IMMUNITY/HIV: Lewis Ch 14: Infection Flashcards
The nurse is advising a patient who was exposed 4 days ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient’s antigen-antibody test has just been reported as negative for HIV. What information should the nurse give to this patient?
a. “You will need to be retested in 2 weeks.”
b. “You do not need to fear infecting others.”
c. “We won’t know for about 10 years if you have HIV infection.”
d. “With no symptoms and this negative test, you do not have HIV.”
a. “You will need to be retested in 2 weeks.”
HIV screening tests detect HIV-specific antibodies or antigens. However, there may be a delay between infection and the time a screening test is able to detect HIV. The typical “window period” for antigen-antibody combination assays is approximately 2 weeks. It is not known based on this information whether the patient is infected with HIV or can infect others. It would be best practice to have him return for repeat testing in approximately 2 weeks.
patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct?
a. “The patient meets the criteria for a diagnosis of acute HIV infection.”
b. “The patient will be diagnosed with asymptomatic chronic HIV infection.”
c. “The patient will likely develop symptomatic HIV infection within 1 year.”
d. “The patient has developed acquired immunodeficiency syndrome (AIDS).”
d. “The patient has developed acquired immunodeficiency syndrome (AIDS).”
Development of PCP meets the diagnostic criteria for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.
A patient informed of a positive rapid screening test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?
a. Inform the patient about the available treatments.
b. Teach the patient how to manage a possible drug regimen.
c. Remind the patient to return for retesting to verify the results.
d. Ask the patient to identify those persons who had intimate contact.
c. Remind the patient to return for retesting to verify the results.
After an initial positive antibody test result, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about the HIV status of other individuals.
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, “I feel obsessed with morbid thoughts about dying.” Which response by the nurse is appropriate?
a. “Thinking about dying will not improve the course of AIDS.”
b. “Do you think that taking an antidepressant might be helpful?”
c. “Can you tell me more about the thoughts that you are having?”
d. “It is important to focus on the good things about your life now.”
c. “Can you tell me more about the thoughts that you are having?”
More assessment of the patient’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” or suggesting an antidepressant discourage the patient from sharing any further information with the nurse and decrease the nurse’s ability to develop a trusting relationship with the patient.
A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, “I am very nervous about making my baby sick.” Which information will the nurse include when teaching the patient?
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. Because it is an early stage of HIV infection, the infant will not contract HIV.
d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
b. Most infants born to HIV-positive mothers are not infected with the virus.
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.
Which exposure by the nurse is most likely to require postexposure prophylaxis when the patient’s human immunodeficiency virus (HIV) status is unknown?
a. Bite to the arm that does not result in open skin
b. Splash into the eyes while emptying a bedpan containing stool
c. Needle stick with a needle and syringe used for a venipuncture
d. Contamination of open skin lesions with patient vaginal secretions
c. Needle stick with a needle and syringe used for a venipuncture
Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient’s blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/μL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient?
a. CD4+ cell count
b. How the patient obtained HIV
c. Patient’s tolerance for potential medication side effects
d. Patient’s ability to follow a complex medication regimen
d. Patient’s ability to follow a complex medication regimen
Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.
Which patient would benefit from education about HIV preexposure prophylaxis (PrEP)?
a. A 23-yr-old woman living with HIV infection.
b. A 52-yr-old recently single woman just diagnosed with chlamydia.
c. A 33-yr-old hospice worker who received a needle stick injury 3 hours ago.
d. A 60-yr-old male in a monogamous relationship with an HIV-uninfected partner.
b. A 52-yr-old recently single woman just diagnosed with chlamydia.
Preexposure prophylaxis (PrEP) is used to prevent HIV infection. Persons who would be good candidates for PrEP include individuals with a recent diagnosis of an STI and those with more than one partner. Individuals who are not on PrEP but who have a recent high-risk exposure (such as a needle stick) would be better candidates for postexposure prophylaxis (PEP). A person in a monogamous relationship with an HIV-uninfected partner is considered low-risk for HIV infection.
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take?
a. Instruct the patient to apply ice to the neck.
b. Tell the patient a secondary infection is present.
c. Explain to the patient that this is an expected finding.
d. Request that an antibiotic be prescribed for the patient.
c. Explain to the patient that this is an expected finding.
Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Lymphadenopathy is common with acute HIV infection and is therefore not likely to represent an additional infection. Ice will not decrease the swelling in persistent generalized lymphadenopathy
Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV) testing needs?
a. Age
b. Lifestyle
c. Symptoms
d. Sexual orientation
a. Age
The current Centers for Disease Control and Prevention policy is to offer routine testing for HIV to all individuals age 13 to 64 years. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.
A patient who uses injectable illegal drugs asks the nurse how to prevent acquired immunodeficiency syndrome (AIDS). Which response by the nurse is most accurate?
a. “Clean drug injection equipment before each use.”
b. “Ask those who share equipment to be tested for HIV.”
c. “Consider participating in a needle-exchange program.”
d. “Avoid sexual intercourse when using injectable drugs.”
c. “Consider participating in a needle-exchange program.”
Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. 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. HIV can be transmitted through both intercourse and injection.
Which nursing action will be most useful in assisting a young adult to adhere to a newly prescribed antiretroviral therapy (ART) regimen?
a. Give the patient detailed information about possible medication side effects.
b. Remind the patient of the importance of taking the medications as scheduled.
c. Help the patient develop a schedule to decide when the drugs should be taken.
d. Encourage the patient to join a support group for adults who are HIV positive.
c. Help the patient develop a schedule to decide when the drugs should be taken.
The best approach to improve adherence is to learn about important activities in the patient’s life and adjust the ART around those activities. The other actions are also useful, but they will not improve adherence as much as individualizing the ART to the patient’s schedule.
A patient with human immunodeficiency virus (HIV) infection has developed Cryptosporidium parvum infection. Which outcome would be appropriate for the nurse to include in the plan of care?
a. The patient will be free from injury.
b. The patient will receive immunizations.
c. The patient will have adequate oxygenation.
d. The patient will maintain intact perineal skin.
d. The patient will maintain intact perineal skin.
The major manifestation of C. pravum infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (e.g., pneumonia, dementia, influenza) associated with HIV infection.
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk with wasting of the arms, legs, and face. What recommendation will the nurse give to the patient?
a. Review foods that are higher in protein.
b. Teach about the benefits of daily exercise.
c. Discuss a change in antiretroviral therapy.
d. Talk about treatment with antifungal agents.
c. Discuss a change in antiretroviral therapy.
A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (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.
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the scheduled time?
a. Nystatin tablet
b. Oral acyclovir (Zovirax)
c. Aerosolized pentamidine (NebuPent)
d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
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.