Question 1

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?

Accepted Answer

To prevent harm,it is most critical to inform patients that efavirenz can cause fetal anomalies and should not be used in patients who may be or may become pregnant. The other information is also accurate,but it does not directly prevent harm. The medication should be taken on an empty stomach with water and patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.

Question 2

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV)status is unknown?

Accepted Answer

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.

Question 3

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?

Accepted Answer

Drug resistance develops quickly unless the patient takes ART medications on a strict,regular schedule. In addition,drug resistance endangers both the patient and 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.

Question 4

The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV)through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient?

Accepted Answer

HIV screening tests detect HIV-specific antibodies or antigens,but typically it takes a several week delay after initial infection before HIV can be detected on a screening test. Combination antibody and antigen tests (also known as fourth-generation tests)decrease the window period to within 3 weeks after infection. It is not known based on this information whether the patient is infected with HIV or can infect others.

Question 5

Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV)testing needs?

Accepted Answer

The current Centers for Disease Control and Prevention policy is to offer routine testing for HIV to all individuals age 13 to 64 years. Although lifestyle,symptoms,and sexual orientation may suggest increased risk for HIV infection,the goal is to test all individuals in this age range.

Question 6

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?

Accepted Answer

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. Maintaining healthy lifestyle behaviors is an important goal in this stage. 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.

Question 7

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/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC),which statement by the nurse is correct?

Accepted Answer

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

Question 8

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 scheduled time?

Accepted Answer

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.

Question 9

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART)for which patient?

Accepted Answer

CMV retinitis is an 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.

Question 10

A patient informed of 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?

Accepted Answer

After an initial positive antibody test result,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 the HIV status of other individuals.

Question 11

To evaluate the effectiveness of antiretroviral therapy (ART),which laboratory test result will the nurse review?

Accepted Answer

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.

Question 12

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best?

Accepted Answer

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.

Question 13

Which of these patients who have arrived at the human immunodeficiency virus (HIV)clinic should the nurse assess first?

Accepted Answer

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.

Question 14

A pregnant woman with 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?

Accepted Answer

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.

Question 15

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?

Accepted Answer

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 (e.g.,pneumonia,dementia,influenza)associated with HIV infection.

Question 16

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 recommendation will the nurse give to the patient?

Accepted Answer

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.

Question 17

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV)infection. Which action would be appropriate for the nurse to take?

Accepted Answer

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. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu. Ice will not decrease the swelling in persistent generalized lymphadenopathy

Question 18

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART)regimen?

Accepted Answer

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 are also useful,but they will not improve adherence as much as individualizing the ART to the patient's schedule.

Question 19

The nurse is caring 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?

Accepted Answer

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. Fatigue is a common side effect of ART. The nurse should discuss medication actions and side effects with the patient,but this is not as important as addressing the skipped doses of AZT.

Question 20

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS)tells the nurse,"I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate?

Accepted Answer

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" or suggesting an antidepressant 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.

Quiz 14: Infection and Human Immunodeficiency Virus Infection

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?

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 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?

The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient?

Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV) testing needs?

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?

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 scheduled time?

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient?

A patient informed of 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?

To evaluate the effectiveness of antiretroviral therapy (ART) ,which laboratory test result will the nurse review?

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS) . Which response by the nurse is best?

Which of these patients who have arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first?

A pregnant woman with 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 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 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 recommendation will the nurse give to the patient?

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take?

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?

The nurse is caring 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 patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse,"I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate?