Chapter 17 Flashcards
A client 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 the nurse include?
a. The EIA test will need to be repeated to verify the results.
b. A viral culture will be done to determine the progress of the disease.
c. It will probably be 10 or more years before the client develops acquired
immunodeficiency syndrome (AIDS).
d. The Western blot test will be done to determine whether AIDS has developed.
A
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.
A client 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?
a. Acute infection
b. Early chronic infection
c. Intermediate chronic infection
d. Late chronic infection or AIDS
D
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.
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?
a. Teach the client about the medications available for treatment.
b. Inform the client how to protect sexual and needle-sharing partners.
c. Remind the client about the need to return for retesting to verify the results.
d. Ask the client to notify individuals who have had risky contact with the client.
C
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.
A client 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?
a. “Thinking about dying will not improve the course of AIDS.”
b. “It is important to focus on the good things about your life now.”
c. “Do you think that taking an antidepressant might be helpful to you?”
d. “Can you tell me more about the kind of thoughts that you are having?”
D
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.
A pregnant 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?
a. The antiretroviral medications used to treat HIV infection are teratogenic.
b. Most infants born to HIV-positive mothers are not infected with the virus.
c. Since she is at an early stage of HIV infection, the infant will not contract HIV.
d. It is likely that her newborn will become infected with HIV unless she uses
antiretroviral drug therapy (ART).
B
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.
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?
a. Needle stick with a needle and syringe used to draw blood
b. Splash into the eyes when emptying a bedpan containing stool
c. Contamination of open skin lesions with client vaginal secretions
d. Needle stick injury with a suture needle during a surgical procedure
A
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.
Replication of HIV is enhanced when the client is taking which of the following herbs?
a. Echinacea
b. St. John’s wort
c. Fish oil
d. Saw palmetto
A
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.
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?
a. Client social support system
b. HIV genotype and phenotype
c. Potential medication adverse effects
d. Client ability to comply with ART schedule
D
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.
Which of the following clients will the nurse working in an HIV testing and treatment clinic anticipate teaching about antiretroviral therapy (ART)?
a. A client who is currently HIV negative but has unprotected sex with multiple
partners
b. A client who was infected with HIV 15 years ago and now has a CD4+ count of
840/μL
c. An HIV-positive client with a CD4+ count of 120/μL who drinks a fifth of whiskey
daily
d. A client who tested positive for HIV 2 years ago and has cytomegalovirus (CMV)
disease
D
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
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?
a. Check neurological orientation.
b. Ask about problems with diarrhea.
c. Palpate the regional lymph nodes.
d. Examine the oral mucosa for lesions.
C
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.
Which of the following tests does the Canadian Blood Services use to detect HIV genetic material in blood?
a. CD4+ T-cell count
b. HIV RNA polymerase chain reaction test
c. Nucleic acid amplification test
d. CD4 fraction
C
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.
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?
a. Participate in a needle-exchange program.
b. Clean drug injection equipment before use.
c. Ask those who share equipment to be tested for HIV.
d. Avoid sexual intercourse when using injectable drugs.
A
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.
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?
a. Give the client detailed information about possible medication adverse effects.
b. Remind the client of the importance of taking the medications as scheduled.
c. Encourage the client to join a support group for students who are HIV positive.
d. Check the client’s class schedule to help decide when the ART should be taken.
D
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.
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?
a. Be free from injury.
b. Receive immunizations on time.
c. Ensure adequate oxygenation.
d. Maintain intact perineal skin.
D
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.
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?
a. The benefits of daily exercise
b. Foods that are higher in protein
c. Treatment with antifungal agents
d. A change in antiretroviral therapy
D
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.
