (HIV) antibody testing. Which nursing intervention is a part of the pretest counseling? 1. Discuss the importance of partner notification with the patients. 2. Remind the patients that treatments are availablefor this disease. 3. Educate the patients to avoid the future risk of exposure to infections. 4. Review the patients' health habits that can improve the immune system.

Educate the patients to avoid the future risk of exposure to infections. During the pretest counseling, the nurse educates patients about decreasing or avoiding future risk of exposure to HIV. Reminding the patients about the availability of treatments to treat the disease, reviewing the health habits that can improve the immune system, and discussing the importance of partner notification is a part of posttest counseling.

The nurse recommends human immunodeficiency virus (HIV) testing for a patient. Which risk factors the nurse might have found in this patient? Select all that apply. 1. Engaging in anal intercourse 2. Working as a prostitute 2 years ago 3. Being in a monogamous relationship 4. Testing positive for a chlamydial infection 5. Sharing needles when using intravenous drugs

Engaging in anal intercourse Working as a prostitute 2 years ago Testing positive for a chlamydial infection Sharing needles when using intravenous drugs The HIV virus is transmitted through blood and body fluids, including semen and vaginal secretions. Patients who have high-risk behaviors should be tested for HIV. Patients with a history of prostitution have frequent exposure to semen and vaginal secretions. Patients with other sexually transmitted diseases, like chlamydia, are at higher risk for HIV infection. Since HIV is spread through blood and body fluids, sharing needles when injecting drugs also increase the patient's risk. Patients who engage in anal intercourse, whether male or female, are at high risk for contracting HIV. Patients in a monogamous relationship have only one sexual partner and are therefore at low risk of acquiring HIV.

A patient visits the clinic after a possible exposure to human immunodeficiency virus (HIV) and would like more information on how she will be tested for HIV. The nurse correctly responds that which test will be used first? 1. Western blot test 2. Rapid plasma reagin test 3. Sexually transmitted infection screening 4. Enzyme-linked immunosorbent assay (ELISA)

Enzyme-linked immunosorbent assay (ELISA). ELISA is performed first for HIV. If a positive result is obtained, the Western blot test is performed, which is a more specific test. The rapid plasma reagin test is used for syphilis. Sexually transmitted infection screening may be done in conjunction, but it is not used initially for assessing for contraction of HIV.

A patient with acquired immunodeficiency syndrome (AIDS) and wasting syndrome is experiencing chronic diarrhea. The nurse should order which meal for the patient's dinner? 1. Fried chicken tenders with macaroni and cheese and raw vegetables 2. Ham and cheese sandwich on whole-grain bread with fresh fruit salad 3. Grilled chicken breast, oven roasted potatoes, and canned green beans 4. Fettuccine Alfredo with chicken and whole-wheat pasta with a chef's salad

Grilled chicken breast, oven roasted potatoes, and canned green beans. The nurse should provide a lactose-free meal that is low in fat, low in fiber, and high in potassium. Grilled chicken breast, oven-roasted potatoes, and canned green beans are low in fiber, high in potassium, and without dairy products. Macaroni and cheese, fettuccine Alfredo, and the ham and cheese sandwich are high in fat and contain dairy products. Raw vegetables, fresh fruit, and whole-grain bread and pasta are high in fiber.

What is the least virulent form of the human immunodeficiency virus (HIV) in the early stages? 1. HIV-1 2. HIV-2 3. Lymphadenopathy-associated virus (LAV) 4. Human T-cell lymphotropic virus type III (HTLV-III)

HIV-2 HIV-2 appears to be a less virulent form of the HIV virus, found primarily in western Africa and countries with historical or commercial ties to that geographic area. One study in Africa showed that women affected with HIV-2 did not develop acquired immunodeficiency syndrome (AIDS) during the 5-year period after infection, compared with 33% of those infected with HIV-1. HIV-1 is the more virulent strain of the HIV virus. It is found worldwide but is most prevalent in the United States and Europe. Human T-cell lymphotropic virus type III is the former name for HIV-1, named by an American scientist in 1984. It was renamed in 1986 to human immunodeficiency virus by the International Committee on Taxonomy of Viruses. Lymphadenopathy-associated virus was named in 1983 by researchers in France; it was believed to be the agent responsible for AIDS.

The nurse educator is teaching nursing students the effective ways to avoid transmission of human immunodeficiency virus (HIV) through syringes and needles. What instructions should the nurse include in the teachings? Select all that apply. 1. Look for oral or topical drug treatment opportunities. 2. Encourage the use of injectable drugs for the patients. 3. Use sterile needles and equipment for injecting the drugs. 4. Clean the shared syringe with clean water, followed by alcohol. 5. Clean the shared syringe with sodium hypochlorite 5.25% (Clorox) bleach.

Look for oral or topical drug treatment opportunities. Use sterile needles and equipment for injecting the drugs. Clean the shared syringe with sodium hypochlorite 5.25% (Clorox) bleach. Oral drugs should be promoted instead of injectables, whenever possible. Nurses should ensure that they use sterile needles and equipment while injecting drugs to avoid transmission of HIV. If the syringe is shared, reduced risk-preventive measures, such as cleaning the syringe with sodium hypochlorite 5.25% (Clorox) bleach twice, should be carried out. Injectable drugs should not be encouraged for patients, as they may increase the transmission of HIV. Cleaning a syringe with water and alcohol is not a strong enough solution to sterilize the syringe, which means the virus may still linger or live on it.

A nurse is caring for a patient in the end stages of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The nurse knows care planning is based on which concept? 1. Allowing family members to say goodbyes 2. Managing symptoms and improving quality of life 3. Helping the patient regain health and independence 4. Preventing complications and increasing the length of the patient's life

Managing symptoms and improving quality of life. In the end stages of HIV/AIDS, care planning is centered on managing the patient's symptoms and improving his or her quality of life. Finding a cure, regaining health and independence, and increasing the length of the patient's life are not the primary goals of care.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which nursing interventions help promote good oral hygiene? Select all that apply. 1. Provide a soft toothbrush to the patient. 2. Provide sodium bicarbonate mouth rinse. 3. Provide magnesium peroxide mouth rinse. 4. Provide abrasive toothpaste to the patient. 5. Provide nonabrasive toothpaste to the patient.

Provide a soft toothbrush to the patient. Provide sodium bicarbonate mouth rinse. Provide nonabrasive toothpaste to the patient. A patient with HIV needs meticulous oral care. The nurse should provide a soft toothbrush to the patient to avoid causing the gums to bleed. Sodium bicarbonate neutralizes acids produced during food intake and prevents microbial infections in the mouth. Therefore, the nurse should provide sodium bicarbonate mouth rinse to the patient to use before and after meals and at bedtime. Another way to promote good oral hygiene is to advise the patient to use nonabrasive toothpaste, which prevents bleeding gums. Magnesium peroxide mouth rinse is not advised for oral hygiene, and patients with HIV should avoid using abrasive toothpastes, as such toothpastes can cause bleeding gums.

The nurse is collecting data from a Hispanic patient with acquired immune deficiency syndrome (AIDS). The nurse finds that the patient is originally a resident of Germany, but has immigrated to the United States for employment. What should the nurse do in such a situation? 1. Provide care in accordance with the patient's European heritage. 2. Suggest that the patient bring a copy of the passport during each visit. 3. Suggest that the patient return to the country of origin for treatment. 4. Provide the patient with information about local AIDS support groups.

Provide the patient with information about local AIDS support groups. The nurse should provide appropriate care and help the patient get the right treatment, irrespective of the patient's financial and residential status. The nurse should inform the patient about local AIDS support groups, as the patient needs emotional support. As the patient is a Hispanic, the nurse should provide culturally competent care according to the patient's cultural preferences. Rather than asking the patient to submit a copy of his or her passport for care and treatment, the nurse should check to see whether the patient has health insurance. The nurse should not suggest that the patient should go back to Germany, as that demonstrates unprofessional and unethical behavior. The patient can take AIDS treatment in any part of the world.

A nurse is caring for a female patient with the human immunodeficiency (HIV) virus infection. Which statement about HIV infection regarding female patients is most significant? 1. Mean survival time is longer in female patients than in men. 2. Intravenous drug use is the major risk factor for HIV infection in women. 3. Recurrent vaginal candidiasis may be the first sign of the virus in female patients. 4. Women are the slowest-growing group with HIV infection and acquired immune deficiency syndrome (AIDS).

Recurrent vaginal candidiasis may be the first sign of the virus in female patients. Gynecologic problems and recurrent vaginal candidiasis may be the first signs of HIV infection in women. The World Health Organization (WHO) reported in 2010 that sexual exposure is the major risk factor for HIV infection in women, not intravenous drug use. Mean survival time is shorter in female patients. This may be due to late diagnosis and social or economic factors, which reduce access to medical care. Women are the fastest-growing group with HIV infection and AIDS.

Which statement is most accurate regarding diagnostic tests for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)? 1. CD8+ cell monitoring is one of the laboratory parameters used to track the progression of HIV disease. 2. With HIV antibody testing, a seronegative test result indicates that the individual is free from HIV infection. 3. The ability to detect HIV viral load measurements in plasma is a significant advancement in the monitoring of HIV disease. 4. The enzyme-linked immunosorbent assay (ELISA) is considered to be more accurate than the Western blot for HIV antibody testing.

The ability to detect HIV viral load measurements in plasma is a significant advancement in the monitoring of HIV disease. Viral load or burden refers to a quantitative measure of HIV viral RNA in the peripheral circulation, or level of virus in the blood. The ability to detect HIV viral load measurements in plasma is a significant advancement in the monitoring of HIV disease. With HIV antibody testing, a seronegative test result does not indicate that the individual is free from HIV infection, because seroconversion may not yet have occurred. Transmission of the virus can still occur if the individual has HIV infection and engages in risky behaviors. The Western blot test is considered to be more accurate than the ELISA for HIV antibody testing. ELISA is the first test usually used to test for HIV; if the result is positive, the test is repeated. After a second positive ELISA result, Western blot is used to confirm the diagnosis, because this is a more specific confirming test. CD4+ cell monitoring is one of the laboratory parameters used to track the progression of HIV disease. As the disease progresses, there is a decrease in the number of CD4+ cells. The more significant the loss, the more severe immunosuppression becomes.

Mycobacterium avium complex (MAC) initially infects which system in persons who have AIDS? a. bone marrow b. central nervous system c. gastrointestinal (GI) tract d. lymphatic

ANS: C These organisms are found in contaminated soil and water. They find their way into the host by way of the GI and respiratory tract.

The term that describes an immunosuppressed patient's inability to react to a skin test is .

ANS: anergic Anergic is the term that describes an immunosuppressed patient's ability to react to a skin test. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1899 OBJ: 2 TOP: Anergia KEY: Nursing Process Step: N/A

is a type of sexual option classified as "no risk" for a person to become infected with the HIV virus.

ANS: Abstinence Abstinence is refraining from sexual contact in which there is exchange of semen, vaginal secretions, or blood. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2000, Box 55-10 OBJ: 5 TOP: HIV infection prevention KEY: Nursing Process Step: Assessment

Early signs and symptoms of acquired immunodeficiency syndrome (AIDS) dementia complex include: a. psychotic behaviors b. depression c. hyperactive behavior d. inability to concentrate

ANS: D Early signs and symptoms of acquired immunodeficiency syndrome (AIDS) dementia include vague onset of symptoms such as poor concentration, forgetfulness and lose of balance.

A nurse is assessing a patient with AIDS for risk factors. What is recognized as the most risky behavior in the patient history? a. Oral sex without contact with the glans penis b. Oral sex with a condom c. Use of sex toys d. Anal sex with a condom

ANS: D Anal sex, even with a condom, is a higher risk behavior than the other three options. DIF: Cognitive Level: Comprehension REF: p. 667 OBJ: 3 TOP: Risk Factors KEY: Nursing Process Step: Assessment

The combination of efforts of the medical team, nutritionist, social workers, and clergy is the necessary approach to the complex needs of the patients with HIV infection.

ANS: multidisciplinary The use of many disciplines in a combined approach to a complex medical problem is multidisciplinary. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1999 OBJ: 11 TOP: Multidisciplinary KEY: Nursing Process Step: N/A

The nurse explains that an enzyme allows the RNA of the retrovirus to be changed to DNA and incorporated into the host's genetic material.

ANS: reverse transcriptase Reverse transcriptase allows the RNA of the retrovirus to be changed to DNA and incorporated into the host's genetic material. PTS: 1 DIF: Cognitive Level: Application REF: Page 1984 OBJ: 7 TOP: Reverse transcriptase KEY: Nursing Process Step: Implementation

An organism that can cross from an animal species to humans is a(n) organism.

ANS: zoonotic A zoonotic organism is an organism that can cross from an animal species to humans. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1978 OBJ: 1 TOP: Zoonotic KEY: Nursing Process Step: N/A

A nurse explains to a pregnant patient with AIDS that her baby will be treated with antiretroviral drugs for _____ weeks after birth.

ANS: 6 six The usual antiretroviral protocol for an infant born to a mother with AIDS is for 6 weeks. DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 7 TOP: Treatment of Newborns of AIDS Patients KEY: Nursing Process Step: Implementation

The nurse should instruct the patient who is diagnosed with AIDS to report signs of Kaposi sarcoma, which include: a. Reddish-purple skin lesions b. Open, bleeding skin lesions c. Blood-tinged sputum d. Watery diarrhea

ANS: A Kaposi sarcoma is a rare cancer of the skin and mucous membranes characterized by blue, red, or purple raised lesions seen mainly in Mediterranean men. Kaposi sarcoma: firm, flat, raised or nodular, hyperpigmented, multicentric lesions on the skin and mucous membranes. PTS: 1 DIF: Cognitive Level: Application REF: Page 1977 OBJ: 8 TOP: Kaposi sarcoma KEY: Nursing Process Step: Implementation

A client is undergoing drug treatment for human immunodeficiency virus (HIV) with nucleoside analog reverse transcriptase inhibitors (NRTIs). The nurse is aware that the outcomes of this treatment is: a. delayed onset of opportunistic infection b. prolonged progression of HIV in early symptomatic stage c. prevention of transmission to others d. increase of viral load

ANS: A NRTIs are a substance that closely resemble nucleosides, which are chemicals that form DNA. The viral genetic code is altered and cannot replicate. They do not prevent HIV transmission, but slow down replication of HIV in the body, delaying onset of other opportunistic infections.

A nurse removes a potted plant from the room of a patient with HIV. What is the nurse trying to prevent? a. Aspergillosis b. Candidiasis c. Coccidioidomycosis d. Cytomegalovirus (CMV)

ANS: A Aspergillosis can be contracted from the potting soil in and around the plant in the pot. DIF: Cognitive Level: Comprehension REF: p. 671 OBJ: 4 TOP: Aspergillosis KEY: Nursing Process Step: Implementation

What is the MOST common initial infection occurring in women who are human immunodeficiency virus (HIV) positive? a. candidiasis b. cryptosporidium c. Epstein-Barr virus d. hairy leukoplakia

ANS: A Vaginal candidiasis is the most common initial fungal infection occurring in HIV infected women.

A patient with HIV complains to the home health nurse that he has been having watery diarrhea for the past 10 days. The nurse suspects toxoplasmosis. What is the most significant question for the nurse to ask? a. "Have you stopped taking your antiviral medication?" b. "Have you been drinking alcohol?" c. "Have you been eating aged cheese or organ meats?" d. "Do you have a cat?"

ANS: D Cat litter boxes and undercooked meats are the major sources of toxoplasmosis, which causes a persistent watery diarrhea. DIF: Cognitive Level: Comprehension REF: p. 669 OBJ: 4 TOP: Toxoplasmosis KEY: Nursing Process Step: Assessment

What childhood exposure causes painful shingles experienced by the patient with HIV? a. Measles b. Mumps c. Impetigo d. Chickenpox

ANS: D Chickenpox can be reactivated as shingles. DIF: Cognitive Level: Knowledge REF: p. 671 OBJ: 4 TOP: Shingles KEY: Nursing Process Step: Implementation

What is the most common form of transmission of the HIV virus? a. Injection drug use b. Heterosexual contact c. Exposure to contaminated blood products d. Male to male

ANS: D Male-to-male transmission is still the most common mode. DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3 TOP: Transmission of HIV KEY: Nursing Process Step: Planning

To be diagnosed as having AIDS, the patient must be HIV-positive, have a compromised immune system without known immune system disease or recent organ transplant, and present with which of the following? a. Opportunistic infection b. A positive ELISA or Western blot test c. Weight loss, fever, and generalized lymphedema d. CD4+ lymphocyte count less than 200 mm3

ANS: D The 1993 expanded case definition of AIDS includes all HIV-infected people who have CD4+, T-lymphocyte counts of less than 200 cells/mm3; this includes all people who have one or more of these three clinical conditions: pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer, and it retains the 23 clinical conditions listed in the 1987 AIDS case definition. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1986, Table 55-1 OBJ: 2 TOP: Definition of AIDS disease KEY: Nursing Process Step: Assessment

A patient with HIV is diagnosed with progressive multifocal leukoencephalopathy (PML). What should a nurse encourage the patient to do? a. Take daily exercise for 30 minutes. b. Avoid excessive fats in the diet. c. Remove all potted plants from inside the home. d. Prepare advanced directives.

ANS: D The of advanced directives is essential as this disease is rapidly progressing, and death usually occurs 4 to 6 weeks after diagnosis. DIF: Cognitive Level: Application REF: p. 672 OBJ: 7 TOP: PML KEY: Nursing Process Step: Planning

Which nursing action should be implemented to increase the comfort of a patient with oral hair leukoplakia? a. Allow aspirin to melt in the mouth and then wash out with warm water. b. Encourage mouth rinses with warm salt water several times a day. c. Limit intake of ice cream and other cold foods. d. Offer fluids through a straw.

ANS: D Using a straw keeps fluids from flooding the entire oral cavity. Warm or acidic items are to be discouraged because they add to the discomfort. Ice cream and popsicles can numb the area. DIF: Cognitive Level: Application REF: p. 672 OBJ: 4 TOP: Oral Hair Leukoplakia KEY: Nursing Process Step: Planning

A nurse caring for a patient newly diagnosed with human immunodeficiency virus (HIV) is providing education on ways to delay the progression of HIV. When asked about social habits, the patient reveals that she uses intravenous drugs, smokes 50 cigarettes per day, and uses condoms with her multiple sex partners. Which initial goal would be most appropriate for this patient to promote a healthy lifestyle and delay disease progression? 1. Limit sexual partners to one person 2. Abstain from use of recreational drugs 3. Begin taking an oral contraceptive drug 4. Decrease cigarettes smoked per day to 20

Decrease cigarettes smoked per day to 20. Decreasing cigarettes smoked per day from 50 to 20 is an attainable goal that improves the health and immune system of the patient. Although limiting sexual partners to one, abstinence from recreational drug use, and prevention of pregnancy are important, these goals are not as attainable and as important to improving the immune system and maintaining health.

Which statement most accurately describes transmission of human immunodeficiency virus (HIV)? 1. HIV transmission occurs as a result of sexual preferences. 2. HIV transmission can occur via sharing food and/or utensils. 3. HIV can be transmitted via inanimate objects, such as toilet seats or computer keyboards. 4. HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk.

HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk. HIV transmission is dependent on the presence of the virus, the infectiousness of the virus, the susceptibility of the uninfected host, and any conditions that may put the person at risk. HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk. If these infected fluids are introduced into an uninfected person, the potential for HIV transmission exists. HIV transmission occurs as a result of sexual practices, not sexual preferences. HIV is generally transmitted by behaviors and not by casual contacts, such as hugging, dry kissing, shaking hands, or sharing food and utensils. HIV is an obligate virus, meaning that it must have a host organism to survive. HIV does not survive very long outside the human body; therefore it cannot be transmitted via inanimate objects.

A patient comes to the clinic with human immunodeficiency virus (HIV) seropositivity. The nurse understands that this patient has which manifestations? 1. Flulike symptoms 2. Weight loss, night sweats 3. Kaposi sarcoma, tuberculosis 4. Positive laboratory test result

Positive laboratory test result The patient with HIV seropositivity is infectious but shows no sign of disease. In the primary infectious period, flulike symptoms are present. Then the patient passes into the seropositivity stage. As the disease progresses the patient may experience weight loss, night sweats, and lymphadenopathy.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which findings suggest that the patient has early symptomatic disease? Select all that apply. 1. Recurrent infections 2. No reactivity to skin tests 3. CD4+ cell count of 400/mm3 4. Generalized lymphadenopathy 5. More CD4+ cells than CD8+ cells

Recurrent infections CD4+ cell count of 400/mm3 Generalized lymphadenopathy Early symptoms include recurrent infections and generalized lymphadenopathy due to compromised immunity. The early symptomatic phase of HIV occurs when the CD4+ cell count drops below 500/mm3. No reactivity to skin tests and the presence of more CD4+ cells than CD8+ cells indicate acquired immunodeficiency syndrome (AIDS).

What factor increases the probability of vertical transmission of a human immunodeficiency virus (HIV) infection? 1. The baby is born at term. 2. The mother's viral load is low. 3. The mother has good nutritional status. 4. The mother is in the initial stage of the HIV infection.

The mother is in the initial stage of the HIV infection. If the mother is in the initial stage of the HIV infection, there is an increased chance of vertical transmission of the infection, because the initial and later stages of infection are the times when more of the virus is circulating in the mother's blood and body fluids. If the mother's viral load is low, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors). A low viral load means that less of the virus is circulating in the mother's blood and body fluids. If the baby is born at term, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors). Extreme prematurity increases the baby's risk of contracting the virus during the actual delivery. If the mother has good nutritional status, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors).