NCLEX Qs 280 Exam 3: HIV/AIDS & TB

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

ANS 1, 2 Immune dysfunction in HIV disease results primarily from dysregulation and dysfunction of the T-helper cells, also known as the 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 are another name for the 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.REF: Page 1984 Foundations and Adult Health Nursing, 7th Edition

Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.) 1- "Take the isoniazid on an empty stomach." 2- "Notify your healthcare provider if your skin starts to turn yellow." 3- "Numbness or tingling in your extremities is a normal response when taking this drug." 4- "Your urine will turn reddish orange because of the effects of this drug." 5- "Use of this drug is associated with vision problems."

ANS 1, 2 Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching Lehne 10th Edition

When teaching a patient about tuberculosis, the nurse will include which statements? (Select all that apply.) 1- "Most people infected with M. tuberculosis are asymptomatic." 2- "Most people infected with M. tuberculosis harbor dormant bacteria for life if they do not receive drug therapy." 3- "Treatment of tuberculosis lasts 3 months." 4- "Isoniazid can cause peripheral neuropathy by depleting vitamin B12." 5- "Rifampin can cause optic neuritis."

ANS 1, 2 Treatment for tuberculosis usually lasts 6 months to 2 years. Isoniazid can cause peripheral neuropathy by depleting vitamin B6. Ethambutol, not rifampin, can cause optic neuritis. The other two statements are true and can be included in patient teaching. Lehne 10th Edition

Which couple has the highest risk for sexual transmission of HIV without the use of a condom or dental dam? A- Uninfected male performing vaginal intercourse with an infected female B- Infected male performing vaginal intercourse with an uninfected female C- Uninfected male performing anal intercourse with an infected male D- Infected male performing oral sex on an uninfected male

B- Infected male performing vaginal intercourse with an uninfected female Rationale: Sexual acts or practices that permit infected seminal fluid to come into contact with mucous membranes or nonintact skin are the most risky for sexual transmission of HIV. HIV is more easily transmitted from an infected man to an uninfected woman than vice versa. This is because HIV is most easily transmitted when infected body fluids come into contact with mucous membranes or nonintact skin. The vagina has much more mucous membrane than does the penis. Iggy 8th Edition

A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings? Choose 1 answer: 1- The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). 2- This is an expected finding because the patient has tested positive for HIV. 3- The patient is now in the latent stages of HIV infectio 4- These findings provide evidence that the patient has seroconverted.

1- The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). Seroconversion refers to the development of detectable antibodies against HIV antigens. Hint #22 / 3 A patient in the latent stage of HIV infection is often asymptomatic. Hint #33 / 3 AIDS is diagnosed when a patient has a CD4 count of less than 200 cells/mcL. The patient's symptoms are consistent with Pneumocystis jirovecii, an infection that can develop in HIV-infected patients as the CD4 count decreases. Khan Academy

#6 The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment? 1- Arrange for a health care worker to watch the client take the medication. 2- Give the client written instructions about how to take prescribed medications. 3- Have the client repeat medication names and side effects. 4- Instruct the client about the possible consequences of nonadherence.

1- Arrange for a health care worker to watch the client take the medication. Because this client is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy. Giving a client who is homeless and addicted to heroin written instructions on how to take prescribed medications is placing too much responsibility on the client to follow through. Also, the question does not indicate whether the client can read. The fact that the client can state the names and side effects of medications does not mean that the client understands what the medications are and why he or she needs to take them. A client who is homeless may be more concerned with obtaining shelter and food than with properly taking his or her medication. Iggy 8th Edition

A patient who is human immunodeficiency positive (HIV) positive is receiving a nucleoside reverse transcriptase inhibitor (NRTI). Which of these clinical findings would indicate the patient is experiencing an adverse effect of this medication? Choose 1 answer: 1- Decreased hemoglobin 2- Increased blood glucose 3- Metabolic alkalosis 4- Weight gain

1- Decreased hemoglobin Toxicity to the mitochondria caused by NRTIs causes lactic acidosis. NRTIs cause bone marrow depression. Bone marrow depression results in anemia and neutropenia. Khan Academy

#3 A client is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? 1- Ethambutol 2- Isoniazid 3- Pyrazinamide 4- Rifampin

1- Ethambutol Ethambutol can cause optic neuritis, leading to blindness at high doses. When discovered early and the drug is stopped, problems can usually be reversed. Both isoniazid and pyrazinamide may cause liver failure; side effects of major concern include jaundice, bleeding, and abdominal pain. Rifampin will cause the urine and all other secretions to have a yellowish-orange color; this is harmless. Contact lenses will also be stained and oral contraceptives will be less effective. Iggy 8th Edition

During the screening process for tuberculosis (TB), the healthcare provider notes that the patient received the bacilli Calmette-Guérin (BCG) vaccination several years ago. Which of the following is the best method to determine this patient's TB status? Choose 1 answer: 1- Interferon-gamma release assay (IGRA) 2- Bronchoscopy for acid-fast bacteria (AFB) smear and culture 3- Computerized tomography (CT) 4- Tuberculin skin test (TST)

1- Interferon-gamma release assay (IGRA) The BCG vaccine may cause a positive TST even though the patient has not been infected with the TB bacteria. A CT scan may be indicated if the results of a chest radiograph suggest TB infection. Unlike the TST, IGRAs are not affected by the BCG vaccination and are not expected to give a false-positive result, so this is the preferred test for a patient with a history of BCG vaccination. A sputum sample is collected from patients when TB is suspected, but sputum collection can be done less invasively than bronchoscopy by deep sputum-producing coughing or sputum induction. Khan Academy

A patient who has tuberculosis is treated with isoniazid. The nurse should monitor for which symptoms, which could indicate a vitamin B6 deficiency caused by the medication? 1- Numbness and tingling in the fingers and toes 2- Alopecia and flaking scalp 3- Dry skin and brittle nails 4- Oral ulcers and tongue fissures

1- Numbness and tingling in the fingers and toes Dose-related peripheral neuropathy is the most common adverse effect of isoniazid. It results from a vitamin B6 deficiency, which is corrected by taking oral supplements. Symptoms include numbness and tingling in the fingers and toes. Alopecia and flaking scalp, oral ulcers and tongue fissures, and dry skin and brittle nails are not adverse effects of isoniazid-induced vitamin B6 deficiency. Lehne 10th Edition

What is the most common mode of transmission of HIV? 1- Sexual transmission 2- Injecting drug use 3- Receiving blood or blood products 4- Occupational exposure

1- 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 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 the MSM category 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 injecting equipment and paraphernalia. Such equipment includes syringes, needles, filters, and cooking devices. Injecting 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 whom might be at risk for HIV infection. As of December 2000, there have 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% Foundations and Adult Health Nursing, 7th Edition

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? 1- The dietary worker hands the disposable meal trays to the LPN assigned to the client. 2- The social worker encourages the client to verbalize about stressors at home. 3- A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. 4- The health care provider orders vital signs, including temperature, every 8 hours

1- The dietary worker hands the disposable meal trays to the LPN assigned to the client. The dietary worker giving the meal tray to the LPN limits the number of health care personnel entering the room, thus reducing the risk for infection. Verbalizing stressors does not reduce the risk for infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection, but this does not reduce the risk for infection Iggy 8th Edition

#11 A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? 1- "You are not contagious unless you stop taking your medication." 2- "You will not be contagious to the people you have been living with." 3- "You will have to take these medications for at least 1 year." 4- "Your sputum may turn a rust color as your condition gets better."

2- "You will not be contagious to the people you have been living with." The people the client has been living with have already been exposed and need to be tested. They cannot be re-exposed simply because the diagnosis has now been confirmed. The client with active tuberculosis is contagious, even while taking medication. The length of time for treatment is 6 months. Fluid from the pulmonary capillaries and red blood cells moving into the alveoli is a result of the inflammatory process. Rust-colored sputum is an indication that the tuberculosis is getting worse. Iggy 8th Edition

The healthcare provider is evaluating the tuberculin skin test (TST) for a patient who has a diagnosis of human immunodeficiency virus (HIV). The skin test is positive if the area of induration is at least __ mm? Choose 1 answer: 1- 1 2- 5 3- 10 4- 15

2- 5 A positive test is defined as an area of induration (an area of firm swelling) that occurs within 48 to 72 hours after injection. The test interpretation is based on the size of the induration in millimeters and a person's risk factors for contracting the disease. A tuberculin skin test is considered positive in an immunocompromised person (e.g. a patient who is HIV positive) if the induration is 5 mm or greater Khan Academy

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

2- AIDS is used to describe the end-stage, or terminal phase, of the HIV infection. AIDS is used to describe the end-stage, or terminal phase, of the 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 can resemble a chronic illness in some patients. The normal ratio of T-helper (CD4+) to T-suppressor (CD8+) cells is 2 to 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+), owing to 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 purified protein derivative (PPD tuberculin), is decreased or absent. An individual is said to be anergic if no skin response is noted. Foundations and Adult Health Nursing, 7th Edition

A patient has been prescribed efavirenz [Sustiva]. The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects? 1- The drug should be taken in divided doses throughout the day. 2- Bedtime dosing is most effective. 3- The drug should be mixed only with an acidic beverage. 4- A steroid medication should be used concurrently.

2- Bedtime dosing is most effective. Efavirenz frequently causes CNS symptoms of dizziness, impaired consciousness, drowsiness, vivid dreams, and nightmares. Bedtime dosing can minimize CNS effects, which typically resolve in 2 to 4 weeks. Mixing with an acidic beverage, using a steroid medication concurrently, and taking efavirenz in divided doses throughout the day are not effective means of minimizing CNS effects. Lehne 10th Edition

A nurse should recognize that which laboratory result is used as a major factor in deciding when antiretroviral therapy is indicated for a patient infected with HIV? 1- Plasma HIV RNA assay 2- CD4 T-lymphocyte count 3- Western blot assay 4- OralQuick Rapid HIV-1 Antibody Test

2- CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections. A plasma HIV RNA assay is a measure of viral load that indicates HIV replication and magnitude and accordingly is used to predict clinical outcomes. The Western blot assay and OralQuick Rapid HIV-1 Antibody Test, respectively, are used for initial screening and follow-up confirmation of HIV infection. Lehne 10th Edition

What is the least virulent form of the HIV virus? 1- HIV-1 2- HIV-2 3- HTLV-III 4- LAV

2- 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 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. HTLV-III (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 HIV by the International Society of the Taxonomy of Viruses. LAV (lymphadenopathy-associated virus) was named in 1983 by researchers in France; it was believed to be the agent responsible for AIDS.REF: Pages 1978-1979 Foundations and Adult Health Nursing, 7th Edition

The nurse develops a care plan for a patient in the continuation phase of treatment for active tuberculosis (TB). The care plan includes teaching about which medication regimen? 1- Pyrazinamide and ethambutol 2- Isoniazid and rifampin 3- Ethambutol and isoniazid 4- Rifampin and ethambutol

2- Isoniazid and rifampin If drug resistance is not a factor, treatment for active TB consists of a four-drug induction phase and a two-drug continuation phase. The continuation phase lasts at least 4 months, and therapy consists of two drugs—isoniazid and rifampin. Pyrazinamide and ethambutol, ethambutol and isoniazid, and rifampin and ethambutol are not the preferred regimens for the continuation phase. Lehne 10th Edition

The tuberculin skin test (TST) results for a patient who has been diagnosed with human immunodeficiency virus (HIV) is negative. How should the healthcare provider interpret this test result? Choose 1 answer: 1- Poor technique was used when administering the TST. 2- The patient is unable to mount an immune response to the test. 3- The examiner failed to palpate the patient's arm thoroughly. 4- The patient has not been exposed to the tuberculosis bacteria.

2- The patient is unable to mount an immune response to the test. Good technique is important when administering the TST to ensure accurate results, but this is not the reason for the test results in this case. The TST contains purified protein derivative (PPD), a TB antigen. An immunocompetent person who has been exposed to TB will mount an immune response to the PPD, causing a positive result. A false-negative test in an immunocompromised person (e.g. HIV patients or patients receiving immunosuppressive therapy) is the result of anergy, where the person is not able to mount an immune response to the test. Khan Academy

#19 A woman who is HIV positive is 8 months pregnant. The woman tells the LPN/LVN that she wants to breastfeed her newborn. The nurse's response is based on which of these understandings about the mode of transmission of HIV? 1- The woman may breastfeed as long as she uses a nipple shield. 2- The woman should not breastfeed. 3- The woman may breastfeed. 4- The woman may breastfeed as long as she does not have AIDS.

2- The woman should not breastfeed. HIV can be passed through breast milk to the infant, so an HIV-positive mother should never breastfeed. Foundations and Adult Health Nursing, 7th Edition

The healthcare provider is assessing a patient with a new diagnosis of pulmonary tuberculosis (TB). Which of the following findings would the healthcare provider anticipate? Choose all answers that apply: 1- Tinnitus 2- Hemoptysis 3- Palpitations 4- Fatigue 5- Night sweats

ANS 2, 4, 5 When infected with the TB bacteria, the patient often develops systemic symptoms as the body's immune system responds to the bacteria. TB bacteria cause caseating necrosis (tissue destruction that's soft, dry, and "cheese like") and cavitation (a "hole") in the lung tissue. Patients who become infected with TB develop nonspecific systemic symptoms such as fatigue, night sweats, and fever. A cough also develops, which progresses to hemoptysis as pulmonary tissue is destroyed. Khan Academy

#13 When a patient takes protease inhibitors for treatment of HIV infection, it is important that the patient be taught to follow a strict administration schedule. The patient demonstrates understanding of this need with which statement? 1- "If I don't take my medication as scheduled, my CD4 lymphocyte count may increase." 2- "If I don't take my medication as scheduled, it may cause my RNA to convert to DNA." 3- "If I don't take my medication as scheduled, the virus may become resistant." 4- "If I don't take my medication as scheduled, it may prevent the HIV from being assembled."

3- "If I don't take my medication as scheduled, the virus may become resistant." When patients do not take their medications for treatment of AIDS as prescribed, drug-resistant strains of the virus develop. Foundations and Adult Health Nursing, 7th Edition

#9 In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority? 1- Loss of social contact related to misunderstanding of transmission of acquired secondary immune deficiency and the social stigma 2- Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency 3- Potential for infection transmission related to recurring opportunistic infections 4- High risk for inadequate nutrition related to acquired secondary immune deficiency and Candida albicans

3- Potential for infection transmission related to recurring opportunistic infections Protecting the client from further opportunistic infection such as Candida albicans is a priority. Loss of social contact is not a priority problem with an opportunistic infection. Mouth sores would be the secondary concern because Candida albicans causes the mouth sores. Nutrition will be affected because of Candida albicans; however, it is not a priority. Iggy 8th Edition

The healthcare provider is assessing the skin of a patient who is at risk for becoming infected with the human immunodeficiency virus (HIV). Which of the following findings requires immediate follow-up by the healthcare provider? Choose 1 answer: 1- Numerous moles on the chest and back 2- Ecchymoses on the legs 3- Purplish-red raised lesions 4- Patches of dry, flaky skin

3- Purplish-red raised lesions Moles (nevi) should be examined for changes that may signal cancerous changes, but this is not the priority for this patient. Areas of ecchymoses are caused by bleeding under the skin, usually from trauma. The healthcare provider will inquire about them but this is not the priority. Because the patient is at risk for HIV, the purplish-red lesions may indicate the patient has developed Kaposi sarcoma (KS). KS is a cancer that develops from the cells that line lymph or blood vessels causing purple, red, or brown blotches or tumors on the skin. This finding is an indication that the patient's immune system is impaired. Khan Academy

#3 A patient who was recently exposed to a person who is HIV positive is tested and found to be HIV negative. Which of these interpretations of the test results is accurate? 1- The patient will not develop AIDS. 2- The patient did not contract HIV. 3- The results are not considered conclusive until 6 months after exposure. 4- The results indicate the need for a repeat test immediately.

3- The results are not considered conclusive until 6 months after exposure. HIV antibody may be detected from 2 weeks up to 6 months after the acute infection; therefore, this patient should be tested again in 6 months. Foundations and Adult Health Nursing, 7th Edition

#25 Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? 1- Homeless people 2- Hospital staff 3- Politicians 4- Prison staff and inmates

4- Prison staff and inmates High-risk groups for respiratory infection include those who live in crowded areas such as long-term care facilities, prisons, and mental health facilities. Although homeless people are a high priority, they are not the group at greatest risk of those listed. Education could be provided in shelters or during outreach activities. Hospital staff are at risk owing to their contact with ill clients and family members; however, they are already aware of how to prevent respiratory infection. Politicians are not at higher risk for respiratory infection than any other group with public exposure. Iggy 8th Edition

A patient is receiving the antitubercular medication streptomycin. Which of these statements made by the patient would alert the healthcare provider that the patient is experiencing a common adverse effect from the medication? Choose 1 answer: 1- "It burns when I urinate." 2- "I sometimes see flashing lights." 3- "I feel bloated and full of gas." 4- "I feel dizzy and my ears are ringing."

4- "I feel dizzy and my ears are ringing." Flashing or flickering lights may be a sign of optic neuritis, a potential adverse effect associated with ethambutol, another antitubercular medication. Streptomycin is an aminoglycoside. Aminoglycosides can be toxic to cranial nerve VIII, which is responsible for hearing and balance. The patient may report dizziness, loss of balance, ringing in the ears (tinnitus), or hearing loss. Khan Academy

A patient who has HIV and is taking the nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) zidovudine [Retrovir] reports vomiting, abdominal pain, fatigue, and hyperventilation. Which laboratory result is the priority for the nurse to evaluate? 1- Megakaryocytes 2- Red blood cell (RBC) counts 3- CD4 T-lymphocyte counts 4- Arterial blood lactate

4- Arterial blood lactate Potentially fatal lactic acidosis and hepatic steatosis (fatty liver) can occur with all NRTIs. Measuring arterial blood lactate is a priority for the diagnosis of lactic acidosis. Associated symptoms of nausea, vomiting, abdominal pain, fever, and hyperventilation may occur. Megakaryocytes, RBC counts, and CD4 T-lymphocyte counts also may be measured with NRTI therapy, but alterations in these values are not associated with the complication of lactic acidosis. Lehne 10th Edition

#10 A client with an acquired immune deficiency is seen in the clinic for re-evaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? 1- Therapeutic highly active antiretroviral therapy (HAART) level 2- Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot 3- Positive Papanicolaou (Pap) test 4- Improved CD4+ T-cell count and reduced viral load

4- Improved CD4+ T-cell count and reduced viral load Improved CD4+ T-cell count and reduced viral load reflect the response to prescribed HAART medication. Therapeutic HAART level is the recommended medication combination given to clients with HIV to cause an increase in the CD4+ T-cell count. ELISA and Western blot, if positive, indicate that the client is HIV positive (a fact already known for this client) and do not indicate response to prescribed medication. Pap smears can be precancerous in an HIV-positive client, but the test does not indicate the immune system's response to prescribed medication. Iggy 8th Edition

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

4- 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 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. Upon the second positive ELISA test, 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. Foundations and Adult Health Nursing, 7th Edition

Which dietary change does the nurse suggest for the client who has diarrhea associated with HIV disease? A- "Avoid fatty foods." B- "Increase your intake of fiber." C- "Take an antacid 30 minutes before each meal." D- "Restrict your intake of fluids to 1 liter per day."

A- "Avoid fatty foods." Rationale: Fatty foods tend to reduce intestinal absorption and make diarrhea worse. Although fiber can prevent some types of diarrhea, it has no benefit for the chronic diarrhea associated with AIDS. Iggy 8th Edition

#15 A client has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this client regarding medications? Select all that apply. 1- Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. 2- The medications may cause nausea. The client should take them at bedtime. 3- The client is generally not contagious after 2 to 3 consecutive weeks of treatment. 4- These medications must be taken for 2 years. 5- These medications may cause kidney failure.

ANS 1, 2, 3 Not taking the medication as prescribed could lead to an infection that is difficult to treat or to total drug resistance. The medications may cause nausea and are best taken at bedtime to prevent this. The client is generally not contagious after 2 to 3 weeks of consecutive treatment and improvement in the condition has been observed. The combination regimen for treatment of TB has decreased treatment time from 6 to 12 months to 6 months. TB medications may cause liver failure, not kidney failure. Iggy 8th Edition

A patient is receiving the protease inhibitor (PI) amprenavir [Agenerase]. Which laboratory results would the nurse evaluate as indicators of adverse effects of this medication? (Select all that apply.) 1- Plasma cholesterol level 2- Serum transaminases 3- Cardiac enzymes 4- Blood glucose level 5- Creatinine level

ANS 1, 2, 4 All PIs cause hyperglycemia and diabetes, and patients should be instructed to report symptoms of polydipsia, polyphagia, and polyuria. In addition, PIs can increase serum levels of transaminases and should be used with caution in patients with chronic liver disease. Cholesterol should be measured for elevation caused by the use of PIs that results in a risk of cardiovascular events. Altered cardiac enzymes and serum creatinine levels are not associated with adverse effects of PIs. Lehne 10th Edition

#2 A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply. 1- Combination drug therapy is effective in preventing transmission. 2- Combination drug therapy is the most effective method of treating TB. 3- Combination drug therapy will decrease the length of required treatment to 2 months. 4- Multiple drug regimens destroy organisms as quickly as possible. 5- The use of multiple drugs reduces the emergence of drug-resistant organisms.

ANS 1, 2, 4, 5 Combination drug therapy is the most effective method for treating TB and preventing transmission. Multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Although combination drug therapy will decrease the required length of time for treatment, the length of treatment is decreased to 6 months from 6 to 12 months. Iggy 8th Edition

#2 The nurse presents a seminar on human immune deficiency virus (HIV) testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention regarding HIV testing? Select all that apply. 1- "I am 78 years old, and I was treated and cured of syphilis many years ago." 2- "In 1986, I received a transfusion of platelets." 3- "Seven years ago, I was released from a penitentiary." 4- "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." 5- "At 68, I am going to get married for the fourth time."

ANS 1, 3, 5 People who have had a sexually transmitted disease should be tested. People who are in or have been in correctional institutions such as jails or prisons and people who are planning to get married should be tested for HIV. HIV testing is recommended for clients who received a blood transfusion between 1978 and 1985. People who have used injectable drugs (not marijuana) should be tested. Iggy 8th Edition

A patient has been diagnosed with latent tuberculosis infection (LTBI). Which of the following statements are true about the patient? Choose all answers that apply: 1- Respiratory specimens for acid-fast bacteria will be positive. 2- The patient will not be able to transmit TB to others. 3- The patient may not report symptoms characteristic of TB. 4- Interferon-gamma release assay (IGRA) results will be positive. 5- The results of a chest radiograph will be negative.

ANS 2, 3, 4 The interferon-gamma release assay (IGRA) is usually positive in patients with LTBI, indicating they have been exposed to Mycobacterium tuberculosis. Respiratory specimens acid-fast bacteria will be negative in a patient with LTBI. This test will be positive in a patient with active TB disease, except if the patient has extrapulmonary disease. TST and IRGA results are usually positive in a patient with LTBI. There will be no symptoms or physical findings that suggest TB disease, but the patient may be treated in order to prevent the LTBI from progressing to TB disease. The chest X-ray will show evidence of TB lesions. Khan Academy

A patient's treatment regimen for tuberculosis (TB) includes rifampin (Rifadin). When teaching the patient about rifampin, which of the following information should be included? Choose all answers that apply: 1- "You will need to take your medication for two full weeks." 2- "It's recommended that you abstain from alcohol during your treatment." 3- "You should switch from contact lenses to glasses during your treatment." 4- " If the medication causes stomach upset, you may take it with food." 5- "Call the clinic if you experience any unusual bruising or bleeding."

ANS 2, 3, 5 Patients who are being treated for TB continue their therapy for several months. Rifampin concentrations may be decreased if taken with food so the patient should be advised to take the medication on an empty stomach (one hour before meals or two hours after meals) with a glass of water. Rifampin may cause orangish discoloration of body fluids like urine, saliva, sweat, and tears. The patient should be warned of this and reassured that the color change is harmless. But because it can stain contact lenses, wearing glasses during treatment is advised. Rifampin may cause thrombocytopenia and/or hepatotoxicity, which may cause unusual bruising or bleeding. Alcohol use during therapy may increase the potential for hepatotoxicity. Khan Academy

#7 A patient has Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia. The LPN/LVN should expect the patient to have which of these signs and symptoms? Select all that apply. 1- Subnormal temperature 2- Nonproductive cough 3- Anemia 4- Night sweats 5- Weight loss

ANS 2, 4, 5 Foundations and Adult Health Nursing, 7th Edition

#12 A patient at your clinic was diagnosed as HIV positive 3 years ago. She tells you that today her "viral load results are 0." What does this information indicate? SATA 1- She is no longer considered HIV positive. 2- The level of virus particles in her blood is low. 3- She has not developed any opportunistic infections. 4- She has not developed any opportunistic infections. 5- She will continue to require monitoring for HIV.

ANS 2, 5 Viral load is the measurement of detectable HIV particles in the blood, indicating extent of HIV infection. Ongoing monitoring of viral load status and T-cell count (to evaluate level of immune system function) will still be necessary, to detect any changes. What the patient has interpreted as a viral load of 0 actually means an undetectable number of HIV particles. This is currently defined as less than 100. Viral load levels are not an indicator of opportunistic infection status. Although it can be presumed that the patient's immune system is adequate, viral load testing reflects only the level of HIV detected. Foundations and Adult Health Nursing, 7th Edition

A patient is being treated for tuberculosis (TB) with isoniazid (INH). Which of these assessment findings would indicate that the patient is experiencing an adverse reaction to the medication? Choose all answers that apply: 1- Fever and loss of appetite 2- Painful urination and flank pain 3- Gouty attacks in the toes 4- Dark urine and yellowish skin 5- Peripheral neuropathy

ANS 4, 5 Fever and loss of appetite are signs of TB, not of an adverse reaction to INH. Hyperuricemia and resulting gouty attacks may be caused by pyrazinamide, which is another antitubercular medication. Signs of INH-induced hepatotoxicity include dark urine and yellowing of the skin (jaundice). Peripheral neuropathies may develop because INH can cause pyridoxine (vitamin B6) deficiency (vitamin B6 has a role in neurotransmitter synthesis). Peripheral neuropathy can be avoided if the patient supplements the diet with vitamin B6. Khan Academy

A client has been admitted to the hospital with suspected TB. What drugs should the nurse plan to teach the client about before discharge? Select all that apply. A- Rifampin (Rifadin); contact lenses can become stained orange B- Isoniazid (INH); report yellowing of the skin or darkened urine C- Pyrazinamide (PZA); maintain a fluid restriction of 1200 mL/day D- Ethambutol (Myambutol); report any changes in vision E- Amoxicillin (Amoxil); take this drug with food or milk

Answer: A, B, D Rationale: Amoxicillin is not prescribed for TB. Pyrazinamide, although prescribed for TB, calls for an increase in fluids, not fluid restriction. Rifampin, isoniazid, and ethambutol are first-line drugs for TB therapy and have side effects. The side effects listed with these drugs are appropriate to teach the client Iggy 8th Edition

What is the most important question the nurse asks the patient prescribed to begin highly active antiretroviral therapy? A- Do you have any symptoms now of active infection? B- Is there any possibility that you are pregnant? C- Are your currently sexually active? D- What other medications do you take?

D- What other medications do you take? Rationale: Before giving an antiretroviral drug, obtain a list of all other drugs the patient also takes because antiretroviral drugs interact with many other drugs. Check with the pharmacist for possible interactions and the need to consult the prescriber about dosage or changing the patient's other drug with the prescriber. Iggy 8th Edition