HIV.AIDS Optional EAQ's + Clicker Questions
Which instructions should the nurse include when teaching preexposure prophylaxis (PrEP) to a group of adults at high risk of sexually acquired HIV infection? Select all that apply. 1) Safe sex practices 2) Regular HIV testing 3) Frequent hand washing 4) Discreet use of antibiotics 5) Risk reduction counseling
Correct 1, 2, 5 Preexposure prophylaxis refers to strategies that aim to prevent HIV infection in adults at high risk of developing sexually acquired HIV infection. The strategies include safe sex practice, regular HIV testing for screening and early detection, and risk reduction counseling. Frequent hand washing helps to prevent transmission of infection in general, but not specifically sexually acquired HIV infection. Discreet use of antibiotics is helpful in preventing antibiotic-resistant infections, but not specifically HIV infection.
The nurse is reviewing home medications with a patient diagnosed with human immunodeficiency virus (HIV). Which medications and over-the-counter pills may have interactions with HIV therapy? Select all that apply. 1) Antacids 2) St. John's wort 3) Protease inhibitors 4) Integrase inhibitors 5) Proton pump inhibitors
Correct 1, 2, 5 Antacids, proton pump inhibitors, and St. John's wort all interact with HIV drug therapy. Protease inhibitors and integrase inhibitors are drugs used to treat HIV.
A nurse is caring for a patient who is diagnosed with HIV infection. What education can the nurse provide the patient in order to delay the progression of the disease? Select all that apply. 1) Eat a well-balanced diet. 2) Avoid all kinds of vaccinations. 3) Get adequate rest and exercise. 4) Avoid alcohol, tobacco, and drug use. 5) Avoid exposure to new infectious agents.
Correct 1, 3, 4, 5 The progression of HIV infection to AIDS may be delayed by maintaining an optimal health level. The patient should get adequate rest and exercise to promote independence and maintain health. Exposure to infectious agents should be avoided because of the patient's compromised immunity. Vaccination will help to increase the immunity of the patient. Eating a well-balanced diet would help the patient restore the nutrients lost during the infectious process and maintain energy. Alcohol, tobacco, and drug use may worsen the condition and should be avoided.
A goal of Healthy People 2020 is to prevent the transmission of human immunodeficiency virus (HIV) and early detection of those infected. Which are strategies aimed at meeting this goal? Select all that apply. 1) Increased accessibility to HIV testing facilities 2) Mandatory HIV testing as a routine part of health care 3) Denial of sterile intravenous equipment to drug abusers 4) Inclusion of voluntary HIV testing in routine prenatal care 5) Advocacy for safer sex practices including use of condoms
Correct 1, 4, 5 Strategies aimed at prevention and early detection of HIV include increasing accessibility to HIV testing facilities (e.g., drug and alcohol treatment centers and community-based organizations); offering voluntary HIV testing as part of routine prenatal care; and advocating for safer sex practices (including use of condoms). Mandated HIV testing may result in avoidance of routine health care. Taking measures to prevent drug abusers from sharing needles is imperative. Many needle/syringe exchange programs have decreased the incidence of HIV among intravenous drug abusers.
A nurse is taking a blood sample with a syringe and large-bore needle from a patient with chronic human immunodeficiency virus (HIV) who has a CD4 +T-cell count of 123/μL. What factors may affect the transmission of HIV infection if the nurse sustains a needle stick from the contaminated needle? Select all that apply. 1) Viral load 2) Age of the nurse 3) Age of the patient 4) Immune status of nurse 5) Volume of blood exposed to
Correct 1, 4, 5 Patients with a poor immune status are more susceptible to any kind of infection, including HIV. The concentration of the virus is an important variable. Other variables that influence the transmission are the volume of blood, virulence of the virus, and concentration of the organism in the blood. Large amounts of HIV can be found in the blood, and to a lesser extent in the semen, during the first six months of infection and again during the late stages. HIV-positive patients can transmit the infection at any age to a person of any age when the route of transmission is established. Therefore the age of the patient or nurse does not affect the transmission of HIV infection to the nurse.
The nurse is planning care for a patient with human immunodeficiency virus (HIV). Which priority nursing action will most help the patient prevent complications? 1) Encourage the patient to eat three high-protein meals each day. 2) Educate the patient about the importance of adherence to drug therapy. 3) Plan an exercise regimen for the patient to adhere to three times a week. 4) Obtain a prescription for the patient to take antibiotics prophylactically to prevent infections.
Correct 2 The priority nursing action is to be sure the patient understands the importance of adhering to the antiviral medication regimen to prevent increasing viral loads. It is not required that the patient eat three high-protein meals per day, and if there is any kidney impairment, this could create problems. Taking antibiotics prophylactically may cause an antibiotic-resistant infectious process, and it is only necessary to take the antibiotics when there is a diagnosed infection. Some form of exercise should be performed regularly, but it is not the most important factor in preventing complications due to HIV.
A patient was exposed to human immunodeficiency virus (HIV) during unprotected intercourse. Two weeks later, the patient reports fever, swollen lymph nodes, sore throat, headache, malaise, nausea, and muscle and joint pain. Which process explains these manifestations? Select all that apply. 1) Flu 2) Seroconversion 3) Mononucleosis 4) Acute HIV infection 5) Guillain-Barré syndrome
Correct 2, 4 In this case, the patient would have acquired HIV infection from the donor. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompany seroconversion (when HIV-specific antibodies develop). These symptoms, called acute HIV infection, generally occur within 2 to 4 weeks after the initial infection and last for 1 to 3 weeks, although some symptoms may persist for several months. Many people, including health care providers, mistake acute HIV symptoms for a bad case of the flu. Some people also develop neurologic complications, such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome. This patient has not yet developed neurologic symptoms.
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? 1) A new onset of polycythemia 2) Presence of mononucleosis-like symptoms 3) A sharp decrease in the patient's CD4+ count 4) A sudden increase in the patient's white blood cell (WBC) count
Correct 3 A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. Mononucleosis-like symptoms, such as malaise, headache, and fatigue, are typical of early HIV infection and seroconversion. A patient's WBC count is very unlikely to increase suddenly, with decreases being typical.
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1) "The baby probably will be infected with HIV." 2) "Only an abortion will keep your baby from having HIV." 3) "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4) "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
Correct 3 On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism are two variables that influence whether transmission of HIV occurs. Volume, virulence, and concentration of the organism, as well as host immune status, are variables related to transmission via blood, semen, vaginal secretions, or breast milk.
The nurse was stuck accidently with a needle used on a patient with human immunodeficiency virus (HIV). After reporting this, what is a priority action by the nurse? 1) A negative evaluation by the manager 2) Applying personal protective equipment 3) Start on combination antiretroviral therapy 4) Begin counseling to report blood exposures
Correct 3 Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first.
A patient asks the nurse about rapid testing for human immunodeficiency virus (HIV) infection at home. What is the best response by the nurse? 1) "These tests are done on freshly voided urine." 2) "Positive rapid tests should be repeated for confirmation." 3) "Rapid tests are screening tests for antibodies, not for antigens." 4) "These tests are not recommended by the Centers for Disease Control and Prevention (CDC)."
Correct 3 Rapid testing is recommended strongly by the CDC and can be done in a variety of settings. These tests are screening tests for antibodies, not antigens; testing is done on oral fluid samples. Positive rapid tests need to be confirmed with the more specific Western blot (WB) or immunofluorescence assay (IFA). This step necessitates a blood draw and a return appointment to get results.
The nurse is assessing a patient with human immunodeficiency virus (HIV) taking antiretroviral therapy (ART) for eight months. Which education should the nurse continue to provide to the patient about metabolic side effects of ART? Select all that apply. 1) Glucose levels often decrease because of insulin resistance. 2) These are a bothersome set of symptoms that are ultimately harmless. 3) Body changes include central fat accumulation and peripheral wasting. 4) Elevated triglyceride levels and decreases in high-density lipoproteins can occur. 5) Exercise, dietary changes, and calcium and vitamin D supplements for bone health.
Correct 3, 4, 5 Some HIV-infected patients, especially those who have been infected and on ART for a long time, develop a set of metabolic disorders that include changes in body shape (i.e., fat deposits in the abdomen, upper back, and breasts, along with fat loss in the arms, legs, and face) caused by lipodystrophy, hyperlipidemia (i.e., elevated triglycerides and decreases in high-density lipoproteins), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease. These disorders are treated early to prevent complications. It is important to recognize and treat these problems early, especially because cardiovascular disease and lactic acidosis are potentially fatal complications.
A nurse is assessing a patient's human immunodeficiency virus (HIV) risk. Which questions should the nurse ask to assess for an increased risk? Select all that apply. 1) "Have you ever had oral thrush?" 2) "Have you ever been hospitalized?" 3) "Have you ever had a blood transfusion?" 4) "Have you ever had unprotected sexual intercourse?" 5) "Have you ever had a sexually transmitted infection?"
Correct 3, 4, 5 To help a patient assess risk of HIV, the nurse should ask questions regarding history of blood transfusion, unprotected sexual intercourse, and sexually transmitted disease. These questions provide the minimum information needed to initiate a risk assessment. A positive response to any of these questions should be followed by an in-depth exploration of issues related to the identified risk. A history of oral thrush or hospitalization may not indicate risky behavior and may not contribute to risk assessment.
A patient was diagnosed with human immunodeficiency virus (HIV) approximately 12 years ago. The nurse recognizes that which assessment findings are diagnostic of acquired immunodeficiency syndrome (AIDS)? Select all that apply. 1) Typhoid fever 2) Hepatitis A infection 3) Esophageal candidiasis 4) Pulmonary cryptococcosis 5) CD4 count less than 200 cells/µL
Correct 3, 5 To diagnose AIDS, the patient should have an opportunistic infection such as esophageal candidiasis, or the CD4 count should be less than 200 cells/µL of blood. Typhoid fever is not a diagnostic parameter for diagnosis of AIDS. Hepatitis A infection is not diagnostic of AIDS because it is not an opportunistic infection. Extrapulmonary cryptococcosis is diagnostic of AIDS, but pulmonary cryptococcosis is not.
When reviewing the assessment data of a human immunodeficiency virus (HIV) patient, the nurse notes that the patient's CD4 cell count is below 200, and that the patient has lost more than 10% of his or her ideal body weight. What does the nurse suspect is occurring with this patient? 1) Kaposi sarcoma 2) Cytomegalovirus (CMV) 3) Pneumocystis jiroveci pneumonia (PCP) 4) Acquired immunodeficiency syndrome (AIDS)
Correct 4 A patient with HIV is diagnosed with AIDS when the CD4 T cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS.
A nurse is caring for a patient who is suspected of being positive for human immunodeficiency virus (HIV) in the hospital setting. What method of transmission precaution should the nurse be sure to use when caring for this patient? 1) Contact precautions 2) Airborne precautions 3) Droplet precautions 4) Standard precautions
Correct 4 The standard precautions system applies to (1) blood; (2) all body fluids, secretions, and excretions; (3) non-intact skin; and (4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms in hospitals. Standard precautions should be applied to all patients regardless of diagnosis or presumed infection status. It is not necessary to use airborne, contact, or droplet precautions.
The nurse assesses a patient who tests positive for human immunodeficiency virus (HIV). Which finding would the nurse identify as the highest priority for follow-up? 1) Anorexia 2) Insomnia 3) Mood swings 4) New or productive cough
Correct 4 The patient who tests positive for HIV should be informed to report a new or productive cough within 24 hours after symptoms begin. After evaluation of the cough, follow-up care for anorexia, insomnia, and mood swings is secondary.
The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV) from clients. Which practice is most effective? A.Consistent use of Standard Precautions B.Double-gloving before body fluid exposure C.Labeling charts and armbands "HIV+" D.Wearing a mask within 3 feet of the client
Correct A According to The Joint Commission, the most effective preventative measure to avoid HIV exposure is consistent use of Standard Precautions. Double-gloving is not necessary. Labeling charts and armbands in this fashion is a violation of the Health Information Portability and Accountability Act (HIPAA). Wearing a mask within 3 feet of the client is part of Airborne Precautions and is not necessary with every client contact.
A client has just been diagnosed with human immune deficiency virus (HIV). The client is distraught and does not know what to do. What intervention by the nurse is best? A.Assess the client for support systems. B.Determine if a clergy member would help. C.Explain legal requirements to tell sex partners. D.Offer to tell the family for the client.
Correct A This client needs the assistance of support systems. The nurse should help the client identify them and what role they can play in supporting him or her. A clergy member may or may not be welcome. Legal requirements about disclosing HIV status vary by state. Telling the family for the client is not appropriate, may be a violation of HIPAA, and the client may not want the family to know.
The nurse is caring for a client diagnosed with human immune deficiency virus. The client's CD4+ cell count is 399/mm3. What action by the nurse is best? A.Counsel the client on safer sex practices/abstinence. B.Encourage the client to abstain from alcohol. C.Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors. D.Help the client plan high-protein/iron meals.
Correct A This client remains highly infectious and should be counseled on either safer sex practices or abstinence. Abstaining from alcohol is healthy but not required. Genetic testing is not commonly done. High-protein/iron meals are important for people who are immunosuppressed, but helping to plan them does not take priority over stopping the spread of the disease.
A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load. What action should the nurse take first? A.Ask the client about travel to any foreign countries. B.Assess the client for adherence to the drug regimen. C.Determine if the client has any new sexual partners. D.Request information about new living quarters or pets.
Correct B Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time. Since this client's viral load has increased dramatically, the nurse should first assess this factor. After this, the other assessments may or may not be needed.
A client with HIV infection is hospitalized for an unrelated condition, and several medications are prescribed in addition to the ART regimen already being used. What action by the nurse is most important? A.Ensure that the client understands the new medications. B.Give the new drugs without considering the old ones. C.Consult with the pharmacy about drug interactions. D.Schedule all medications at standard times.
Correct C The drug regimen for someone with HIV/AIDS is complex. Many medications must be given at specific times of the day and may interact with other drugs. The nurse should consult with a pharmacist about possible interactions. Client teaching is important but does not take priority over ensuring the medications do not interfere with each other, which could lead to drug resistance or a resurgence of symptoms.
All of the following are AIDS-defining characteristics EXCEPT: A.CD4+ cell count less than 200/mm3 or less than 14% B.Infection with Pneumocystis jiroveci C.Positive antigen-antibody test for human immune deficiency virus (HIV) D.Presence of HIV wasting syndrome
Correct C A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as Pneumocystis jiroveci and HIV wasting syndrome. Having a positive antigen-antibody test and taking antiretroviral medications are not AIDS-defining characteristics.
A client with HIV/AIDS asks the nurse why gabapentin (Neurontin) is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best? A."Gabapentin can be used as an antidepressant too." B."I have no idea why you should be taking this drug." C."This drug helps treat the pain from nerve irritation." D."You are at risk for seizures due to fungal infections."
Correct C Many classes of medications are used for neuropathic pain, including gabapentin. It is not being used as an antidepressant or to prevent seizures from fungal infections. If the nurse does not know the answer, he or she should find out for the client.
A student nurse is learning about human immune deficiency virus (HIV) infection. Which statement about HIV infection is NOT correct? A.Antibodies produced are incomplete and do not function well. B.Macrophages stop functioning properly. C.Opportunistic infections and cancer are leading causes of death. D.People with stage 1 HIV disease are not infectious to others. E.CD4+ cells begin to create new HIV virus particles.
Correct D In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produces are incomplete and do not function well. Macrophages also stop functioning properly. Opportunistic infections and cancer are the two leading causes of death in clients with HIV infection. People infected with HIV are infectious in all stages of the disease.
A client with acquired immune deficiency syndrome is in the hospital with severe diarrhea. The nurse may delegate all of the following to the UAP (unlicensed assistive personnel) EXCEPT: A.Assisting the client to get out of bed to prevent falls B.Obtaining a bedside commode if the client is weak C.Providing gentle perianal cleansing after stools D.Assessing the client's fluid and electrolyte status E.Reporting any perianal abnormalities
Correct D The UAP can assist the client with getting out of bed, obtain a bedside commode for the client's use, cleanse the client's perianal area after bowel movements, and report any abnormal observations such as redness or open areas. The nurse assesses fluid and electrolyte status.
A client is hospitalized with Pneumocystis jiroveci pneumonia. The client reports shortness of breath with activity and extreme fatigue. What intervention is best to promote comfort? A.Administer sleeping medication. B.Perform most activities for the client. C.Increase the client's oxygen during activity. D.Pace activities, allowing for adequate rest.
Correct D This client has two major reasons for fatigue: decreased oxygenation and systemic illness. The nurse should not do everything for the client but rather let the client do as much as possible within limits and allow for adequate rest in between. Sleeping medications may be needed but not as the first step, and only with caution. Increasing oxygen during activities may or may not be warranted, but first the nurse must try pacing the client's activity.
An HIV-positive client is admitted to the hospital with Toxoplasmosis. Which action by the nurse is most appropriate? A.Initiate Contact Precautions. B.Place the client on Airborne Precautions. C.Place the client on Droplet Precautions. D.Use Standard Precautions consistently.
Correct D Toxoplasmosis is an opportunistic infection that poses no threat to immunocompetent health care workers. Use of Standard Precautions is sufficient to care for this client.
The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? 1) "I need to keep my appointments for follow-up laboratory work." 2) "I will call my health care provider if I am too sick to take these drugs." 3) "Once my tests show that the virus has decreased, I cannot give HIV to another person." 4) "I won't take any new drugs or herbal products without checking with my health care provider first."
Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first.
A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the patient reflects a correct understanding of the purpose of these drugs? 1) "Antiretroviral drugs can cure HIV infection." 2) "These drugs work by decreasing the viral load." 3) "Antiretroviral drugs will prevent opportunistic diseases." 4) "These drugs only work in the initial replication stage of the virus."
The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4 + T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection, nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle.
