Question 1

A male patient is concerned about telling others he has HIV infection.What should the nurse stress when discussing his concerns?

Accepted Answer

Nurses have a responsibility to assess each patient's risk for HIV infection and counsel those at risk about HIV testing and the behaviors that put them at risk,and about how to reduce or eliminate those risks.The diagnosis needs to be carefully protected and shared only with caregivers who need to know for the purpose of assessment and treatment.

Question 2

Why should interventions such as promotion of nutrition,exercise,and stress reduction be undertaken by the nurse for patients who have HIV infection?

Accepted Answer

HIV disease progression may be delayed by promoting a healthy immune system.Useful interventions for HIV-infected patients include the following: nutritional changes that maintain lean body mass,regular exercise,and stress reduction.

Question 3

To be diagnosed as having AIDS,the patient must be HIV-positive,have a compromised immune system without known immune system disease or recent organ transplant,and present with which of the following?

Accepted Answer

The 1993 expanded case definition of AIDS includes all HIV-infected people who have CD4+,T-lymphocyte counts of less than 200 cells/mm³;this includes all people who have one or more of these three clinical conditions: pulmonary tuberculosis,recurrent pneumonia,or invasive cervical cancer,and it retains the 23 clinical conditions listed in the 1987 AIDS case definition.

Question 4

A 21-year-old male who has been an IV heroin user has been experiencing fever,weight loss,and diarrhea and has been diagnosed as having AIDS.At this time,he has a low-grade fever,severe diarrhea,and a productive cough.He is admitted with Pneumocystis jiroveci.What should the nurse do when caring for the patient?

Accepted Answer

The use of Standard Precautions and body substance isolation has been shown not only to reduce the risk of blood-borne pathogens,but also to reduce the risk of transmission of other disease between the patient and the health care worker.

Question 5

The HIV patient asks the nurse about what to expect in terms of disease progression.The nurse tells this patient that although the disease can vary greatly among individuals,the usual pattern of progression includes:

Accepted Answer

The progression from HIV to AIDS includes initial exposure,primary HIV infection,asymptomatic HIV infection,early HIV disease,and AIDS.

Question 6

A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms,because "they don't work." Which is the most appropriate response?

Accepted Answer

Risk-reducing sexual activities decrease the risk of contact with HIV through the use of barriers.The most commonly used barrier is the male condom.Although not 100% effective,when used correctly and consistently,male condoms are very effective in the prevention of HIV transmission.

Question 7

What do the activated monocytes and macrophages produce in the presence of an inflammatory process?

Accepted Answer

Neopterin is produced in the presence of an inflammatory reaction and is increased in HIV disease.

Question 8

The anxious male patient is fearful that he has been exposed to a person with an HIV infection.He states he does not want to go to a laboratory for the ELISA tests because he does not want to be identified.What would be the nurse's most helpful response?

Accepted Answer

The OraQuick is a home OTC test approved by the FDA.One seronegative on the ELISA is not evidence because seroconversion may not have taken place.The Western blot test follows if the ELISA is positive.

Question 9

What should the nurse emphasize when counseling an anxious HIV-positive mother about the care of her HIV-positive infant?

Accepted Answer

The decline in pediatric AIDS incidence is associated with the increased compliance with universal counseling and testing of pregnant women and the use of zidovudine by HIV-infected pregnant women and their newborn infants.Infants born to HIV-infected mothers will have positive HIV antibody results as long as 15 to 18 months after birth.This is caused by maternal antibodies that cross the placenta during gestation and remain in the infant's circulatory system.

Question 10

A 28-year-old married attorney with one child is in the first trimester of her second pregnancy.The patient states that she is at no risk for HIV,so she would not need to be counseled about testing for HIV.Which is the most appropriate response?

Accepted Answer

Increases in AIDS cases in women and heterosexuals and a slowing of cases in the men who have sex with men (MSM)category are a direct reflection of early educational efforts directed at the MSM population,who were believed to be the only population at risk.Women need to be assessed for different manifestations of HIV infection.It is the current recommendation for voluntary HIV testing for all pregnant women.

Question 11

For most people who are HIV-positive,marker antibodies are usually present 10 to 12 weeks after exposure.What is the development of these antibodies called?

Accepted Answer

Seroconversion is the development of antibodies from HIV,which takes place approximately 5 days to 3 months after exposure,generally within 1 to 3 weeks.Although the conversion has taken place,the patient is not yet immunodeficient.

Question 12

The patient,age 21,has been treated for chlamydia and has a history of recurrent herpes.What should the nurse counsel this patient about?

Accepted Answer

Chlamydia is considered a sexually transmitted disease (STD).As such it requires further testing and a sexual history to advise the sexual partners.

Question 13

A male patient is advised to receive HIV antibody testing because of his multiple sexual partners and injectable drug use.What should the nurse inform the patient to ensure understanding?

Accepted Answer

The individual's blood is tested with ELISA or enzyme immunoassay (ELA),antibody tests that detect the presence of HIV antibodies.If the ELA is positive for HIV,then the same blood is tested a second time.If the second ELA is positive,a more specific confirming test such as the Western blot is done.Blood that is reactive or positive in all three steps is reported to be HIV-positive.A seronegative is not an assurance that the individual is free of infection since seroconversion may not have yet occurred.

Question 14

A patient has just been diagnosed as HIV-positive.He asks the nurse,"Does this mean I have AIDS?" Which response would be most informative?

Accepted Answer

Typical progress of HIV includes a period of relative clinical latency,occurring immediately after the primary infection,which can last for several years.Long-term nonprogressors remain symptom-free for 8 to10 years.

Question 15

Which of the following is a CDC criterion for the progression of HIV infection to AIDS?

Accepted Answer

AIDS is the end stage of an HIV infection.The CDC has developed criteria for the diagnosis of AIDS,which are: increase in viral load even with pharmacologic interventions,increase in the ratio of CD8 to CD4,decline in the WBCs,and a decreased reactivity to skin tests.

Question 16

When assigned to a newly admitted patient with AIDS,the nurse says,"I'm pregnant.It is not safe for me or my baby if I am assigned to his case." Which is the most appropriate response by the charge nurse?

Accepted Answer

HIV is transmitted from human to human through infected blood,semen,cervicovaginal secretions,and breast milk.The use of Standard Precautions by all staff members for all patients all the time simplifies this issue.

Question 17

What should the nurse look for when reviewing a patient's chart to determine whether she has progressed from HIV disease to AIDS?

Accepted Answer

Patients who have progressed from HIV disease to AIDS will have the condition in which the CD4+ cell count drops to less than 200 cells/mm³ and have a history of opportunistic diseases.

Question 18

The nurse should instruct the patient who is diagnosed with AIDS to report signs of Kaposi sarcoma,which include:

Accepted Answer

Kaposi sarcoma is a rare cancer of the skin and mucous membranes characterized by blue,red,or purple raised lesions seen mainly in Mediterranean men.Kaposi sarcoma: firm,flat,raised or nodular,hyperpigmented,multicentric lesions on the skin and mucous membranes.

Question 19

While teaching community groups about AIDS,what should the nurse indicate as the most common method of transmission of the HIV virus?

Accepted Answer

Modes of transmission have remained constant throughout the course of the HIV pandemic.It is also important for health care providers to remember that transmission of HIV occurs through sexual practices,not sexual preferences.Worldwide,sexual intercourse is by far the most common mode of HIV transmission.

Question 20

A patient states that he feels terrific,but a blood test shows that he is HIV-positive.It is important for the nurse to discuss with him that HIV may remain dormant for several years.What is true of the patient during this time?

Accepted Answer

A prolonged period in which HIV is not readily detectable in the blood follows within a few weeks or months of the initial infection.This titer,or viral load,falls dramatically as the immune system responds and controls the HIV infection,and it may last 10 to 12 years.During this period,there are few clinical symptoms of HIV infection,although an individual is still capable of transmitting HIV to others.

Quiz 16: Care of the Patient with HIV/AIDS