Chapter 14 Infection and HIV Study Guide Flashcards
Which characteristic corresponds with the acute stage of HIV infection?
a. Burkitt’s lymphoma
b. Temporary fall of CD4+ T cells
c. Persistent fevers and night sweats
d. Pneumocystis jiroveci pneumonia
b. The symptoms of acute HIV infection occur 2 to 4 weeks after initial infection and last for 1 to 2 weeks. The CD4+ T-cell counts fall temporarily but quickly return to baseline levels. Burkitt’s lymphoma and Pneumocystis jiroveci pneumonia are two of the opportunistic diseases that can occur in acquired immunodeficiency syndrome (AIDS). Persistent fevers and drenching night sweats occur in the symptomatic infection stage.
What finding supports the diagnosis of acquired immunodeficiency syndrome (AIDS) in the individual with HIV?
a. Flu-like symptoms
b. Oral hairy leukoplakia
c. CD4+ T cells 200-500/μL
d. Cytomegalovirus retinitis
d. Cytomegalovirus retinitis could be an opportunistic viral infection that occurs when AIDS is diagnosed. Flu-like symptoms occur in the acute HIV infection stage. CD4+ T cells drop to 200-500/μL and oral hairy leukoplakia are seen in the symptomatic infection stage of HIV.
Which characteristics describe Pneumocystis jiroveci infection, an opportunistic disease that can be associated with HIV?
a. May cause fungal meningitis
b. Diagnosed by lymph node biopsy
c. Pneumonia with dry, nonproductive cough
d. Viral retinitis, stomatitis, esophagitis, gastritis, or colitis
c. Pneumocystis jiroveci infection is characterized by pneumonia with a dry, nonproductive cough. Cryptococcus infection may cause fungal meningitis. Non-Hodgkin’s lymphoma is diagnosed by lymph node biopsy. Cytomegalovirus infection is characterized by viral retinitis, stomatitis, esophagitis, gastritis, or colitis.
Which opportunistic disease associated with AIDS is characterized by hyperpigmented lesions of skin, lungs, and gastrointestinal (GI) tract?
a. Kaposi sarcoma
b. Candida albicans
c. Herpes simplex type 1 infection
d. Varicella-zoster virus infection
a. Hyperpigmented lesions of skin, lungs, and GI tract are seen in Kaposi sarcoma. Candida albicans is a common yeast infection of the mouth, esophagus, GI tract, or vagina. Herpes simplex type 1 infection has oral and mucocutaneous vesicular and ulcerative lesions. Varicella- zoster virus infection or shingles is a maculopapular, pruritic rash and is treated with acyclovir.
A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is most important for the nurse to do?
a. Ask the patient to identify all sexual partners
b. Determine when the patient thinks exposure to HIV occurred
c. Explain that all test results must be repeated at least twice to be valid
d. Discuss prevention practices to prevent transmission of the HIV to others
b. Because there is a median delay of several weeks after infection before antibodies can be detected, testing during this “window” may result in false-negative results. Risky behaviors that may expose a person to HIV should be discussed and possible scheduling for repeated testing done. Positive results on initial testing will be verified by additional testing. Identification of sexual partners and prevention practices are important but do not relate immediately to the testing situation.
The “rapid” HIV antibody testing is performed on a patient at high risk for HIV infection. What should the nurse explain about this test?
a. The test measures the activity of the HIV and reports viral loads as real numbers.
b. This test is highly reliable, and in 5 minutes the patient will know if HIV infection is present.
c. If the results are positive, another blood test and a return appointment for results will be necessary.
d. This test detects drug-resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral
drugs.
c. Although the “rapid” test is highly reliable and results are available in about 20 minutes, if results are positive from any testing, blood will be drawn for more specific enzyme immunosorbent assay (EIA) or Western blot testing and another visit will be necessary to obtain the results of the additional testing. CD4+ T-cell counts are not used for screening but rather are used to monitor the progression of HIV infection and new assay tests measure resistance of the virus to antiviral drugs.
Treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI) is prescribed for a patient with HIV infection who has a CD4+ T-cell count of <400/μL. The patient asks why so many drugs are necessary for treatment. What should the nurse explain as the primary rationale for combination therapy?
a. Cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination.
b. Combinations of antiretroviral drugs decrease the potential for development of antiretroviral-resistant HIV variants.
c. Side effects of the drugs are reduced when smaller doses of three different drugs are used rather than large doses of one drug.
d. When CD4+ T-cell counts are <500/μL, a combination of drugs that have different actions is more effective in slowing HIV growth.
b. The use of potent combination antiretroviral therapy limits the potential for development of resistance to antiretroviral medications, the major factor that limits the ability of antiretroviral drugs to inhibit virus replication and delay disease progression. The drugs selected should be ones with which the patient has not been previously treated and that are not cross-resistant with antiretroviral agents previously used by the patient.
Prophylactic measures that are routinely used as early as possible in HIV infection to prevent opportunistic and debilitating secondary problems include administration of
a. isoniazid (INH) to prevent tuberculosis
b. trimethoprim/sulfamethoxazole (TMP/SMX) for toxoplasmosis
c. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B
d. varicella-zoster immune globulin (VZIG) to prevent chickenpox or shingles
c. Pneumococcal pneumonia, influenza, and hepatitis A and B vaccines should be given as early as possible in HIV infection while there is still immunologic function. Isoniazid (INH) is used for 9 to 12 months only if a patient has reactive purified protein derivative (PPD) >5 mm, has had high-risk exposure, or has prior untreated positive PPD. Trimethoprim/sulfamethoxazole (TMP/ SMX) is initiated when CD4+ T-cell count is <200/μL or when there is a history of Pneumocystis jiroveci pneumonia (PCP) and varicella-zoster immune globulin (VZIG) is indicated only after significant exposure to chickenpox or shingles in patients with no history of disease or a negative varicella-zoster virus (VZV) antibody test.
A patient identified as HIV antibody-positive 1 year ago manifests acute HIV infection but does not want to start antiretroviral therapy at this time. What is an appropriate nursing intervention for the patient at this stage of illness?
a. Assist with end-of-life issues
b. Provide care during acute exacerbations
c. Provide physical care for chronic diseases
d. Teach the patient about immune enhancement
d. After a patient has positive HIV antibody testing and is in acute disease, the overriding goal is to keep the viral load as low as possible and to maintain a functioning immune system. The nurse should provide teaching regarding ways to enhance immune function to prevent the onset of opportunistic diseases in addition to teaching about the spectrum of the infection, options for care, signs and symptoms to watch for, ways to prevent HIV spread, and ways to adhere to treatment regimens.
