Question 1

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient:&#10;A) has an increased risk of transmitting the HIV infection.&#10;B) is less likely to develop AIDS than younger persons with HIV infection.&#10;C) is less likely to respond to antiretroviral agents.&#10;D) may have comorbid illnesses that can complicate HIV.

Accepted Answer

Patients with long-standing HIV infection are at risk for developing comorbid illnesses including cardiovascular disease, liver disease, and malignancies. These comorbidities can complicate the management of HIV infection.

Question 2

A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm³. Today's lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm³. How will the nurse interpret the patient's results?

A) A drug-resistant strain is likely.
B) The patient is progressing as expected.
C) The patient's treatment goals have been met.
D) Treatment failure has occurred.

Accepted Answer

The patient's improvement, indicated by a decreased viral load (from 60 to 20 copies/mL) and an increased CD4 count (from 450 to 800 cells/mm^3), suggests that the antiretroviral therapy is effective, and the patient is progressing as expected.

Question 3

A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take?&#10;A) Ask the patient's family members to administer the medications.&#10;B) Avoid discussing adverse effects to prevent focus on negative aspects of ART.&#10;C) Give a detailed list of medications and stress the need to adhere to the schedule.&#10;D) Offer written and verbal information about each drug's purpose.

Accepted Answer

Offering written and verbal information about each drug's purpose can help the patient understand the importance of sticking to the regimen and the potential benefits of the therapy. This approach can also help the patient feel more in control and informed about their treatment, which may increase adherence. Option A (asking family members to administer medications) may not be feasible or desirable for all patients, and option B (avoiding discussions about adverse effects) could lead to poor understanding and adherence. Option C (providing a detailed list of medications and stressing the need to adhere to the schedule) may not address the patient's concerns or reasons for poor adherence in the past.

Question 4

A pregnant patient is HIV-positive. Which of the following is true of antiretroviral therapy during pregnancy?&#10;A) To avoid toxicity to the fetus, antiretroviral therapy is discontinued during pregnancy&#10;B) To minimize toxicity to the fetus, antiretroviral monotherapy is used&#10;C) Combination antiretroviral drug therapy is the standard of care during pregnancy&#10;D) Intravenous antiretroviral therapy is absolutely contraindicated

Accepted Answer

Combination antiretroviral drug therapy is the standard of care during pregnancy to reduce the risk of mother-to-child transmission of HIV. Discontinuing antiretroviral therapy can lead to a rebound in viral load, which increases the risk of transmission. Monotherapy is not recommended as it can lead to drug resistance. Intravenous antiretroviral therapy may be used in certain situations such as during labor and delivery, but it is not contraindicated.

Question 5

A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will recommend next?

A) Administration of a high dose of corticosteroids
B) Changing the regimen to a single antiretroviral drug
C) Temporarily discontinuing the antiretroviral therapy
D) Treating an underlying opportunistic infection

Accepted Answer

Immune reconstitution inflammatory syndrome (IRIS) is a condition where the immune system of an individual, who starts antiretroviral therapy (ART), becomes hyperactive and results in inflammation. The provider may recommend treating any underlying opportunistic infection, which could be contributing to the development of IRIS. The provider may choose to continue ART and manage IRIS symptoms with supportive care and possibly anti-inflammatory medication, but not high doses of corticosteroids as they can hinder immune reconstitution. Changing the regimen to a single antiretroviral drug or temporarily discontinuing antiretroviral therapy is not the appropriate management for IRIS.

Question 6

A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in combination with other antiretrovirals in order to:&#10;A) avoid development of psychiatric comorbidities.&#10;B) prevent dizziness, sedation, and nightmares.&#10;C) reduce viral resistance.&#10;D) prevent severe rash and hepatotoxicity.

Accepted Answer

Efavirenz, like all antiretrovirals, is recommended to be given in combination with other antiretrovirals to reduce viral resistance. This is because HIV quickly develops resistance to single-drug therapy, and the use of combination therapy helps to prevent this. While efavirenz can cause psychiatric side effects such as dizziness, sedation, and nightmares, it is not given in combination solely to prevent these effects. Severe rash and hepatotoxicity are potential side effects of efavirenz, but giving it in combination with other antiretrovirals does not prevent them.

Question 7

A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir:

A) allows decreasing the dosing from 3 times daily to twice daily.
B) can lead to increased cholesterol and triglycerides.
C) may worsen insulin resistance.
D) will require increased dietary restrictions.

Accepted Answer

The addition of ritonavir to indinavir allows for decreasing the dosing frequency from three times daily to twice daily. This is because ritonavir enhances the pharmacokinetics of indinavir, increasing its effectiveness and allowing for less frequent dosing. However, ritonavir can also lead to potential side effects such as increased cholesterol and triglycerides, worsened insulin resistance, and increased dietary restrictions.

Question 8

A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing which of the following?

A) acute retroviral syndrome.
B) AIDS.
C) an increased viral load.
D) an opportunistic infection.

Accepted Answer

The symptoms of fever, sore throat, myalgia, and night sweats are consistent with acute retroviral syndrome (ARS), which occurs within the first few weeks of HIV infection. ARS is a flu-like illness that occurs as the body works to mount an immune response to the virus. While opportunistic infections and an increased viral load may occur later in the course of HIV infection, they would not typically present with these symptoms. AIDS is a late stage of HIV infection, and it would not typically present with these acute symptoms.

Question 9

A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes?&#10;A) Consume a low-cholesterol diet.&#10;B) Consume more acidic foods.&#10;C) Take the pill on an empty stomach.&#10;D) Take the pill with fatty foods.

Accepted Answer

Protease inhibitors can elevate cholesterol levels, so it is important for the patient to consume a low-cholesterol diet to minimize this side effect. Consuming acidic or fatty foods or taking the pill on an empty stomach can interfere with the absorption of the medication.

Question 10

The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient's blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond?

A) "No treatment is necessary since the patient is receiving antiretroviral therapy."
B) "We will treat you if the patient's VL is greater than 20 copies/mL."
C) "You will require 4 weeks of antiretroviral therapy."
D) "You will undergo HIV testing and will be treated if you are positive."

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Accepted Answer

Post-exposure prophylaxis (PEP) with antiretroviral therapy for 4 weeks is recommended for healthcare workers after potential exposure to HIV, regardless of the patient's viral load or treatment status.

Question 11

A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient's creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action?

A) Instruct the patient to take the medication 60 minutes prior to meals.
B) Notify the provider to discuss dose adjustments.
C) Request an order for once-daily dosing of this medication.
D) Suggest that the patient increase fluid intake.

Accepted Answer

The answer of A patient who is HIV-positive begins therapy...

Deck 29: Hiv- and Aids-Related Drugs