Chapter 56 Care of the Patient with HIV/AIDS

When assigned to a newly admitted patient with AIDS, the nurse says, "I'm pregnant. It is not safe for me or my baby if I am assigned to his case." Which is the most appropriate response by the charge nurse?

a. "This patient would not be a risk for your baby if you use standard precautions and

avoid direct contact with blood or body fluids."

b. "You should ask for a transfer to another unit because contact with this patient

would put you and your baby at risk for AIDS."

c. "Wear a mask, gown, and gloves every time you go into his room and use

disposable trays, plates, and utensils to serve his meals."

d. "We should recommend that this patient be transferred to an isolation unit."

ANS: A

HIV is transmitted from human to human through infected blood, semen, cervicovaginal secretions, and breast milk. The use of Standard Precautions by all staff members for all patients all the time simplifies this issue.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 1996, Box 55-6 OBJ: 6 TOP: Transmission of AIDS

KEY: Nursing Process Step: Implementation

The anxious male patient is fearful that he has been exposed to a person with an HIV infection. He states he does not want to go to a laboratory for the ELISA tests because he does not want to be identified. What would be the nurse's most helpful response?

a. "There really is not an option, you will need to get the Western blot test first."

b. "There is an FDA-approved home test called OraQuick."

c. "The rapid test Reveal can identify all the HIV strains."

d. "You can be tested anonymously for ELISA. If you are seronegative, your

concerns are over."

ANS: B

The OraQuick is a home OTC test approved by the FDA. One seronegative on the ELISA is not evidence because seroconversion may not have taken place. The Western blot test follows if the ELISA is positive.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2008

OBJ: 6 TOP: HIV testing KEY: Nursing Process Step: Implementation

The patient, age 21, has been treated for chlamydia and has a history of recurrent herpes. What should the nurse counsel this patient about?

a. Sexual history, risk reduction measures, and testing for HIV

b. Getting an appointment at a family planning clinic

c. Testing for HIV and what the test results mean

d. Abstinence and a monogamous relationship

ANS: A

Chlamydia is considered a sexually transmitted disease (STD). As such it requires further testing and a sexual history to advise the sexual partners.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2008 OBJ: 6 TOP: Risk for infection

KEY: Nursing Process Step: Planning

A patient has just been diagnosed as HIV-positive. He asks the nurse, "Does this mean I have AIDS?" Which response would be most informative?

a. "Most people get AIDS within 3 to 12 weeks after they are infected with HIV."

b. "Don't worry. You may never get AIDS if you eat properly, exercise, and get

plenty of rest."

c. "It varies with every individual, but the average time is 8 to 10 years from the time

a person is infected, and some go much longer."

d. "You can expect to develop signs and symptoms of AIDS within 6 months."

ANS: C

Typical progress of HIV includes a period of relative clinical latency, occurring immediately after the primary infection, which can last for several years. Long-term nonprogressors remain symptom-free for 8 to10 years.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1988 OBJ: 4 TOP: Progression of disease

KEY: Nursing Process Step: Implementation

Which of the following is a CDC criterion for the progression of HIV infection to AIDS?

a. Increase in viral load

b. Decreased ratio of CD8 to CD4

c. Increase in white blood cells

d. Increased reactivity to skin tests

ANS: A

AIDS is the end stage of an HIV infection. The CDC has developed criteria for the diagnosis of AIDS, which are: increase in viral load even with pharmacologic interventions, increase in the ratio of CD8 to CD4, decline in the WBCs, and a decreased reactivity to skin tests.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1989 OBJ: 7 TOP: AIDS diagnostic criteria

KEY: Nursing Process Step: Implementation

What should the nurse look for when reviewing a patient's chart to determine whether she has progressed from HIV disease to AIDS?

a. CD4+ count below 500, chronic fatigue, night sweats

b. HIV-positive test result, CD4+ count below 200, history of opportunistic disease

c. Weight loss, persistent generalized lymphadenopathy, chronic diarrhea

d. Fever, chills, CD4+ count below 200

ANS: B

Patients who have progressed from HIV disease to AIDS will have the condition in which the CD4+ cell count drops to less than 200 cells/mm3 and have a history of opportunistic diseases.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 1986, Table 55-1 OBJ: 9 TOP: Progression of disease

KEY: Nursing Process Step: Assessment

A male patient is advised to receive HIV antibody testing because of his multiple sexual partners and injectable drug use. What should the nurse inform the patient to ensure understanding?

a. The blood is tested with the highly sensitive test called the Western blot.

b. The blood is tested with an ELISA; if positive, it is tested again with an ELISA,

followed by a Western blot if the second ELISA is positive.

c. A series of HIV tests is performed to confirm if the patient has AIDS.

d. If the HIV tests are seronegative, the patient can be assured that he is not infected.

ANS: B

The individual's blood is tested with ELISA or enzyme immunoassay (ELA), antibody tests that detect the presence of HIV antibodies. If the ELA is positive for HIV, then the same blood is tested a second time. If the second ELA is positive, a more specific confirming test such as the Western blot is done. Blood that is reactive or positive in all three steps is reported to be HIV-positive. A seronegative is not an assurance that the individual is free of infection since seroconversion may not have yet occurred.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1990, Box 55-2 OBJ: 9 TOP: Diagnostic procedures

KEY: Nursing Process Step: Implementation

A 28-year-old married attorney with one child is in the first trimester of her second pregnancy. The patient states that she is at no risk for HIV, so she would not need to be counseled about testing for HIV. Which is the most appropriate response?

a. "She's a professional woman in a monogamous relationship. She obviously is not

at risk."

b. "Women are not at great risk. The greatest risk is with gay men."

c. "The fastest-growing segment of the population with AIDS is women and children.

We need to assess her risks."

d. "We need to review her chart to determine if her first child was infected."

ANS: C

Increases in AIDS cases in women and heterosexuals and a slowing of cases in the men who have sex with men (MSM) category are a direct reflection of early educational efforts directed at the MSM population, who were believed to be the only population at risk. Women need to be assessed for different manifestations of HIV infection. It is the current recommendation for voluntary HIV testing for all pregnant women.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2008 OBJ: 6 TOP: Risk for infection

KEY: Nursing Process Step: Implementation

A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms, because "they don't work." Which is the most appropriate response?

a. "Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting

infected with HIV or other sexually transmitted diseases."

b. "You are correct. Condoms don't always work, so your best protection is to limit

your number of partners."

c. "Condoms do not provide 100% protection, so you should always discuss with

your sexual partners their HIV status or ask if they have any STD."

d. "Condoms do not provide 100% protection, but when used with a spermicide you

can be assured of complete protection against HIV and other STDs."

ANS: A

Risk-reducing sexual activities decrease the risk of contact with HIV through the use of barriers. The most commonly used barrier is the male condom. Although not 100% effective, when used correctly and consistently, male condoms are very effective in the prevention of HIV transmission.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2010 OBJ: 5 TOP: Transmission of disease

KEY: Nursing Process Step: Implementation

A 21-year-old male who has been an IV heroin user has been experiencing fever, weight loss, and diarrhea and has been diagnosed as having AIDS. At this time, he has a low-grade fever, severe diarrhea, and a productive cough. He is admitted with Pneumocystis jiroveci. What should the nurse do when caring for the patient?

a. Use a gown, mask, and gloves when assisting the patient with his bath

b. Wear a gown when assisting the patient to use the bedpan

c. Use a gown, mask, and gloves to administer oral medications

d. Use a mask when taking the patient's temperature

ANS: A

The use of Standard Precautions and body substance isolation has been shown not only to reduce the risk of blood-borne pathogens, but also to reduce the risk of transmission of other disease between the patient and the health care worker.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2011 OBJ: 16 TOP: Transmission of disease

KEY: Nursing Process Step: Implementation

The nurse should instruct the patient who is diagnosed with AIDS to report signs of Kaposi sarcoma, which include:

a. Reddish-purple skin lesions

b. Open, bleeding skin lesions

c. Blood-tinged sputum

d. Watery diarrhea

ANS: A

Kaposi sarcoma is a rare cancer of the skin and mucous membranes characterized by blue, red, or purple raised lesions seen mainly in Mediterranean men. Kaposi sarcoma: firm, flat, raised or nodular, hyperpigmented, multicentric lesions on the skin and mucous membranes.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1977 OBJ: 8 TOP: Kaposi sarcoma

KEY: Nursing Process Step: Implementation

A patient states that he feels terrific, but a blood test shows that he is HIV-positive. It is important for the nurse to discuss with him that HIV may remain dormant for several years. What is true of the patient during this time?

a. He is not dangerous to anyone.

b. He experiences minor symptoms only.

c. He experiences decreased immunity.

d. He is contagious.

ANS: D

A prolonged period in which HIV is not readily detectable in the blood follows within a few weeks or months of the initial infection. This titer, or viral load, falls dramatically as the immune system responds and controls the HIV infection, and it may last 10 to 12 years.

During this period, there are few clinical symptoms of HIV infection, although an individual is still capable of transmitting HIV to others.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1988 OBJ: 15 TOP: Progression of disease

KEY: Nursing Process Step: Implementation

To be diagnosed as having AIDS, the patient must be HIV-positive, have a compromised immune system without known immune system disease or recent organ transplant, and present with which of the following?

a. Opportunistic infection

b. A positive ELISA or Western blot test

c. Weight loss, fever, and generalized lymphedema

d. CD4+ lymphocyte count less than 200 mm3

ANS: D

The 1993 expanded case definition of AIDS includes all HIV-infected people who have CD4+, T-lymphocyte counts of less than 200 cells/mm3; this includes all people who have one or more of these three clinical conditions: pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer, and it retains the 23 clinical conditions listed in the 1987 AIDS case definition.

PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1986, Table 55-1 OBJ: 2 TOP: Definition of AIDS disease

KEY: Nursing Process Step: Assessment

Why should interventions such as promotion of nutrition, exercise, and stress reduction be undertaken by the nurse for patients who have HIV infection?

a. They will promote a feeling of well-being in the patient.

b. They will improve immune function.

c. They will prevent transmission of the virus to others.

d. They will increase the patient's strength and ability to care for himself or herself.

ANS: B

HIV disease progression may be delayed by promoting a healthy immune system. Useful interventions for HIV-infected patients include the following: nutritional changes that maintain lean body mass, regular exercise, and stress reduction.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2001 OBJ: 15 TOP: Immune function improvement

KEY: Nursing Process Step: Implementation

A male patient is concerned about telling others he has HIV infection. What should the nurse stress when discussing his concerns?

a. Care providers and sexual partners should be told about his diagnosis.

b. There is no reason to hide his disease.

c. Secrecy is a poor idea because it will lower his self-esteem.

d. His diagnosis will be obvious to most people with whom he will come into contact.

ANS: A

Nurses have a responsibility to assess each patient's risk for HIV infection and counsel those at risk about HIV testing and the behaviors that put them at risk, and about how to reduce or eliminate those risks. The diagnosis needs to be carefully protected and shared only with caregivers who need to know for the purpose of assessment and treatment.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2000

OBJ: 13 TOP: Coping KEY: Nursing Process Step: Implementation

The HIV patient asks the nurse about what to expect in terms of disease progression. The nurse tells this patient that although the disease can vary greatly among individuals, the usual pattern of progression includes:

a. viremia, clinical latency, opportunistic diseases, and death.

b. asymptomatic phase, clinical latency, ARC, and AIDS.

c. acute retroviral syndrome, early infection, early symptomatic disease, and AIDS.

d. transitional viral syndrome, inactive disease, early symptomatic infection, and

opportunistic diseases.

ANS: C

The progression from HIV to AIDS includes initial exposure, primary HIV infection, asymptomatic HIV infection, early HIV disease, and AIDS.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1980, Figure 55-3 OBJ: 4 TOP: Progression of disease

KEY: Nursing Process Step: Implementation

While teaching community groups about AIDS, what should the nurse indicate as the most common method of transmission of the HIV virus?

a. Sexual contact with an HIV-infected partner

b. Perinatal transmission

c. Exposure to contaminated blood

d. Nonsexual exposure to saliva and tears

ANS: A

Modes of transmission have remained constant throughout the course of the HIV pandemic. It is also important for health care providers to remember that transmission of HIV occurs through sexual practices, not sexual preferences. Worldwide, sexual intercourse is by far the most common mode of HIV transmission.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2000, Box 55-11 OBJ: 7 TOP: Transmission of disease

KEY: Nursing Process Step: Implementation

What do the activated monocytes and macrophages produce in the presence of an inflammatory process?

a. Reduction of red cells

b. Increase in WBCs

c. Neopterin

d. Increase in T-helper cells increase natural killer (NK) cells

ANS: C

Neopterin is produced in the presence of an inflammatory reaction and is increased in HIV disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1990, Box 55-2 OBJ: 5 TOP: Neopterin KEY: Nursing Process Step: Intervention

For most people who are HIV-positive, marker antibodies are usually present 10 to 12 weeks after exposure. What is the development of these antibodies called?

a. Immunocompetence

b. Seroconversion

c. Opportunistic infection

d. Immunodeficiency

ANS: B

Seroconversion is the development of antibodies from HIV, which takes place approximately 5 days to 3 months after exposure, generally within 1 to 3 weeks. Although the conversion has taken place, the patient is not yet immunodeficient.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1987 OBJ: 10 TOP: Progression of disease

KEY: Nursing Process Step: Assessment

What should the nurse emphasize when counseling an anxious HIV-positive mother about the care of her HIV-positive infant?

a. The baby will develop AIDS and refer her to a local AIDS support group. The

baby will remain HIV-positive for the rest of its life.

b. Although infants of HIV-infected mothers may test positive for HIV antibodies,

not all infants are infected with the virus.

c. She has not yet developed AIDS, and that it is possible the baby will not develop

AIDS for many years.

d. If the infant is started on zidovudine (AZT) within the first month after delivery,

AIDS can be prevented.

ANS: B

The decline in pediatric AIDS incidence is associated with the increased compliance with universal counseling and testing of pregnant women and the use of zidovudine by

HIV-infected pregnant women and their newborn infants. Infants born to HIV-infected mothers will have positive HIV antibody results as long as 15 to 18 months after birth. This is caused by maternal antibodies that cross the placenta during gestation and remain in the infant's circulatory system.

PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1983-1984 OBJ: 5 TOP: Transmission of disease

KEY: Nursing Process Step: Planning

Why are snacks high in potassium, such as bananas and apricot nectar, recommended?

a. Electrolytes are lost through diaphoresis.

b. Sodium is lost through frequent diarrhea.

c. Potassium will support weight gain.

d. Potassium helps fight infection.

ANS: C

HIV disease progression may be delayed by promoting a healthy immune system. Nutritional changes that maintain lean body mass, increase weight, and ensure appropriate levels of vitamins and micronutrients are helpful. Eat potassium-rich foods, such as bananas and apricot nectar.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000, Box 55-6 OBJ: 15 TOP: Nutrition KEY: Nursing Process Step: Implementation

The depressed patient with AIDS says, "I don't understand why I am going to be getting doses of testosterone. What good will that do me now?" What should the nurse keep in mind about testosterone when responding?

a. It can lower viral load

b. It can lighten depression

c. It can increase lean body mass

d. It can increase appetite

ANS: C

Testosterone can increase body mass and lean weight.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2005 OBJ: 16 TOP: Transmission of disease

KEY: Nursing Process Step: Implementation

After what period of time would the home health nurse make a mental health appointment for a patient with an HIV infection after assessing a diminished ability to attend to daily functioning?

a. 1 week

b. 2 weeks

c. 3 weeks

d. 1 month

ANS: B

Patients with HIV infection have a great deal of anxiety and guilt, which may interfere with the daily functions of maintaining relationships and making decisions. When this apathy is assessed for a period of 2 weeks, the nurse should refer the patient for a mental health consult.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000 OBJ: 13 TOP: Coping KEY: Nursing Process Step: Assessment

The HIV-infected patient who has just seroconverted says he just cannot take all those confusing, expensive antiretroviral (ART) medications. He says he still feels fine, anyway. What should the nurse keep in mind when counseling this patient?

a. Resumption of the ART later in the disease is just as effective

b. Adherence to the ART protocol is essential to the success of the treatment

c. Cessation of the ART may prevent the emergence of a resistant strain of HIV

d. Once ART is initiated it cannot be restarted in the same patient

ANS: B

Compliance and adherence to the ART protocol is essential to its success. Cessation of the medication may stimulate the emergence of a resistant strain of HIV virus. ART can be restarted, but the optimum time to start is soon after seroconversion.

PTS: 1 DIF: Cognitive Level: Application REF: Page 2001 OBJ: 5 TOP: Adherence to ART

KEY: Nursing Process Step: Assessment

What medication times should the nurse use in writing out a schedule for taking antiretroviral medication three times a day?

a. 8 AM - 2 PM - 8 PM

b. 8AM - 4PM - 12 AM

c. 8AM - 5PM - 1 AM

d. Be given with meals

ANS: C

Antivirals should be given around the clock to keep the therapeutic level of the ART at a constant level.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1993 OBJ: 15 TOP: Antiretroviral therapy (ART)

KEY: Nursing Process Step: Implementation

Which of the following are early signs and symptoms of an HIV infection? (Select all that apply.)

a. Dry mouth

b. Weight loss

c. Sore throat

d. Vaginal dryness

e. Nausea

f. Dyspnea

ANS: B, C, F

Signs and symptoms of HIV infection include weight loss, sore throat, and dyspnea.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1980, Box 55-1 OBJ: 8 TOP: HIV infection

KEY: Nursing Process Step: Assessment

Which of the following are methods in which children with AIDS could have contracted their disease? (Select all that apply.)

a. During intrauterine life with an HIV-positive mother

b. During the birth process of an HIV-positive mother

c. From other children who are HIV positive

d. From receiving a transfusion contaminated with the HIV virus

e. From breastfeeding by an HIV-positive mother

ANS: A, B, D, E

In the United States, transfusion of infected blood and blood products and transplantation of infected tissues account for 1% of the total adult and adolescent AIDS cases and 2% of the total pediatric AIDS cases. HIV infection can be transmitted from a mother to her infant during pregnancy, at the time of delivery, or after birth, through breastfeeding. In the United States, it is estimated that approximately 30% of infected mothers will transmit HIV to their infants, with approximately 50% to 70% of the transmissions occurring late in utero or intrapartum. In the United States, among children who are less than 13 years old and have AIDS, 93% were infected at birth.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1983 OBJ: 5 TOP: Transmission of disease

KEY: Nursing Process Step: Assessment

The home health nurse designing a teaching plan for a person with HIV disease that would support weight gain would include information pertaining to (Select all that apply.)

a. Limit fluid intake

b. Eating high-protein/high-calorie diet

c. Drinking nutritional supplements (Boost, Sustacal, etc.)

d. Eating several small meals during the day

e. Providing referrals to dietitians

f. Resistance weight training

ANS: B, C, D, E, F

Increase protein, calorie, and fat intake. Offer nutritional supplements. Eat several small meals per day instead of three large meals. Provide for referrals. Weigh the patient daily. Weight training maintains muscle tone and improves appetite.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2011

OBJ: 15 TOP: Weight loss KEY: Nursing Process Step: Implementation

Which foods would a nurse recommend for a person with debilitating diarrhea as a result of HIV infection? (Select all that apply.)

a. Bananas

b. Ensure

c. Fresh broccoli

d. Cooked fruits and vegetables

e. Red meat

f. Apricot nectar

ANS: A, D, F

Avoid dairy products, red meat, margarine, butter, eggs, dried beans, peas, and raw fruits and vegetables. Cooked or canned fruits and vegetables will provide needed vitamins. Eat potassium-rich foods, such as bananas and apricot nectar. Discontinue foods, nutritional supplements, and medications that may make diarrhea worse (Ensure, antacids, stool softeners). Avoid gas-producing foods. Serve warm, not hot, foods. Plan small, frequent meals. Drink plenty of fluids between meals.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2000, Table 55-6 OBJ: 15 TOP: Weight loss KEY: Nursing Process Step: Implementation

How does the HIV-2 virus compare to the HIV-1 virus? (Select all that apply.)

a. It has lower mortality risks in the older adult

b. It is less virulent

c. It is less infectious in the initial stage of infection

d. It predisposes the HIV-infected person to a normal life span

e. It develops high viral loads

ANS: A, B, C, D

Persons who are infected with the HIV-2 are less infectious during the initial stage because the virus is less virulent than HIV-1. These persons tend to live a normal life span and the mortality in the later years is less.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1978 OBJ: 7 TOP: HIV-2 KEY: Nursing Process Step: Planning

Which of the following are examples of the AIDS wasting syndrome in a patient with an HIV infection? (Select all that apply.)

a. Episodes of vomiting for 20 days

b. Appearance of Kaposi sarcoma

c. Loss of 10% of body mass

d. Marked hair loss

e. Episodes of diarrhea for 30 days

f. Episodes of hypotension

ANS: C, E

The AIDS wasting syndrome is due to disturbances in metabolism involving lean body mass. The wasting syndrome is signaled by 10% loss of body weight, 30 days of diarrhea, weakness, and fever. The person who has the wasting syndrome is considered to have AIDS.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2001 OBJ: 4 TOP: Wasting syndrome

KEY: Nursing Process Step: Assessment

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

ANS:

Abstinence

Abstinence is refraining from sexual contact in which there is exchange of semen, vaginal secretions, or blood.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2000, Box 55-10 OBJ: 5 TOP: HIV infection prevention

KEY: Nursing Process Step: Assessment

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

ANS:

zoonotic

A zoonotic organism is an organism that can cross from an animal species to humans.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1978 OBJ: 1 TOP: Zoonotic KEY: Nursing Process Step: N/A

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

ANS:

reverse transcriptase

Reverse transcriptase allows the RNA of the retrovirus to be changed to DNA and incorporated into the host's genetic material.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1984 OBJ: 7 TOP: Reverse transcriptase

KEY: Nursing Process Step: Implementation

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

.

ANS:

anergic

Anergic is the term that describes an immunosuppressed patient's ability to react to a skin test.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1899 OBJ: 2 TOP: Anergia KEY: Nursing Process Step: N/A

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

ANS:

multidisciplinary

The use of many disciplines in a combined approach to a complex medical problem is multidisciplinary.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1999

OBJ: 11 TOP: Multidisciplinary KEY: Nursing Process Step: N/A

The historical progress of the HIV infection began to be tracked in 1979. Arrange the historical events in sequence of their discovery. (Separate letters by a comma and space as follows: A, B, C, D)

a. Infection in heterosexual men and women

b. Infection in hemophiliacs

c. Infection in injection drug users

d. Increased incidence of Kaposi carcinoma in young homosexual men

e. Increased incidence of Pneumocystis jiroveci (previously PCP)

ANS:

E, D, C, B, A

The history of the incidence of HIV infection was slow in being recognized. The first observation was an increase in incidence of Pneumocystis jiroveci, followed by increasing incidence of Kaposi carcinoma in the homosexual population. The infection began to be seen in injection drug users, hemophiliacs, then into the heterosexual population.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1977 OBJ: 1 | 12 TOP: History of incidence of HIV infection

KEY: Nursing Process Step: N/A

When educating a client who has human immunodeficiency virus (HIV), the nurse should include the information that it is possible to remain asymptomatic for:

a. up to 2 years

b. up to 5 years

c. 8 to 10 years

d. 10 or more years

ANS: C

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

When caring for a client with a diagnosis of human immunodeficiency virus (HIV), the nurse understands that HIV is transmitted by:

a. airborne droplets

b. exchange of body fluids

c. exposure to infected animals or their waste products

d. sexual activity only

ANS: B

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

As the disease progresses, symptoms of human immunodeficiency virus (HIV) become evident when which of the cells of the immune system decrease?

a. B cells

b. macrophages

c. neutrophils

d. CD4 T cells

ANS: D

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

A client is undergoing drug treatment for human immunodeficiency virus (HIV) with nucleoside analog reverse transcriptase inhibitors (NRTIs). The nurse is aware that the outcomes of this treatment is:

a. delayed onset of opportunistic infection

b. prolonged progression of HIV in early symptomatic stage

c. prevention of transmission to others

d. increase of viral load

ANS: A

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

The nurse caring for a client with human immunodeficiency virus (HIV) understands that a client is considered to have acquired immunodeficiency syndrome (AIDS) when which of the following occurs?

a. appearance of flulike symptoms

b. CD4 T cell count of less than 200 cells/mm3 and one defined clinical condition

c. enlarged lymph nodes for more than 3 months

d. one positive enzyme-linked immunosorbent assay (ELISA) test

ANS: B

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

The nurse is usually responsible for which of the following actions prior to a client being tested for human immunodeficiency virus (HIV)?

a. explaining venipuncture to client and obtaining specimen for testing

b. obtaining a signed consent only

c. pretest counseling and ensuring a signed consent is completed

d. pretest counseling only

ANS: C

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

A nurse is clarifying information for a client whose ELISA test is negative. After reviewing the test results with the client, which aspect should be included?

a. Assess the client's risk behavior and strategies for reducing risk.

b. Make a follow-up appointment for further testing.

c. Review the symptoms of disease progression.

d. Discuss the medication regimen.

ANS: A

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

When is a health care worker at greatest risk of being exposed to tuberculosis (TB)?

a. during and after procedures that induce coughing in clients with TB

b. when handling blood products of a client with HIV

c. when caring for clients at risk for developing TB, such as clients who are HIV-positive

d. when caring for clients who have come to the United States from other countries

ANS: A

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

Mycobacterium avium complex (MAC) initially infects which system in persons who have AIDS?

a. bone marrow

b. central nervous system

c. gastrointestinal (GI) tract

d. lymphatic

ANS: C

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

Which of these conditions belongs to the herpes virus group and lies dormant in tissues waiting to be reactivated in the immunocompromised client?

a. cryptosporidium enteritis

b. cytomegalovirus

c. Pneumocystis carinii pneumonia

d. tuberculosis

ANS: B

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

Which of these statements about the medical treatment for cryptosporidiosis is TRUE?

a. It is aimed at palliative treatment.

b. It consists of antibiotic therapy such as penicillin G IV over a period of 14 to 21 days.

c. It consists of antifungal therapy IV for a period of 6 weeks.

d. It consists of radiation therapy for the gastrointestinal (GI)tract.

ANS: A

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

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

a. anorexia

b. histoplasmosis

c. HIV-wasting syndrome

d. malabsorption syndrome

ANS: C

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

What oral fungal infection produces symptoms such as creamy, white intraoral lesions; mucosal tenderness; and painful swallowing in clients who are immunocompromised?

a. cryptosporidium colitis

b. Epstein-Barr virus

c. oral candidiasis

d. oral hairy leukoplakia

ANS: C

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

The majority of clients who have oral hairy leukoplakia receive which kind of treatment?

a. none

b. acyclovir sodium

c. nystatin suspension

d. oral fluconazole

ANS: A

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

What is the MOST common initial infection occurring in women who are human immunodeficiency virus (HIV) positive?

a. candidiasis

b. cryptosporidium

c. Epstein-Barr virus

d. hairy leukoplakia

ANS: A

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

Early signs and symptoms of acquired immunodeficiency syndrome (AIDS) dementia complex include:

a. psychotic behaviors

b. depression

c. hyperactive behavior

d. inability to concentrate

ANS: D

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

The nurse is caring for a client who is human immunodeficiency virus (HIV) positive with a diagnosis of toxoplasmosis. Confirmation the diagnosis of toxoplasmosis in the client is made by which of these signs?

a. recent onset of neurological abnormality

b. presence of CD4 T cells

c. presence of white patches on tongue or oral mucosa

d. evidence of elevated protein level in cerebrospinal fluid

ANS: A

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

The nurse is aware that when caring for the client who is human immunodeficiency virus (HIV) positive, once initial treatment for acute cryptococcal meningitis is completed, interventions should include:

a. avoiding fresh juice and fruit

b. being reevaluated every 2 to 4 weeks for reoccurrence

c. recognizing the signs and symptoms of meningitis, so any reoccurrence can be identified soon

d. beginning lifelong suppressive therapy

ANS: D

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

What is the name of the vascular malignancy that can occur anywhere in the body, but whose first lesions often appear on the face or oral cavity in clients with acquired immunodeficiency syndrome (AIDS)?

a. Kaposi's sarcoma

b. oral candidiasis

c. oral hairy leukoplakia

d. non-Hodgkin's lymphoma

ANS: A

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

A client has received testing for human immunodeficiency virus (HIV). The client's results of two enzyme-linked immunosorbent assay (ELISA) tests have been positive. In explaining the next step, the nurse's response is based on the understanding that:

a. the client will have a bone marrow biopsy to confirm the diagnosis

b. a Western blot test will be done to confirm the diagnosis

c. a CD4+ cell count will be obtained to measure T-helper lymphocytes

d. the client will be diagnosed as HIV-positive and begin medical treatment

ANS: B

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

The nurse is caring for a client with a diagnosis of human immunodeficiency virus (HIV). The nurse understands that the therapeutic management of the client does NOT include:

a. using antiretrovirals to prolong the HIV stage

b. preventing opportunistic infections from occurring

c. radiation to inhibit HIV replication

d. medications to treat opportunistic infections

ANS: C

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

The nurse is educating the client with histoplasmosis about prevention methods for future exposure. The nurse evaluates that the client needs future instruction if the client states that the possible sources include which of the following?

a. cleaning bird cages

b. chicken coops

c. fruit trees

d. mushroom cellars

ANS: C

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

During the incubation period following exposure to HIV, some individuals will experience which of the following symptoms? (Select all that apply.)

a. fever

b. night sweats

c. herpes simplex

d. rash

e. headache

f. myalgia

g. neuralgia

h. candidiasis

ANS: A, B, D, E, F, G

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

Health care workers are at risk for contracting HIV due to exposure to which of the following? (Select all that apply.)

a. blood

b. semen

c. urine

d. tears

e. vaginal fluids

f. placentas

g. stool

ANS: A, B, E, F

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

Which population, according to statistics from the Centers for Disease Control and Prevention (CDC), has the greatest incidence of human immunodeficiency viral (HIV) infection in the United States?

a. Asian Americans

b. African Americans

c. Latinos

d. Whites

ANS: B

Of those with HIV infection in the United States, African Americans make up 49%, whites 27%, and Latinos 12%. Asian Americans were not reported.

DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3

TOP: Human Immunodeficiency Virus (HIV) Incidence in the United States

KEY: Nursing Process Step: Implementation

What does enzyme reverse transcriptase transcribe?

a. DNA to mimic CD4 cells

b. T4-helper cells to RNA

c. HIV RNA to HIV DNA

d. T4 cells to HIV virions

ANS: C

Reverse transcriptase reverses the normal process and allows the RNA to be transcribed to the DNA rather than the DNA to be transcribed to the RNA.

DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2

TOP: Pathophysiology KEY: Nursing Process Step: Implementation

What is the most common form of transmission of the HIV virus?

a. Injection drug use

b. Heterosexual contact

c. Exposure to contaminated blood products

d. Male to male

ANS: D

Male-to-male transmission is still the most common mode.

DIF: Cognitive Level: Knowledge REF: p. 664 OBJ: 3

TOP: Transmission of HIV KEY: Nursing Process Step: Planning

A nurse is assessing a patient with AIDS for risk factors. What is recognized as the most risky behavior in the patient history?

a. Oral sex without contact with the glans penis

b. Oral sex with a condom

c. Use of sex toys

d. Anal sex with a condom

ANS: D

Anal sex, even with a condom, is a higher risk behavior than the other three options.

DIF: Cognitive Level: Comprehension REF: p. 667 OBJ: 3

TOP: Risk Factors KEY: Nursing Process Step: Assessment

When is a patient with HIV considered to have progressed to AIDS?

a. Two or more opportunistic infections are diagnosed.

b. Kaposi sarcoma appears.

c. CD4 cell level drops to 200.

d. Patient tested positive for enzyme-linked immunosorbent assay (ELISA).

ANS: C

A person with an HIV infection is not diagnosed with AIDS until the CD4 count falls to 200. Other AIDS markers exist as well.

DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 5

TOP: AIDS KEY: Nursing Process Step: Implementation

A very anxious young man comes to the clinic believing that he may have HIV infection because of his persistent influenza-like symptoms and his risky sexual behavior. What should the nurse anticipate that a positive blood analysis would show?

a. High levels of CD8 cells

b. High levels of HIV-infected cells

c. Low levels of T cells

d. Low levels of antibodies

ANS: B

In the initial phase of HIV infection, high levels of HIV-infected cells, high levels of T cells, and high levels of antibodies are present as the body attempts to rid the body of the virus through the immune response.

DIF: Cognitive Level: Comprehension REF: p. 668-669 OBJ: 2

TOP: Diagnosis of AIDS KEY: Nursing Process Step: Assessment

How long does the initial stage of an HIV infection usually last?

a. 2 to 4 weeks

b. 4 to 8 weeks

c. 8 to 12 weeks

d. 12 to 16 weeks

ANS: B

The initial phase of an HIV infection lasts from 4 to 8 weeks.

DIF: Cognitive Level: Knowledge REF: p. 668 OBJ: 2

TOP: Initial Phase of HIV Infection KEY: Nursing Process Step: Implementation

A young man at the HIV clinic tells the nurse how relieved he is that he does not have HIV because he now has no symptoms at all when just a few weeks ago he felt awful. What is the most appropriate nursing response?

a. "Flulike symptoms frequently are misdiagnosed as HIV."

b. "In the latent stage, the physical symptoms are reduced, but the HIV is still present in the lymph nodes."

c. "A high antibody count can overwhelm HIV infection in the early stage."

d. "Antiretroviral drugs are very effective in the first stage in reducing symptoms."

ANS: B

In the latent stage, the symptoms are reduced as the virus enters the lymph nodes.

DIF: Cognitive Level: Application REF: p. 668 OBJ: 2

TOP: Stages of HIV Infection KEY: Nursing Process Step: Implementation

A nurse is educating patients about the progression of HIV infections. Which statement by the patient in the latent stage indicates that teaching has been effective?

a. "I had better get my affairs in order. I don't have a lot of time left."

b. "Whew! I thought when I got AIDS that I was a 'goner.'"

c. "Now I won't have to take all those expensive drugs that I have been using."

d. "I can still enjoy life and live pretty much as I want for the next several years."

ANS: D

The latent stage may last as long as 12 years without developing into AIDS. Medications will be continued.

DIF: Cognitive Level: Application REF: p. 668 OBJ: 7

TOP: Latent Stage of HIV Infection KEY: Nursing Process Step: Evaluation

A nurse is caring for a patient with HIV infection taking Retrovir, a nucleoside antiviral that is a reverse transcriptase inhibitor. For what should the nurse be especially observant?

a. Decreased urine output

b. Hypertensive episodes

c. Jaundice

d. Edema of the face

ANS: C

Retrovir has the potential of causing a fatal hepatotoxic reaction. Jaundice is a possible sign of hepatic impairment.

DIF: Cognitive Level: Comprehension REF: p. 675 OBJ: 6

TOP: Drug Side Effects KEY: Nursing Process Step: Assessment

What indicates that a patient has entered the third stage of HIV infection?

a. T-helper CD4 cell count of 500

b. Rise in antibody count

c. Drop in viral load

d. Increase in T4 helper cells

ANS: A

In the third stage of HIV infection, T-helper CD4 cells drop to approximately 500. Antibodies are always high throughout the infection but are ineffective. The viral count is high.

DIF: Cognitive Level: Comprehension REF: p. 668 OBJ: 5

TOP: Third Stage of HIV Infection KEY: Nursing Process Step: Assessment

A nurse is preparing a teaching plan for a patient with HIV who has been diagnosed with microsporidiosis. Which implementation should be included?

a. Drink 3 quarts of fluid a day to combat dehydration.

b. Include milk products with every meal.

c. Consume liberal amounts of fat for increased energy.

d. Limit protein intake to reduce serum ammonia levels.

ANS: A

The patients need plenty of fluids to combat the diarrhea and proteins for calories. They should avoid milk products and fat.

DIF: Cognitive Level: Application REF: p. 670 OBJ: 7

TOP: Microsporidiosis KEY: Nursing Process Step: Implementation

What should a patient be encouraged to do before the initiation of any anti-HIV drug protocol?

a. Give up sexual activity for several months.

b. Follow the strict dietary guidelines.

c. Comply with the drug protocol.

d. Involve the partner in a support program.

ANS: C

Patients with HIV are assessed for their willingness to comply with the drug protocol because nonadherence causes the HIV organisms to become resistant to the drug.

DIF: Cognitive Level: Application REF: p. 676 OBJ: 7

TOP: Compliance KEY: Nursing Process Step: Implementation

A patient with HIV complains to the home health nurse that he has been having watery diarrhea for the past 10 days. The nurse suspects toxoplasmosis. What is the most significant question for the nurse to ask?

a. "Have you stopped taking your antiviral medication?"

b. "Have you been drinking alcohol?"

c. "Have you been eating aged cheese or organ meats?"

d. "Do you have a cat?"

ANS: D

Cat litter boxes and undercooked meats are the major sources of toxoplasmosis, which causes a persistent watery diarrhea.

DIF: Cognitive Level: Comprehension REF: p. 669 OBJ: 4

TOP: Toxoplasmosis KEY: Nursing Process Step: Assessment

A patient with HIV is diagnosed with progressive multifocal leukoencephalopathy (PML). What should a nurse encourage the patient to do?

a. Take daily exercise for 30 minutes.

b. Avoid excessive fats in the diet.

c. Remove all potted plants from inside the home.

d. Prepare advanced directives.

ANS: D

The of advanced directives is essential as this disease is rapidly progressing, and death usually occurs 4 to 6 weeks after diagnosis.

DIF: Cognitive Level: Application REF: p. 672 OBJ: 7

TOP: PML KEY: Nursing Process Step: Planning

Which nursing diagnosis should take priority in the care of an outpatient with AIDS?

a. Ineffective therapeutic regimen management

b. Impaired physical mobility

c. Impaired skin integrity

d. Social isolation

ANS: A

Failure to take anti-HIV drugs as scheduled can encourage resistant strains of HIV.

DIF: Cognitive Level: Analysis REF: p. 676 OBJ: 7

TOP: Nursing Diagnosis: AIDS KEY: Nursing Process Step: Nursing Diagnosis

A nurse removes a potted plant from the room of a patient with HIV. What is the nurse trying to prevent?

a. Aspergillosis

b. Candidiasis

c. Coccidioidomycosis

d. Cytomegalovirus (CMV)

ANS: A

Aspergillosis can be contracted from the potting soil in and around the plant in the pot.

DIF: Cognitive Level: Comprehension REF: p. 671 OBJ: 4

TOP: Aspergillosis KEY: Nursing Process Step: Implementation

What childhood exposure causes painful shingles experienced by the patient with HIV?

a. Measles

b. Mumps

c. Impetigo

d. Chickenpox

ANS: D

Chickenpox can be reactivated as shingles.

DIF: Cognitive Level: Knowledge REF: p. 671 OBJ: 4

TOP: Shingles KEY: Nursing Process Step: Implementation

Which nursing action should be implemented to increase the comfort of a patient with oral hair leukoplakia?

a. Allow aspirin to melt in the mouth and then wash out with warm water.

b. Encourage mouth rinses with warm salt water several times a day.

c. Limit intake of ice cream and other cold foods.

d. Offer fluids through a straw.

ANS: D

Using a straw keeps fluids from flooding the entire oral cavity. Warm or acidic items are to be discouraged because they add to the discomfort. Ice cream and popsicles can numb the area.

DIF: Cognitive Level: Application REF: p. 672 OBJ: 4

TOP: Oral Hair Leukoplakia KEY: Nursing Process Step: Planning

What should a patient with HIV avoid to prevent bacillary angiomatosis (BA)?

a. Cats

b. Large crowds of people

c. Consuming unwashed fruits

d. Exposure to mosquito bites

ANS: A

Cats and their fleas are thought to transmit BA.

DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4

TOP: Prevention KEY: Nursing Process Step: Implementation

What sign should a nurse report when caring for the patient with AIDS who has cutaneous Kaposi sarcoma?

a. Nausea

b. Fatigue

c. Abdominal pain

d. Weight loss

ANS: C

Abdominal pain may be an indication of organ involvement from Kaposi sarcoma.

DIF: Cognitive Level: Comprehension REF: p. 673 OBJ: 2

TOP: Kaposi Sarcoma KEY: Nursing Process Step: Assessment

What should a nurse anticipate will happen when a patient's first ELISA result is positive?

a. The diagnosis of AIDS is confirmed.

b. The test is repeated in 6 to 8 months.

c. Another blood sample must be obtained for testing.

d. A Western blot test is performed on the same sample.

ANS: C

If the ELISA result is positive, the ELISA is repeated. If the second ELISA result is positive, a Western blot test is performed.

DIF: Cognitive Level: Application REF: p. 673 OBJ: 5

TOP: HIV Laboratory Tests KEY: Nursing Process Step: Planning

Which statement by a patient diagnosed with AIDS should lead a nurse to suspect an infection by CMV?

a. "I need to get glasses; I can't see as well as I did a few months ago."

b. "I need to drink more water. This diarrhea has really dehydrated me."

c. "I need to get smaller clothes. I have lost 10 lb in the past 6 weeks."

d. "I need to take some pep pills. I don't have any energy."

ANS: A

Visual changes indicate the presence of CMV retinitis, which will eventually lead to blindness. Diarrhea is indicative of a fungal infection, and decreases in weight and energy are expected manifestations of AIDS.

DIF: Cognitive Level: Comprehension REF: p. 672 OBJ: 4

TOP: Assessing CMV KEY: Nursing Process Step: Assessment

A nurse is caring for a patient with HIV infection who has been prescribed highly active antiretroviral therapy (HAART). What should the nurse warn the patient that inconsistent administration of the drug can result in?

a. HIV strain becoming resistant to the drug

b. Decrease in antibodies in the circulating volume

c. Addition of another antiretroviral agent to the protocol

d. Rapid increase in the symptoms of AIDS

ANS: A

Inconsistent administration of HAART drugs can cause the HIV strain to become resistant to the drug.

DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 6

TOP: HAART KEY: Nursing Process Step: Implementation

Which populations are at the highest risks of contracting HIV? (Select all that apply.)

a. Health care workers who mishandle infected sharps

b. Breastfed infants of HIV-infected mothers

c. Persons sharing living quarters with an HIV-infected person

d. Heterosexual partners of an HIV-infected person

e. Newborns of an HIV-infected mother

ANS: A, B, D, E

Sharing living quarters without intimate contact does not expose a person to HIV infection.

DIF: Cognitive Level: Comprehension REF: p. 664 OBJ: 2

TOP: Prevalence of HIV KEY: Nursing Process Step: Implementation

A nurse is designing a teaching plan for a patient with AIDS. What should be included relative to food preparation precautions? (Select all that apply.)

a. Check expiration dates on frozen foods.

b. Leave produce unwashed to preserve protective spray.

c. Drink a small glass of red wine before each meal to stimulate the appetite.

d. Eat three large, well-balanced meals daily.

e. Avoid leftovers.

ANS: A, E

Using food before the expiration date and avoiding leftovers reduce the risk of food contamination. Individuals with AIDS should wash all fresh produce to get rid of contaminants, eat several small meals daily, and avoid alcohol and caffeine.

DIF: Cognitive Level: Application REF: p. 678 OBJ: 7

TOP: Nutritional Precautions KEY: Nursing Process Step: Implementation

Which factors explain the increase in HIV infections in persons over the age of 50 years? (Select all that apply.)

a. Older persons are usually not questioned by health professionals about sex or drug abuse.

b. Older persons are more promiscuous in earlier years.

c. Older persons are less likely to seek HIV screening.

d. Older persons mistake HIV symptoms as part of the discomforts of increased age.

e. Older persons tend to use hormonal forms of contraception.

ANS: A, C, D

Individuals older than 50 years of age are less likely to be questioned by health care professionals relative to sex activities or illicit drug use. Older adults are less likely to seek HIV screening and frequently accept the symptoms of HIV as part of increasing age.

DIF: Cognitive Level: Comprehension REF: p. 674 OBJ: 7

TOP: Older Persons with HIV KEY: Nursing Process Step: N/A

Which opportunistic fungal diseases threaten patients with HIV? (Select all that apply.)

a. Aspergillosis

b. Pneumocystis jiroveci

c. Herpes simplex

d. Oral hairy leukoplakia

e. Tuberculosis

ANS: A, B

Aspergillosis and P. jiroveci are caused by fungi. Herpes simplex and leukoplakia are caused by viruses. Tuberculosis is caused by bacteria.

DIF: Cognitive Level: Knowledge REF: p. 670 OBJ: 7

TOP: Fungal Infections KEY: Nursing Process Step: Implementation

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

ANS:

macrophage

The macrophage introduces HIV into the system.

DIF: Cognitive Level: Knowledge REF: p. 667 OBJ: 2

TOP: Macrophage KEY: Nursing Process Step: Implementation

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

ANS:

6

six

The usual antiretroviral protocol for an infant born to a mother with AIDS is for 6 weeks.

DIF: Cognitive Level: Knowledge REF: p. 674 OBJ: 7

TOP: Treatment of Newborns of AIDS Patients

KEY: Nursing Process Step: Implementation

A patient comes to the clinic with human immunodeficiency virus (HIV) seropositivity. The nurse understands that this patient has which manifestations?

1. Flulike symptoms

2. Weight loss, night sweats

3. Kaposi sarcoma, tuberculosis

4. Positive laboratory test result

Positive laboratory test result

The patient with HIV seropositivity is infectious but shows no sign of disease.

In the primary infectious period, flulike symptoms are present.

Then the patient passes into the seropositivity stage.

As the disease progresses the patient may experience weight loss, night sweats, and lymphadenopathy.

Which drug does the primary health care provider prescribe for a patient with human immunodeficiency virus (HIV)?

1. Dronabinol (Marinol)

2. Zidovudine (Retrovir)

3. Pravastatin (Pravachol)

4. Rosiglitazone (Avandia)

Zidovudine (Retrovir)

Zidovudine (Retrovir) is used to treat HIV.

Dronabinol (Marinol) is given to stimulate appetite in patients who have anorexia.

Pravastatin (Pravachol) is an anticholesterol drug that is given to treat hyperlipidemia.

Rosiglitazone (Avandia) is an oral hypoglycemic agent given to treat diabetes.

According to the Centers for Disease Control and Prevention (CDC), in 2010 what percentage of men who have sex with men (MSM) accounted for the total number of human immunodeficiency virus (HIV) infections in males 13 years old and older?

1. 23%

2. 56%

3. 78%

4. 95%

78%

In 2010 the CDC reported that MSM constitute the biggest proportion of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) patients, accounting for 78% of the total number of HIV infections in males 13 years old and older.

The category labeled as men who have sex with men still accounts for the largest number of individuals with HIV and AIDS.

A nurse caring for a patient newly diagnosed with human immunodeficiency virus (HIV) is providing education on ways to delay the progression of HIV. When asked about social habits, the patient reveals that she uses intravenous drugs, smokes 50 cigarettes per day, and uses condoms with her multiple sex partners. Which initial goal would be most appropriate for this patient to promote a healthy lifestyle and delay disease progression?

1. Limit sexual partners to one person

2. Abstain from use of recreational drugs

3. Begin taking an oral contraceptive drug

4. Decrease cigarettes smoked per day to 20

Decrease cigarettes smoked per day to 20.

Decreasing cigarettes smoked per day from 50 to 20 is an attainable goal that improves the health and immune system of the patient.

Although limiting sexual partners to one, abstinence from recreational drug use, and prevention of pregnancy are important, these goals are not as attainable and as important to improving the immune system and maintaining health.

The nurse is caring for a patient with human immunodeficiency virus (HIV). Which findings suggest that the patient has early symptomatic disease? Select all that apply.

1. Recurrent infections

2. No reactivity to skin tests

3. CD4+ cell count of 400/mm3

4. Generalized lymphadenopathy

5. More CD4+ cells than CD8+ cells

Recurrent infections

CD4+ cell count of 400/mm3

Generalized lymphadenopathy

Early symptoms include recurrent infections and generalized lymphadenopathy due to compromised immunity.

The early symptomatic phase of HIV occurs when the CD4+ cell count drops below 500/mm3.

No reactivity to skin tests and the presence of more CD4+ cells than CD8+ cells indicate acquired immunodeficiency syndrome (AIDS).

Which statement most accurately describes transmission of human immunodeficiency virus (HIV)?

1. HIV transmission occurs as a result of sexual preferences.

2. HIV transmission can occur via sharing food and/or utensils.

3. HIV can be transmitted via inanimate objects, such as toilet seats or computer keyboards.

4. HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk.

4. HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk.

Rationale: HIV transmission is dependent on the presence of the virus, the infectiousness of the virus, the susceptibility of the uninfected host, and any conditions that may put the person at risk.

HIV is transmitted from human to human via infected blood, semen, cervicovaginal secretions, and breast milk.

If these infected fluids are introduced into an uninfected person, the potential for HIV transmission exists.

HIV transmission occurs as a result of sexual practices, not sexual preferences.

HIV is generally transmitted by behaviors and not by casual contacts, such as hugging, dry kissing, shaking hands, or sharing food and utensils.

HIV is an obligate virus, meaning that it must have a host organism to survive.

HIV does not survive very long outside the human body; therefore it cannot be transmitted via inanimate objects.

What factor increases the probability of vertical transmission of a human immunodeficiency virus (HIV) infection?

1. The baby is born at term.

2. The mother's viral load is low.

3. The mother has good nutritional status.

4. The mother is in the initial stage of the HIV infection.

The mother is in the initial stage of the HIV infection.

If the mother is in the initial stage of the HIV infection, there is an increased chance of vertical transmission of the infection, because the initial and later stages of infection are the times when more of the virus is circulating in the mother's blood and body fluids. If the mother's viral load is low, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors).

A low viral load means that less of the virus is circulating in the mother's blood and body fluids. If the baby is born at term, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors).

Extreme prematurity increases the baby's risk of contracting the virus during the actual delivery. If the mother has good nutritional status, there is a lower chance of vertical transmission of an HIV infection (although this is only one of numerous factors).

The nurse is caring for a postpartum patient with human immunodeficiency virus (HIV). What should the nurse suggest to the patient to prevent the spread of infection to the newborn?

1. Avoid kissing the newborn.

2. Avoid hugging the newborn.

3. Avoid breastfeeding the newborn.

4. Avoid providing kangaroo care to the newborn.

Avoid breastfeeding the newborn.

HIV is transmitted through blood, semen, cervicovaginal secretion, and breast milk.

Therefore, to prevent the transmission of infection to the newborn, the nurse should suggest that the patient avoids breastfeeding the newborn.

HIV does not spread through saliva, urine, or feces. Therefore, the nurse need not advise the patient to avoid kissing the newborn.

HIV is not transmitted through skin-to-skin contact. Therefore, the nurse should not tell the patient to avoid hugging and providing kangaroo care to the newborn.

The nurse is caring for a patient with human immunodeficiency virus (HIV) who is experiencing bouts of diarrhea. Which dietary instruction does the nurse give to the patient to prevent complications? Select all that apply.

1. Increase the intake of peas.

2. Increase the intake of bananas.

3. Increase the intake of dried beans.

4. Increase the intake of apricot nectar.

5. Increase the intake of margarine foods.

Increase the intake of bananas.

Increase the intake of apricot nectar.

Diarrhea causes loss of electrolytes in the body.

Therefore, the nurse should instruct the patient to increase the intake of bananas and apricot nectar.

Both are rich sources of potassium and help maintain potassium levels in the body.

The nurse should not instruct the patient to increase the intake of peas, dried beans, and margarine foods because these foods worsen the symptoms of diarrhea.