Lewis - Chapter 15: Infection and Human Immunodeficiency Virus Infection

The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital?

1 Droplet precautions
2 Contact precautions
3 Air-borne precautions
4 Standard precautions

2
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). Air-borne 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.
Text Reference - p. 231

The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as?

1 Delaying disease progression
2 Preventing disease transmission
3 Helping to cure the HIV infection
4 Enabling an increase in self-care activities

1
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.
Text Reference - p. 242

The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching?
1 "I can't contract HIV unless there's an opportunistic infection present."
2 "Using a condom with a spermicide will give 100% protection from HIV."
3 "Using a condom with a spermicide will reduce my risk of contracting HIV."
4 "Kaposi's sarcoma is one of the first opportunistic infections to show up in someone with HIV."

3
Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse. An opportunistic infection does not have to be present, a condom with spermicide does not provide 100% protection, and Kaposi's sarcoma is not one of the first opportunistic infections to appear in someone infected with HIV.
Text Reference - p. 240

The nurse reviews a plan of care for a patient who has sustained a deep laceration to an extremity. Which goal listed on the plan is inappropriate and should be questioned by the nurse?

1 The patient will be free of signs and symptoms of infection.
2 The patient will demonstrate how to change the sterile dressing on the laceration.
3 The patient will report any change in sensation of the extremity distal to the laceration.
4 The patient will stop taking the antibiotics after 2 days if he detects no signs of infection

4
If antibiotics are prescribed, the patient should not stop them; rather, the entire course should be taken even if there are no signs of infection. Appropriate goals for this patient are to be free of signs and symptoms of infection, to maintain a dry and intact dressing, and to report changes in the distal extremity.
Text Reference - p. 230

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

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

2
Teaching the mother 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.
Text Reference - p. 227

A patient diagnosed with a staph infection is started on vancomycin. What should the nurse educate the patient on to decrease resistance to the medications? Select all that apply.
1
"Make sure you take all of the medication as prescribed."
2
"Wash your hands frequently, so you do not spread the infection."
3
"You can skip doses, and double the dose at the next scheduled dose."
4
"It is okay to save unused doses for later if you do not use all of them."
5
"If you have a cold or the flu, this medication will help treat them as well."

1, 2

Ways to decrease resistance include not taking unless prescribed, following the prescription directions, washing hands frequently, and finishing the medication. Ways that will contribute to resistance include skipping doses, saving unused doses for later, and taking the antibiotics for cold or flu.
Text Reference - p. 230

A female patient who is HIV positive is prescribed Efavirenz (Sustiva) in large doses. What question should the nurse ask of the patient before administering the therapy to ensure drug safety?
1
"Are you pregnant?"
2
"Is your partner HIV positive?"
3
"Are you on your menses?"
4
"Have you ever had a blood transfusion?"

1

Efavirenz (Sustiva) is an antiretroviral drug. Large doses could cause fetal anomalies; therefore, it is important to know if the patient is pregnant. Asking about the HIV status of the partner is unrelated to administration of the drug. The information about the patient's menses does not impact the antiretroviral therapy. A history of blood transfusion helps ascertain the mode of infection, but does not impact the drug therapy.
Text Reference - p. 238

A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method?
1
Shaking hands
2
Sharing a toilet seat
3
Eating from the same utensils
4
Having unprotected sex

4

AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes.
Text Reference - p. 231

A nurse is conducting a class for human immunodeficiency virus (HIV) positive pregnant women. What information should the nurse give them about routes of transmission and infective periods? Select all that apply.
1 HIV can be transmitted by breastfeeding.
2 HIV can be transmitted even before it is detected on a screening test.
3 HIV can be transmitted by contact with vomitus.
4 HIV can be transmitted lifelong once a person is HIV-positive.
5 HIV can be transmitted by hugging and dry kissing.

HIV can be transmitted as a result of contact with infected blood, semen, vaginal secretions, or breast milk. Transmission of HIV occurs through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV-infected individuals can transmit HIV to others within a few days after becoming infected, even before it is detected on a screening test. The ability to transmit HIV continues for life. HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. It is not spread by tears, saliva, urine, emesis (vomiting), sputum, feces, sweat, respiratory droplets, or enteric routes.
Text Reference - p. 232

A nurse works in a long-term care unit. An elderly patient who has a continuous indwelling catheter seems to be confused and shows behavioral changes. On examination, the nurse finds the patient's body temperature to be normal. What does the change in cognition and behavior most likely indicate?
1
The patient has an infection.
2
The patient is developing dementia.
3
The patient is depressed.
4
The patient has a psychotic illness.

1

Patients living in long-term care facilities are at an increased risk of developing infections. The risk is higher in patients who have an indwelling catheter. Elderly patients may not have fever when they have an infection. Cognitive or behavioral changes are early indications of the presence of infection. Dementia is a slow and progressive disease, and does not have acute symptoms. Depression, until severe, does not manifest as cognitive and behavioral change. While cognitive and behavioral changes may indicate a psychotic illness, other possibilities are more likely in this patient.
Text Reference - p. 230

When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching?
1
"I will need to isolate any tissues I use so as not to infect my family."
2
"I will notify all of my sexual partners so they can get tested for HIV."
3
"Unprotected sexual contact is the most common mode of transmission."
4
"I do not need to worry about spreading this virus to others by sweating at the gym."

1

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. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching.
Text Reference - p. 232

The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive?
1
Personal protective equipment
2
Combination antiretroviral therapy
3
Counseling to report blood exposures
4
A negative evaluation by the manager

2

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

A woman is afraid she may get human immunodeficiency virus (HIV) from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis? Select all that apply.
1
Take fluconazole (Diflucan)
2
Take amphotericin B (Fungizone)
3
Use condoms for risk-reducing sexual relations
4
Take emtricitabine and tenofovir (Truvada) regularly
5
Have regular HIV testing for herself and her husband

3, 4, 5

Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has 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 Cryptococcosus neoformans , which are all opportunistic diseases associated with HIV infection.
Text Reference - p. 237

A patient is being placed on efavirenz (Sustiva) with a once-a-day dose. Which instructions should the nurse give to help the patient cope with the side effects?
1
Use electronic reminders, timers, and beepers.
2
Take the dose at bedtime before going to sleep.
3
Have tests regularly to assess viral load in the body.
4
Inform the health care provider about other drugs being taken.

2

The antiretroviral drug efavirenz (Sustiva) is associated with side effects like dizziness and confusion. Therefore, the nurse should teach the patient to take the drug dose at bedtime to cope better with the side effects. Electronic reminders, timers, and beepers are used to increase adherence to drug regimens. Informing the health care providers about concurrent medicines is important to decrease adverse drug interactions but may not help in coping with side effects of the drug. Regular testing should be done to assess the viral load on the body and, in turn, indicate the efficacy of the drug therapy.
Text Reference - p. 236

A human immunodeficiency virus (HIV) patient comes into the clinic for a follow-up appointment with a temperature of 102 degrees Fahrenheit. Which statement would the nurse report immediately?
1
"I woke up this morning with a mild headache."
2
"I vomited once this morning."
3
"I started coughing up some clear mucous when I woke up this morning."
4
"I have a rash that appeared on my stomach this morning."

4
Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms that can be delayed up to 24 hours.
Text Reference - p. 242

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease?
1
A new onset of polycythemia
2
Presence of mononucleosis-like symptoms
3
A sharp decrease in the patient's CD4+ count
4
A sudden increase in the patient's white blood cell (WBC) count

3

A decrease in CD4+ count signals an exacerbation of the severity of HIV . Polycythemia is not characteristic of the course of HIV. Mononucleosis-like symptoms, such as malaise, headache, and fatigue, are typical of early HIV infection and seroconversion. A patient's WBC count is very unlikely to increase suddenly, with decreases being typical.
Text Reference - p. 234

Which instructions should the nurse include when teaching preexposure prophylaxis (PrEP) to a group of adults at high risk of sexually acquired HIV infection? Select all that apply.
1
Safe sex practices
2
Regular HIV testing
3
Frequent hand washing
4
Discreet use of antibiotics
5
Risk reduction counseling

Preexposure prophylaxis refers to strategies that aim to prevent HIV infection in adults at high risk of developing sexually acquired HIV infection. The strategies include safe sex practice, regular HIV testing for screening and early detection, and risk reduction counseling. Frequent hand washing helps to prevent transmission of infection in general, but not specifically sexually acquired HIV infection. Discreet use of antibiotics is helpful in preventing antibiotic-resistant infections, but not specifically HIV infection.
Text Reference - p. 238

The nurse is caring for a patient who is being treated with antibiotics. The nurse recalls that what factors lead to antibiotic resistance? Select all that apply.

1 Skipping of doses
2 Continuing antibiotic use beyond symptomatic relief
3 Administering antibiotics for viral infections
4 Using narrow spectrum antibiotics
5 Saving unused antibiotics

1, 3, 5
Various factors lead to bacterial resistance to antibiotics. Skipping doses leads to incomplete treatment and promotes antibiotic resistance. Saving unused antibiotic for future use may lead to inappropriate use related to the specific disease and may contribute to antibiotic resistance. Administering antibiotics for viral infections also promotes antibiotic resistance because antibiotics are ineffective against viruses. The use of broad spectrum antibiotics leads to the development of bacterial resistance, not the use of narrow spectrum antibiotics. Antibiotics should be used for the prescribed duration irrespective of symptomatic relief.
Text Reference - p. 229

A medical team is conducting human immunodeficiency virus (HIV) screening in a community. Which finding would indicate a positive diagnosis for HIV infection? Select all that apply.

1 A history of fever, diarrhea, candidiasis, or weight loss
2 A history of intercourse with an HIV-positive woman or man
3 A positive tuberculin test
4 A positive Western blot test
5 A positive enzyme immunoassay (EIA) test

4, 5
Positive EIA and Western blot tests confirm the presence of HIV antibodies. A positive antibody test should be followed by a test to confirm (usually the Western blot). Engaging in high-risk sexual behaviors places someone at risk but does not constitute a positive diagnosis. A positive tuberculin test does not confirm the presence of HIV infection; it just indicates that the person has been exposed to Mycobacterium tuberculosis. Extreme weight loss or high fever does not confirm the presence of HIV; these adaptations are related to many disorders, and not just HIV infection. The diagnosis of an opportunistic infection alone is not sufficient to confirm the diagnosis of HIV.
Text Reference - p. 236

Which piece of data is of highest priority for the nurse to verify to safely give a dose of cephalexin (Keflex) to a patient?

1 Normal white blood cell count
2 Patient is afebrile
3 No allergy to penicillin
4 Urine output is greater than 30 mL per hour

3
It is critically important to verify that the patient has no allergies to medication, specifically to cephalosporins or penicillins. There is a risk of cross-sensitivity to penicillins and cephalosporins in patients with a known penicillin allergy. An elevated white blood cell count and fever are common in the setting of infection being treated with this antibiotic. Urine output should be greater than 30 mL/hour; however, is not the priority assessment data.
Text Reference - p. 230

CD4+ T-cells are an important component of the immune system. What is the minimum count of CD4+ T-cells to maintain a healthy immune function? Record your answer using a whole number.

500
Adults without immune dysfunction normally have 800 to 1200 CD4+ T-cells per microliter (μL) of blood. The normal life span of a CD4+ T-cell is about 100 days, but human immunodeficiency virus (HIV)-infected CD4+ T-cells die after an average of only 2 days. Generally, the immune system remains healthy with more than 500 CD4+ T-cells/μL. Immune problems start to occur when the count drops below 500 CD4+ T-cells/μL. Severe problems develop when the count is below 200 CD4+ T-cells/μL.

TEST-TAKING TIP: Being prepared reduces your stress or tension level and helps you maintain a positive attitude.
Text Reference - p. 233

A patient is on first-line therapy for a chronic bacterial infection. The health care provider has prescribed the full course of treatment for 10 days. The patient has skipped one tablet on the morning of the 2nd day but took 2 tablets that night instead of one. After 7 days, the patient felt well and stopped taking tablets. What could be the possible causes for development of drug resistance in this patient? Select all that apply.

1 Associated viral infection
2 Poor drug compliance
3 Skipping the dose
4 First-line antibiotics
5 Diabetes

2, 3
Causes for drug resistance are using broad-spectrum or combination agents for infections that should be treated with first-line medications, administering antibiotics for viral infections, unnecessary antibiotic therapy, and using inadequate drug regimens. Patients can also contribute to resistance development by skipping doses and not taking antibiotics for the full duration of prescribed therapy. Viral infections and diabetes do not directly contribute to drug resistance.
Text Reference - p. 229

The nurse understands that a patient with human immunodeficiency virus (HIV) starts to develop immune problems when their CD4 count:

1 Drops below 200
2 Drops below 500
3 Is greater than 500
4 Falls between 800 to 1200

2
Immune problems start to occur when the count drops below 500 CD4 T cells. When it drops below 200 CD4 T cells, severe immune problems will develop and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 to 1200 CD4 T cells is normal for adults that do not have any immune dysfunction.
Text Reference - p. 233

A nurse is asked to teach a human immunodeficiency virus (HIV) positive patient about the measures to be taken to prevent resistance to antibiotics and infections. What information should the nurse give? Select all that apply.

1 Advise patient to avoid requesting an antibiotic for flu or colds.
2 Advise patient to avoid skipping antibiotic doses.
3 Advise patient to wash hands properly and regularly.
4 Advise patient to save unfinished antibiotics for later use.
5 Advise patient to only take antibiotics until the patient feels better

1, 2, 3
Antibiotics are effective against bacterial infections but not viruses, which cause colds and flu. Therefore, antibiotics should not be requested for flu or colds. Hand washing is the single most important thing to do to prevent infection. The patient should not skip antibiotic doses, as doing so can lead to development of resistance. A person should never stop taking antibiotics when feeling better. If an antibiotic is stopped early, the hardiest bacteria survive and multiply. Eventually, the patient could develop an infection resistant to many antibiotics. It is also important to never have leftover antibiotics.
Text Reference - p. 230

A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient?

1 The patient does not have HIV infection.
2 The test might give a false negative report.
3 The test should be repeated at 3 weeks, 6 weeks, and 3 months.
4 The patient is HIV positive, but the viral load is not detectable

3
An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at 3 weeks, 6 weeks, and 3 months. The test is unlikely to give a false negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he is HIV positive.
Text Reference - p. 236

A nurse is taking a blood sample with a syringe and large bore needle from a patient with chronic human immunodeficiency virus (HIV) who has a CD4+ T-cell count of 123/μL. If the nurse gets a needle injury, what factors may affect the transmission of HIV infection? Select all that apply.

1 Viral load
2 Age of the nurse
3 Volume of blood exposed to
4 Age of the patient
5 Immune status of nurse

1, 3, 5
Patients with a poor immune status are more susceptible to any kind of infection, including HIV. The concentration of the virus is an important variable. Other variables that influence the transmission are the volume of blood, virulence of the virus, and concentration of the organism in the blood. Large amounts of HIV can be found in the blood, and to a lesser extent in the semen, during the first 6 months of infection and again during the late stages. HIV positive patients can transmit the infection at any age to a person of any age when the route of transmission is established. Therefore, the age of the patient or nurse does not affect the transmission of HIV infection to the nurse.
Text Reference - p. 231

A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is:

1 Hyperthermia
2 Social isolation
3 Impaired memory
4 Sexual dysfunction

1
Temperature increase is the highest priority for the nurse because Pneumocystis jiroveci pneumonia (PCP) is an indication of AIDS (acquired immunodeficiency syndrome). Early detection and treatment of PCP is directly related to a positive outcome. Temperature increase in an immunosuppressed patient is always a concern. Social isolation is a secondary risk of all persons who test positive for human immunodeficiency virus (HIV). Impaired memory and sexual dysfunction may develop as complications in patients with HIV disease, but these issues are not always present.
Text Reference - p. 236

A patient receiving long-term antiretroviral therapy (ART) for HIV has developed lipodystrophy, hyperlipidemia, insulin resistance, and bone disease. Which should be the first intervention?

1 Suggest dietary changes to lower lipid levels.
2 Promote weight loss through exercise.
3 Advocate use of calcium supplements.
4 Change antiretroviral medications

4
Long-term therapy with antiretroviral drugs may lead to development of certain metabolic disorders, including lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, renal disease, and cardiovascular disease. Therefore, the first intervention should be to change the antiretroviral drug and start medications that have fewer side effects. Other interventions like dietary changes, weight loss through exercise, and taking calcium supplements are general measures and may not contribute directly to the reduction of side effects.
Text Reference - p. 243

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient?
a. "The EIA test will need to be repeated to verify the results."
b. "A viral culture will be done to determine the progression of the disease."
c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)."
d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A
After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?
a. "The patient meets the criteria for a diagnosis of an acute HIV infection."
b. "The patient will be diagnosed with asymptomatic chronic HIV infection."
c. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C
Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?
a. Teach the patient about the medications available for treatment.
b. Inform the patient how to protect sexual and needle-sharing partners.
c. Remind the patient about the need to return for retesting to verify the results.
d. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C
After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best?
a. "Thinking about dying will not improve the course of AIDS."
b. "It is important to focus on the good things about your life now."
c. "Do you think that taking an antidepressant might be helpful to you?"
d. "Can you tell me more about the kind of thoughts that you are having?"

ANS: D
More assessment of the patient's psychosocial status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient?
a. The antiretroviral medications used to treat HIV infection are teratogenic.
b. Most infants born to HIV-positive mothers are not infected with the virus.
c. Because she is at an early stage of HIV infection, the infant will not contract HIV.
d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

ANS: B
Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown?
a. Needle stick with a needle and syringe used to draw blood
b. Splash into the eyes when emptying a bedpan containing stool
c. Contamination of open skin lesions with patient vaginal secretions
d. Needle stick injury with a suture needle during a surgical procedure

ANS: A
Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan?
a. Driving is allowed when starting this medication.
b. Report any bizarre dreams to the health care provider.
c. Continue to use contraception while on this medication.
d. Take this medication in the morning on an empty stomach.

ANS: C
Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?
a. HIV genotype and phenotype
b. Patient's social support system
c. Potential medication side effects
d. Patient's ability to comply with ART schedule

ANS: D
Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?
a. Patient who is currently HIV negative but has unprotected sex with multiple partners
b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL
c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily
d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

ANS: D
CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count.

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take?
a. Instruct the patient to apply ice to the neck.
b. Advise the patient that this is probably the flu.
c. Explain to the patient that this is an expected finding.
d. Request that an antibiotic be prescribed for the patient.

ANS: C
Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing?
a. Patient age
b. Patient lifestyle
c. Patient symptoms
d. Patient sexual orientation

ANS: A
The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best?
a. "Avoid sexual intercourse when using injectable drugs."
b. "It is important to participate in a needle-exchange program."
c. "You should ask those who share equipment to be tested for HIV."
d. "I recommend cleaning drug injection equipment before each use."

ANS: B
Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?
a. Give the patient detailed information about possible medication side effects.
b. Remind the patient of the importance of taking the medications as scheduled.
c. Encourage the patient to join a support group for students who are HIV positive.
d. Check the patient's class schedule to help decide when the drugs should be taken.

ANS: D
The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.

A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care?
a. The patient will be free from injury.
b. The patient will receive immunizations.
c. The patient will have adequate oxygenation.
d. The patient will maintain intact perineal skin.

ANS: D
The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient?
a. Review foods that are higher in protein.
b. Teach about the benefits of daily exercise.
c. Discuss a change in antiretroviral therapy.
d. Talk about treatment with antifungal agents.

ANS: C
A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time?
a. Oral acyclovir (Zovirax)
b. Oral saquinavir (Invirase)
c. Nystatin (Mycostatin) tablet
d. Aerosolized pentamidine (NebuPent)

ANS: B
It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day.

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review?
a. Viral load testing
b. Enzyme immunoassay
c. Rapid HIV antibody testing
d. Immunofluorescence assay

ANS: A
The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.

The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care?
a. The patient's blood glucose level is 142 mg/dL.
b. The patient complains of feeling "constantly tired."
c. The patient is unable to state the side effects of the medications.
d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

ANS: D
Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT.

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time?
a. Teach about the effects of antiretroviral agents.
b. Encourage adequate nutrition, exercise, and sleep.
c. Discuss likelihood of increased opportunistic infections.
d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B
The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first?
a. Patient whose latest CD4+ count is 250/µL
b. Patient whose rapid HIV-antibody test is positive
c. Patient who has had 10 liquid stools in the last 24 hours
d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C
The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching?
a. Many medications have interactions with antiretroviral drugs.
b. Less frequent CD4+ level monitoring is needed in older adults.
c. Hospice care is available for patients with terminal HIV infection.
d. Progression of HIV infection occurs more rapidly in older patients.

ANS: A
The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease.

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)?
a. Teach the patient about how to use tissues to dispose of respiratory secretions.
b. Stock the patient's room with all the necessary personal protective equipment.
c. Interview the patient to obtain the names of family members and close contacts.
d. Tell the patient's family members the reason for the use of airborne precautions.

ANS: B
A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority?
a. Methods to prevent perinatal HIV transmission
b. Ways to sterilize needles used by injectable drug users
c. Prevention of HIV transmission between sexual partners
d. Means to prevent transmission through blood transfusions

ANS: C
Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)?
a. Hepatitis B vaccine
b. Pneumococcal vaccine
c. Influenza virus vaccine
d. Trimethoprim-sulfamethoxazole
e. Varicella zoster immune globulin

ANS: A, B, C
Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)?
a. Mask
b. Gown
c. Gloves
d. Shoe covers
e. Eye protection

ANS: B, C
Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)?
a. Continue taking antibiotics until all the medication is gone.
b. Antibiotics may sometimes be prescribed to prevent infection.
c. Unused antibiotics that are more than a year old should be discarded.
d. Antibiotics are effective in treating influenza associated with high fevers.
e. Hand washing is effective in preventing many viral and bacterial infections.

ANS: A, B, E
All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza