Lewis ch 14: infection and human immunodeficiency virus infection QUESTIONS

1. Emerging and reemerging infections affect health care by (select all that apply)
a. reevaluating vaccine practices.
b. revealing antimicrobial resistance.
c. limiting antibiotics to those with life-threatening infection.
d. challenging researchers to discover new antimicrobial therapies.

1. Correct answers: a, b, d

An emerging infection is an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future. Reemerging infections are those infections that were previously controlled but have resurfaced. The most common reason for reemerging infectious is low vaccination rates. Ways in which emerging and reemerging infectious have affected the health care system include revising vaccine recommendations for previously controlled infections (e.g., pertussis and measles); discovery of antimicrobial-resistant organisms; and creation of new antiinfective agents to combat new organisms or antimicrobial-resistant infections.

2. Which types(s) of isolation precautions is (are) appropriate for a patient with tuberculosis (select all that apply)?
a. contact precautions
b. droplet precautions
c. airborne precautions
d. standard precautions
e. neutropenic precautions

2. Correct answers: c, d

Standard precautions should be used for all patients. In addition to standard precautions, patients with TB should be placed on airborne precautions to minimize risk of transmission and infection of HCPs and visitors.

3. Transmission of HIV from an infected individual to another most commonly occurs as a result of
a. unprotected anal or vaginal sexual intercourse.
b. low levels of virus in the blood and high levels of CD4+ T cells.
c. transmission from mother to infant during labor and delivery and breastfeeding.
d. sharing of drug-using equipment, including needles, syringes, pipes, and straws.

3. Correct answer: a

Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner infected with human immunodeficiency virus (HIV) is the most common mode of HIV transmission.

4. During HIV infection
a. reverse transcriptase helps HIV fuse with the CD4+ T cell.
b. HIV RNA uses the CD4+ T cell's mitochondria to replicate.
c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.
d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.

4. Correct answer: c

Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

5. Which statements accurately describe HIV infection (select all that apply)?
a. Untreated HIV infection has a predictable pattern of progression.
b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS).
c. Untreated HIV infection can remain in the early chronic stage for a decade or more.
d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less.
e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

5. Correct answers: a, b, c

The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

6. A diagnosis of AIDS is made when an HIV-infected patient has
a. a CD4+ T cell count below 200/µL.
b. a high level of HIV in the blood and saliva.
c. lipodystrophy with metabolic abnormalities.
d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.

6. Correct answer: a

AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 14-10.

7. Screening for HIV infection generally involves
a. detecting CD8+ cytotoxic T cells in saliva.
b. laboratory analysis of saliva to detect CD4+ T cells.
c. analysis of lymph tissues for the presence of HIV RNA.
d. laboratory analysis of blood to detect HIV antigen or antibody.

7. Correct answer: d

Rationale: The most useful screening tests for HIV detect HIV-specific antibodies and/or antigen.

8. HIV antiretroviral drugs are used to
a. cure acute HIV infection.
b. decrease viral RNA levels.
c. treat opportunistic diseases.
d. decrease pain and symptoms in terminal disease.

8. Correct answer: b

Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

9. Opportunistic diseases in HIV infection
a. are usually benign.
b. are generally slow to develop and progress.
c. occur in the presence of immunosuppression.
d. are curable with appropriate drug interventions.

9. Correct answer: c

Rationale: Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (Table 14-10).

10. Which statement(s) about metabolic side effects of ART is (are) true (select all that apply)?
a. These are annoying symptoms that are ultimately harmless.
b. ART-related body changes include fat redistribution and peripheral wasting.
c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol.
d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol.
e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients.

10. Correct answers: b, c, d

Rationale: Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

11. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission?
a. Using sterile equipment to inject drugs
b. Cleaning equipment used to inject drugs
c. Taking lamivudine (Epivir) during pregnancy
d. Using latex or polyurethane barriers to cover genitalia during sexual contact

11. Correct answer: a

Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment. Lamivudine alone is not appropriate for treatment in pregnancy. Barrier methods reduce but do not eliminate risk.

12. What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen?
a. "Set up" a drug pillbox for the patient every week.
b. Give the patient a video and a brochure to view and read at home.
c. Tell the patient that the side effects of the drugs are bad but that they go away after a while.
d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

12. Correct answer: d

Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.

1. The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). What does the nurse explain to the patient the criteria for diagnosis is based on?

A. Presence of HIV antibodies
B. CD4+ T cell count below 200/µL
C. Presence of oral hairy leukoplakia
D. White blood cell count below 5000/µL

B

Diagnostic criteria for AIDS include a CD4+ T-cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

2. When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching?

A. "I will need to isolate any tissues I use so as not to infect my family."
B. "I will notify all of my sexual partners so they can get tested for HIV."
C. "Unprotected sexual contact is the most common mode of transmission."
D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A

HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

3. The nurse has experienced a recent increase in the incidence of hospital care-associated infections (HAIs) on the unit. Which nursing action should be prioritized in the response to this trend?

A. Use of gloves during patient contact
B. Frequent and thorough hand washing
C. Prophylactic, broad-spectrum antibiotics
D. Fitting and appropriate use of N95 masks

B

Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient.

4. The nurse teaches the staff ensuring that standard precautions should be used when providing care for which type of patient?

A. All patients regardless of diagnosis
B. Pediatric and gerontologic patients
C. Patients who are immunocompromised
D. Patients with a history of infectious diseases

A

Standard precautions are designed for all care of all patients in hospitals and health care facilities.

5. The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease?

A. A new onset of polycythemia
B. Presence of mononucleosis-like symptoms
C. A sharp decrease in the patient's CD4+ count
D. A sudden increase in the patient's WBC count

C

A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

6. The patient is diagnosed with vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to others?

A. Droplet precautions
B. Contact precautions
C. Airborne precautions
D. Standard precautions

B

Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., tuberculosis, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.

7. A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection?

A. "The baby will probably be infected with HIV."
B. "Only an abortion will keep your baby from having HIV."
C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."
D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C

On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

8. A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What rationale for taking more than one antiretroviral medication should the nurse give to the patient to improve compliance?

A. Viral replication will be inhibited.
B. They will decrease CD4+ T cell counts.
C. It will prevent interaction with other drugs.
D. More than one drug has a better chance of curing HIV.

A

The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T-cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

9. A nurse was accidently stuck with a needle used on a patient who is infected with human immunodeficiency virus (HIV). After reporting the incident, what care should this nurse first receive?

A. Personal protective equipment
B. Combination antiretroviral therapy
C. Counseling to report blood exposures
D. A negative evaluation by the manager

B

Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

10. A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother?

A. There is currently no need for those older vaccines.
B. There is a reemergence of some of the infections, such as pertussis.
C. There is no longer an immunization available for some of those diseases.
D. The only way to protect your child is to have the federally required vaccines.

B

Teaching the parent that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.

11. An older adult patient is brought to the primary health care provider by an adult child reporting confusion. What testing should the nurse anticipate obtaining from this patient?

A. Urinalysis
B. Sputum culture
C. Red blood cell count
D. White blood cell count

A

The developments of urinary tract infections commonly contribute to atypical manifestations such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection.

12. A patient who is infected with human immunodeficiency virus (HIV) is being taught by the nurse about health promotion activities such as good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows?

A. Delaying disease progression
B. Preventing disease transmission
C. Helping to cure the HIV infection
D. Enabling an increase in self-care activities

A

These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.

13. The nurse is teaching a group of young adults who live in a dormitory about the prevention of antibiotic-resistant infections. What should be included in the teaching plan?

A. Save leftover antibiotics for future uses.
B. Hand washing can prevent many infections.
C. Antibiotics are indicated for preventing most colds.
D. Stop taking prescribed antibiotics when symptoms improve.

B

Hand washing is the single most important action to prevent infections. Antibiotics are used to treat bacterial infections, not colds and flu caused by viruses. Patients should complete the entire prescription of antibiotics to prevent the development of resistant bacteria. Antibiotics should not be taken to prevent infections unless they are given prophylactically before undergoing certain surgeries and dental work.

14. The nurse is providing postoperative care for a patient with human immunodeficiency virus (HIV) infection after an appendectomy. What type of precautions should the nurse observe to prevent the transmission of this disease?

A. Droplet precautions
B. Contact precautions
C. Airborne precautions
D. Standard precautions

D

Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or though breastfeeding.

15. A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection?

A. Cough, diarrhea, headaches, blurred vision, muscle fatigue
B. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy
C. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes
D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

D

Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lymphadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

16. The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a patient with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications are effective?

A. Increased viral load
B. Decreased neutrophil count
C. Increased CD4+ T cell count
D. Decreased white blood cell count

C

Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

17. A patient has acquired immunodeficiency syndrome (AIDS) and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result?


A. The patient has the virus present and can transmit the infection to others.
B. The patient is not able to transmit the virus to others through sexual contact.
C. The patient will be prescribed lower doses of antiretroviral medications for 2 months.
D. The syndrome has been cured, and the patient will be able to discontinue all medications.

A

In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.

18. What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection (select all that apply.)?

A. Wash hands frequently.
B. Take antibiotics as prescribed.
C. Take the antibiotic until it is gone.
D. Take antibiotics to prevent illnesses like colds.
E. Save leftover antibiotics to take if needed later.

A, B, C

To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, finish the antibiotic, do not request antibiotics for colds or flu, do not save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider.

19. A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What should the nurse include when teaching about preexposure prophylaxis (select all that apply.)?

A. Take fluconazole (Diflucan).
B. Take amphotericin B (Fungizone).
C. Use condoms for risk-reducing sexual relations.
D. Take emtricitabine and tenofovir (Truvada) regularly.
E. Have regular HIV testing for herself and her husband.

C, D, E

Using male or female condoms, having monthly HIV testing for the patient and partner, and taking emtricitabine and tenofovir regularly have shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcus neoformans, which are all opportunistic diseases associate with HIV infection.

20. A patient is admitted to the emergency department (ED) with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing actions will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply.)?

A. Assessment of lung sounds
B. Assessment of sexual behavior
C. Assessment of living conditions
D. Assessment of drug and syringe use
E. Assessment of exposure to an ill person

B, D

With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).