Hepatitis & HIV
Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/L b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs
ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock
Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patients class schedule to help decide when the drugs should be taken.
The best approach to improve adherence is to learn about important activities in the patients life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patients schedule
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay
The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood.
The client with acquired immune deficiency syndrome (AIDS) asks the nurse why he must take so many medications. What is the best response by the nurse? a. "To decrease the possibility of the virus developing resistance to the medications." b. "Research has shown single medications to be ineffective." c. "Because the earlier we start multiple medications, the better for you." d. "To provide you with the most effective treatment for your illness."
a. "To decrease the possibility of the virus developing resistance to the medications." Decreasing the possibility of resistance is the key; single drugs can be effective, but viral resistance is a problem.
A patient with human immunodeficiency virus (HIV) has sought care because of the recent development of new skin lesions. The nurse should interpret these lesions as most likely suggestive of what? a. A reduction in the patients CD4 count b. A reduction in the patients viral load c. An adverse effect of antiretroviral therapy d. Virus-induced changes in allergy status
a. A reduction in the patients CD4 count Cutaneous signs may be the first manifestation of human immunodeficiency virus (HIV), appearing in more than 90% of HIV-infected people as immune function deteriorates. These skin signs correlate with low CD4 counts and may become very atypical in immunocompromised people. Viral load increases, not decreases, as the disease progresses.
The client receives zidovudine (Retrovir) for treatment of human immunodeficiency virus (HIV) infection. Which assessment data indicates an adverse reaction to zidovudine (Retrovir)? a. Decreased white blood count (WBC) b. Enlarged lymph nodes c. Fever d. Edema
a. Decreased white blood count (WBC) Bone marrow suppression is a common adverse effect of zidovudine (Retrovir), and decreased white blood cells (WBCs) are indicative of bone marrow suppression. Enlarged lymph nodes are not an adverse effect of zidovudine (Retrovir). Fever is the result of infection, not the use of zidovudine (Retrovir). Edema is not an adverse effect of zidovudine (Retrovir).
The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed
An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients
a. Many medications have interactions with antiretroviral drugs.
Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patients human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure
a. Needle stick with a needle and syringe used to draw blood Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patients blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.
A 36-year-old male patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer the HCV vaccine and immune globulin. c. Teach the patient about ribavirin (Rebetol) treatment. d. Explain that the infection will resolve over a few month
a. Schedule the patient for HCV genotype testing. Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Because most patients with acute HCV infection convert to the chronic state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV infection.
A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. The EIA test will need to be repeated to verify the results. b. A viral culture will be done to determine the progression of the disease. c. It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS). d. The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed
a. The EIA test will need to be repeated to verify the results. After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS
The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication noncompliance in the acquired immune deficiency syndrome (AIDS) population? a. The necessity of having to take multiple medications throughout the day b. A lack of understanding for the reason to take the medications c. The weight gain associated with the medications d. The difficulty with availability of medications to treat acquired immune deficiency syndrome (AIDS)
a. The necessity of having to take multiple medications throughout the day
The nurse plans to teach a client with human immunodeficiency virus (HIV) infection about zidovudine (Retrovir). What will the best plan of the nurse include? Select all that apply. a. Zidovudine (Retrovir) will need to be stopped if bone marrow depression occurs. b. Zidovudine (Retrovir) therapy frequently results in the development of anemia. c. Zidovudine (Retrovir) prevents spread of the virus through sexual contact. d. Zidovudine (Retrovir) will slow the disease, but not cure it. e. Zidovudine (Retrovir) was the first drug developed to treat acquired immune deficiency syndrome (AIDS)
a. Zidovudine (Retrovir) will need to be stopped if bone marrow depression occurs. b. Zidovudine (Retrovir) therapy frequently results in the development of anemia. d. Zidovudine (Retrovir) will slow the disease, but not cure it.
A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection.
a. acute retroviral syndrome. Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.
The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for a. leukopenia. b. hypokalemia. c. polycythemia. d. hypoglycemia.
a. leukopenia. Therapy with ribavirin and a -interferon may cause leukopenia
A patient is started on efavirenz (Sustiva) for HIV. What should the nurse teach the patient about this drug? a. Efavirenz (Sustiva) will cure the disease over time. b. Efavirenz (Sustiva) will not cure the disease but may signifcantly extend the life expectancy. c. Efavirenz (Sustiva) will be used prior to vaccines. d. Efavirenz (Sustiva) will prevent the transmission of the disease.
b. Efavirenz (Sustiva) will not cure the disease but may signifcantly extend the life expectancy.
Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/L and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).
b. Encourage adequate nutrition, exercise, and sleep. The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4 + level would receive ART. c
An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer? a. Corticosteroids b. Gamma globulin c. Hepatitis B vaccine d. Fresh frozen plasma
b. Gamma globulin The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The hepatitis B vaccination series should be started to provide active immunity.
A patient with HIV has been taking lopinavir with ritonavir (Kaletra) for the past 8 years and has noticed a redistribution of body fat in the arms, legs, and abdomen (lipodystrophy). The nurse will evaluate this patient for what other additional adverse effects associated with this drug? (Select all that apply.) a. Renal failure b. Hyperglycemia c. Pancreatitis d. Bone marrow suppression e. Hepatic failure
b. Hyperglycemia c. Pancreatitis e. Hepatic failure Rationale: Hyperglycemia, pancreatitis, and hepatic failure are adverse effects associated with lopinavir with ritonavir (Kaletra). Options 1 and 4 are incorrect. Renal failure and bone marrow suppression are not adverse effects associated with this drug.
Which goal has the highest priority in the plan of care for a 26-year-old homeless patient admitted with viral hepatitis who has severe anorexia and fatigue? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable environment. d. Identify sources of hepatitis exposure.
b. Maintain adequate nutrition. The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as ensuring adequate nutrition. Although the patients activity level will be gradually increased, rest is indicated during the acute phase of hepatitis
A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, I am very nervous about making my baby sick. Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).
b. Most infants born to HIV-positive mothers are not infected with the virus. Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.
A 34-year old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the health care provider before administration? a. Ribavirin (Rebetol, Copegus) 600 mg PO bid b. Pegylated a-interferon (PEG-Intron, Pegasys) SQ daily c. Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching d. Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea
b. Pegylated a-interferon (PEG-Intron, Pegasys) SQ daily Pegylated a -interferon is administered weekly. The other medications are appropriate for a patient with chronic hepatitis C infection.
Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 20 years ago c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.
b. The patient used IV drugs about 20 years ago Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by traveling in underdeveloped countries.
The nurse provides care for clients with acquired immune deficiency syndrome (AIDS). Which laboratory test is the best indicator of effective treatment with antiviral medications? a. CD4 count b. Viral load c. T4 lymphocyte count d. Absolute neutrophil count
b. Viral load The viral load is an actual count of viral presence and is the best of these tests.
Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when a specimen of the patients blood reveals a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.
b. anti-HBs. The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV
A client with clinical AIDS is treated with a protease inhibitor. The highest priority nursing intervention based on this medication is to monitor for incidence of: a. hepatic steatosis. b. hyperglycemia. c. urinary retention. d. coma.
b. hyperglycemia. An adverse reaction with the protease inhibitors is hyperglycemia and the development of diabetes mellitus.
The nurse will plan to teach the patient diagnosed with acute hepatitis B about a. side effects of nucleotide analogs. b. measures for improving the appetite. c. ways to increase activity and exercise. d. administering a-interferon (Intron A).
b. measures for improving the appetite. Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended
The client has acquired immune deficiency syndrome (AIDS) and has just learned she is pregnant. She tearfully asks the nurse if her baby will die of acquired immune deficiency syndrome (AIDS). What is the nurse's best response? a. "There are special tests that we can do to see if your baby is positive before birth." b. "I know that is a great worry for all of us." c. "Drug therapy can help prevent your child from contracting the virus." d. "There are drugs that can be given after birth to reverse AIDS."
c. "Drug therapy can help prevent your child from contracting the virus." A regime of oral zidovudine (Retrovir) will decrease the possibility of mother-to-baby transmission by 70%.
Which of the following findings would suggest that myelosuppression is occurring in a patient who is taking zidovudine (Retrovir)? a. Increase in serum blood urea nitrogen (BUN) levels b. Increase in white blood cell (WBC) count c. Decrease in platelet count d. Decrease in blood pressure
c. Decrease in platelet count Rationale: Myelosuppression is the declining ability of the bone marrow to produce blood cells. A de- crease in platelet count may indicate myelosuppression is occurring. Options 1, 2, and 4 are incorrect. An increase in BUN or a decrease in blood pressure does not indicate myelosuppression. A decrease, rather than increase, in WBC count would be expected if myelosuppression is occurring.
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
c. Discuss a change in antiretroviral therapy. A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
c. Explain to the patient that this is an expected finding. Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusion
c. Prevention of HIV transmission between sexual partners
A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.
c. Remind the patient about the need to return for retesting to verify the results. After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis iroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. The patient meets the criteria for a diagnosis of an acute HIV infection. b. The patient will be diagnosed with asymptomatic chronic HIV infection. c. The patient has developed acquired immunodeficiency syndrome (AIDS). d. The patient will develop symptomatic chronic HIV infection in less than a year.
c. The patient has developed acquired immunodeficiency syndrome (AIDS). Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection
he nurse accidentally sticks herself with a needle after starting an intravenous (IV) line on a client with acquired immune deficiency syndrome (AIDS). The nurse tells the supervisor about the accident. What is the best initial response by the supervisor to decrease anxiety in the nurse? a. "If you are started on medications soon, it will decrease the severity of the disease." b. "Workers compensation will cover the cost of your illness and medications." c. "Did you use the hospital protocols for starting intravenous (IV) lines on a client with acquired immune deficiency syndrome (AIDS)?" d. "Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small."
d. "Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small." There have been very few cases of client-to-health care worker transmission; the risk is very small.
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/L. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patients social support system c. Potential medication side effects d. Patients ability to comply with ART schedule
d. Patients ability to comply with ART schedule Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART
The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patients blood glucose level is 142 mg/dL. b. The patient complains of feeling constantly tired. c. The patient is unable to state the side effects of the medications. d. The patient states, Sometimes I miss a dose of zidovudine (AZT).
d. The patient states, Sometimes I miss a dose of zidovudine (AZT). Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART.
A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patients illness, the nurse would expect serologic testing to reveal a. antibody to hepatitis D (anti-HDV). b. hepatitis B surface antigen (HBsAg). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM) Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity