Question 1

After having a positive rapid-antibody test for HIV, a client is anxious and does not appear to hear what the nurse is saying. Which of the following actions should the nurse implement?

Accepted Answer

After an initial positive antibody test, the next step is retesting to confirm the results. A client 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.

Question 2

Ten years after seroconversion, an HIV-infected client has a CD4+ cell count of 800 cells per microlitre and an undetectable viral load. Which of the following actions is the priority nursing intervention at this time?

Accepted Answer

The CD4+ level for this client is in the normal range, indicating that the client is the early chronic stage of 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 initiation of ART is highly individual, it would not be likely that a client with a normal CD4+ level would receive ART.

Question 3

Which of the following nursing actions will be most useful in assisting a young adult 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 client'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 client's schedule.

Question 4

The nurse is caring for a client with HIV who has a CD4+ cell count of 400/µL. Which of the following factors is most important to consider when determining whether antiretroviral therapy (ART) will be initiated for this client?

Accepted Answer

Drug resistance develops quickly unless the client takes ART medications on a stringent schedule, and this endangers both the client and the community. The other information is also important to consider, but clients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.

Question 5

The nurse is caring for a pregnant client who has recently been diagnosed with HIV. The client asks the nurse, "How soon after delivery of my baby can ART treatment be started?" Which of the following provide the basis for the nurse's response?

Accepted Answer

Women infected with HIV should receive optimal ART immediately, regardless of whether or not they are pregnant.

Question 6

Aclient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and HIV testing is positive. Based on diagnostic criteria established by the World Health Organization (WHO), which of the following diagnoses should the nurse anticipate?

Accepted Answer

Development of PCP pneumonia meets the diagnostic criterion for AIDS. The other responses indicate an earlier stage of HIV infection than is indicated by the PCP infection.

Question 7

Replication of HIV is enhanced when the client is taking which of the following herbs?

Accepted Answer

Some herbs (e.g., echinacea, astragalus) should not be used because they can enhance the replication of HIV. St. John's wort can interfere with ART rather than enhance replication of HIV. Saw palmetto does not enhance HIV replication.

Question 8

The nurse is caring for a client with HIV infection who has developed Mycobacterium avium complex infection. Which of the following goals is most appropriate for this client?

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 (pneumonia, dementia, influenza, etc.) associated with HIV infection.

Question 9

Aclient who has vague symptoms of fatigue and headaches is found to have a positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV) antibodies. In discussing the test results with the client, which of the following information should thenurseinclude?

Accepted Answer

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 part of HIV testing. Because the nurse does not know how recently the client was infected, it is not appropriate to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

Question 10

A client who has been treated for HIV infection for 7 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. Which of the following topics should the nurse include in the client teaching plan?

Accepted Answer

A frequent first intervention for metabolic disorders is a change in 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 11

Which of the following clients will the nurse working in an HIV testing and treatment clinic anticipate teaching about antiretroviral therapy (ART)?

Accepted Answer

CMV disease is an AIDS-defining illness and indicates that the client is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative client would not be offered ART. A client with a CD4+ count in the normal range would not typically be started on ART. A client 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 12

Which of the following tests is used to evaluate the effectiveness of ART?

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 13

The nurse is preparing to give the following medications to an HIV-positive client who is hospitalized with Pneumocystis jiroveci pneumonia (PCP). Which of the following medications is most important to administer at the right 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 14

When assessing an individual who has diagnosed with early chronic HIV infection and has a normal CD4+ count, which of the following assessments should the nurse conduct?

Accepted Answer

Persistent generalized lymphadenopathy is common in the early stage of chronic infection. Diarrhea, oral lesions, and neurological abnormalities would occur in the later stages of HIV infection.

Question 15

A young adult who uses injectable illegal drugs asks the nurse about preventing AIDS. Which of the following information should the nurse inform the client is the best way to reduce the risk of HIV infection from drug use?

Accepted Answer

Participation in needle and syringe exchange programs has been shown to control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practised by individuals in withdrawal. 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 16

Which of the following tests does the Canadian Blood Services use to detect HIV genetic material in blood?

Accepted Answer

In 2001, a new, highly sensitive nucleic acid amplification test (NAAT) was implemented by the Canadian Blood Services to detect HIV genetic material in blood of potential donors. The NAAT has a much shorter window period than antibody testing and is now the standard test for donated blood in Canada. CD4+ T-cell count, CD4 fraction, and the HIV RNA polymerase chain reaction test are not used by Canadian Blood Services.

Question 17

The nurse is caring for a client whose HIV status is unknown. Which of these client exposures is most likely to require postexposure prophylaxis for the nurse?

Accepted Answer

Puncture wounds are the most common means for workplace transmission of bloodborne diseases, and a needle with a hollow bore that had been contaminated with the client'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 18

Aclient who has diagnosed with AIDS tells the nurse, "I have lots of thoughts about dying. Do you think I am just being morbid?" Which of the following responses by the nurse is most appropriate?

Accepted Answer

More assessment of the client'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 client from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the client. Although antidepressants may be helpful, the initial action should be further assessment of the client's feelings.

Question 19

Which information about an HIV-positive client who is taking antiretroviral medications is most important for the nurse to address when planning care?

Accepted Answer

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

Question 20

Apregnant woman with a history of early chronic HIV infection is seen at the clinic. Which of the following information should the nurse include when teaching the client?

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.

Quiz 17: Infection and Human Immunodeficiency Virus Infection