PrepU Chapter 37: Management of Patients With HIV Infection and AIDS

A patient receiving antiretroviral therapy is complaining of "not urinating enough." What is the nurse's best action?

Assess BUN and creatinine.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. Which of the following would the nurse describe as the first step?

attachment

A patient taking amprenavir (APV, Agenerase) complains of "getting fat." What is the nurse's best action?

Teach the patient about medication side effects.

A client with suspected HIV has had two positive enzyme-linked immunosorbent assay tests. What diagnostic test would be run next?

Western Blot

Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material?

Ribonucleic acid (RNA)

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?

Bank autologous blood

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often."What should the nurse consult with the physician regarding?

Testing the client for the presence of HIV

The term used to define the balance between the amount of HIV in the body and the immune response is

viral set point.

The nursing instructor is talking about HIV/AIDS with their pre-nursing pathophysiology class. The instructor explains to the class that the virus that causes HIV/AIDS is called a retrovirus. What characteristics of this retrovirus would the instructor talk with the class about?

HIV-1 and HIV-2 subtypes

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by ____.

HIV-1 is more prevalent than HIV-2 subtypes

Which of the following is an early manifestation of HIV encephalopathy?

Headache

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?

Hypokalemia

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay with positive results twice. What is the next step for the nurse to explain to the patient for confirmation of the diagnosis?

Perform a Western blot test for confirmation of diagnosis.

The nurse receives a phone call at the clinic from the family of a patient with AIDS. They state that the patient started "acting funny" after complaining of headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?

"The patient may have cryptococcal meningitis and will need to be evaluated by the physician."

As part of HAART therapy, a client is prescribed a non-nucleoside reverse transcriptase inhibitor (NNRTI). Which of the following would be an example of a drug from this class? Select all that apply.

- Delavirdine - Efavirenz

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply.

- Semen - Breast milk -Blood -Vaginal secretions

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse?

"I understand your concern. The blood is screened very carefully for different viruses as well as HIV."

Antiretroviral medications should be offered to individuals with T-cell counts of less than

350 cell/mm

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe?

4 weeks

A patient is on ART for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year?

50 mm3 to 150 mm3

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when he schedules a return visit for viral load testing at which time?

6 weeks

The nurse teaches the patient that lowering his or her viral load will have what effect?

A longer survival time

A client with AIDS is brought to the clinic by his family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

AIDS dementia complex (ADC)

When do most perinatal HIV infections occur?

After exposure during delivery

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?

Antibodies to HIV are not present in his blood.

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care?

Assist with chest physiotherapy every 2 to 4 hours.

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

Avoid residue, lactose, fat, and caffeine.

Diagnosis of Kaposi's sarcoma (KS) is made by which of the following?

Biopsy

Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy?

CD4 counts

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

CDC category A: HIV asymptomatic

A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action?

Call the health care provider to report.

The nurse is collecting objective data for a client with AIDS at the clinic. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does the nurse understand this finding indicates?

Candidiasis

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:

Chronic diarrhea.

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?

Disclosure of the client's condition

A client suspected of having HIV has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?

ELISA

Which blood test confirms the presence of antibodies to HIV?

Enzyme-linked immunosorbent assay (ELISA)

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?

Gynecologic problems

Which of the following indicates that a client with HIV has developed AIDS?

Herpes simplex ulcer persisting for 2 months

When assisting the patient to interpret a negative HIV test result, what does the nurse tell the patient this result means?

His body has not produced antibodies to the AIDS virus.

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient?

Inform the patient that it would be beneficial to test for HIV.

During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?

Kaposi's sarcoma

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate?

Kaposi's sarcoma

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy?

Keep the CD4 cell count above 350/mm3 and viral load undetectable.

HIV is harbored within which type of cell?

Lymphocyte

A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in?

Primary infection

The nurse is administering an injection to a client with AIDS and, when finished, attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse?

Report the incident to the supervisor

A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about?

Reverse transcriptase inhibitors

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

Risk for injury

You are caring for a client who has a diagnosis of HIV. Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications?

Side effects of drug therapy

A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions?

Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens.

A patient is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the patient about for treatment?

TMP-SMZ (Bactrim)

A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care?

The client can state that he is at his home.

The client comes to the clinic to obtain the results from the test to determine if he is infected with HIV. The physician informs the client that he has a CD4 cell count of 300 cells/mm3 and a high viral load. What does the nurse anticipate the physician will discuss with the client?

The initiation of antiretroviral therapy

A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection?

Trimethoprim-sulfamethoxazole (Bactrim, Septra)

What test will the nurse assess to determine the patient's response to antiretroviral therapy?

Viral load

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test?

Western blot assay

Which of the following options should the nurse encourage to replace fluid and electrolyte losses in a patient with AIDS?

liquids

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission?

urine

The nurse is teaching a client with HIV how to use a male condom. The client demonstrates understanding of the information when he states which of the following? Select all that apply.

-"I need to hold the condom by the tip to squeeze out the air before putting it on." -"I should unroll the condom all the way over my erect penis." -"I should avoid using baby oil or petroleum jelly with a condom."

Which assessment finding is not likely to cause noncompliance with antiretroviral treatment?

past substance abuse

Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________.

1 hour; 72 hours; 4 weeks

Which of the following has not been implicated as a factor for noncompliance with antiretroviral treatment?

Past substance abuse

A client with AIDS is exhibiting shortness of breath, cough, and fever. The nurse most likely would suspect infection with which of the following?

Pneumocystis jiroveci

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis?

Stool specimen for ova and parasites