Lewis 4th ed: Ch 17 - Infection and HIV Infection Flashcards
A client who has vague symptoms of fatigue and headaches is found to have a positive enzyme immunoassay (EIA) for HIV antibodies. In discussed 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 AIDS.
d. The Western blot test will be done to determine whether AIDS has developed.
a. The EIA test will need to be repeated to verify the results.
After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Vital 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 timeframe 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 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. Late chronic infection or AIDS
Development of PCP pneumonia meets the diagnostic criterion for AIDS. the other responses indicate 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 medications available for treatment.
b. Inform the client how to protect sexual and need-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.
d. Remind the client about the need to return for retesting to verify the results.
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 to 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. “Can you tell me more about the kind of thoughts that you are having.”
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 mother 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. Most infants born to HIV-positive mother 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.
The nurse is caring for a client whose HIV status is unknown. WHich of these client exposures is most likely to require post-exposure 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. Needle stick with a needle and syringe used to draw blood.
Puncture wounds are the most common means for workplace transmission of bloodborne diseases, and needle with a hollow bore that had been contaminated with the clients blood would be a high-risk situation.
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. Echinacea
Some herbs (e.g. echinacea) should not be used because they can enhance replication of HIV. St. John’s wort can interfere with ART.
The nurse is caring for a client with HIV who has a CD4+ cell count of 400/uL. 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. Client ability to comply with ART schedule
Drug resistance develops quickly unless the client takes ART medications on a stringent schedule, and this endangers both the client and the community.
Which of the following clients will the nurse working in an HIV testing and treatment clinic anticipate teaching about 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/uL.
c. An HIV-positive client with a CD4+ count of 120/uL who drinks a fifth of whiskey daily.
d. A client who tested positive for HIV 2 years ago and has cytomegalovirus disease.
d. A client who tested positive for HIV 2 years ago and has cytomegalovirus disease.
Key Takeaways:
• Antiretroviral therapy (ART) is recommended for all HIV-positive individuals, but it is critical for those with opportunistic infections, like cytomegalovirus (CMV).
• A CD4+ count below 200/uL or the presence of AIDS-defining illnesses (such as CMV, PCP pneumonia, or tuberculosis) signals advanced HIV/AIDS, making ART education a priority.
• The correct answer (d) is justified because CMV is a serious opportunistic infection, meaning the client’s immune system is severely compromised and they need urgent ART education.
What is Cytomegalovirus (CMV)?
Cytomegalovirus (CMV) is a common herpesvirus that most people carry asymptomatically. However, in immunocompromised individuals (such as those with advanced HIV/AIDS), CMV can reactivate and cause severe disease.
How CMV Affects HIV/AIDS Patients:
• CMV typically causes serious infections when CD4+ counts drop below 50–100/uL.
• It can affect multiple organs, including:
• Eyes (CMV retinitis) → Can lead to blindness.
• Lungs (CMV pneumonia) → Causes severe respiratory distress.
• Digestive tract (CMV colitis, esophagitis, gastritis) → Leads to diarrhea, weight loss, and ulcers.
• Brain (CMV encephalitis) → Causes confusion, weakness, and neurological deficits.
Symptoms of CMV Disease in HIV Patients:
✔ Blurred vision, floaters (CMV retinitis)
✔ Shortness of breath, cough (CMV pneumonia)
✔ Severe diarrhea, weight loss (CMV colitis)
✔ Fever, fatigue, body aches
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. Palpate the regional lymph nodes.
Persistent generalized lymphadenopathy is common in the early 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. CD$+ T-cell count
b. HIV RNA polymerase chain reaction test
c. Nucleic acid amplification test
d. CD4 fraction
c. Nucleic acid amplification test
✅ Correct Answer: (c) Nucleic Acid Amplification Test (NAAT)
• NAAT detects the presence of HIV RNA/DNA in the blood at very early stages of infection, even before antibodies are formed.
• It is highly sensitive and is used in blood donation screening to prevent HIV transmission through transfusions.
Why Not the Other Options?
1. (a) CD4+ T-cell count ❌
• This measures immune function in people already diagnosed with HIV.
• It does not detect the virus itself.
2. (b) HIV RNA polymerase chain reaction (PCR) test ❌
• While PCR is a type of NAAT, the test used for blood screening is specifically called NAAT because it can detect both RNA and DNA viruses.
• PCR is mainly used for monitoring viral load in HIV-positive individuals, not initial screening.
3. (d) CD4 fraction ❌
• CD4 fraction refers to the percentage of total lymphocytes that are CD4+ cells, used for HIV disease monitoring, not for detecting HIV itself.
Why Does the Canadian Blood Services Use NAAT?
• Faster and more sensitive than antibody tests.
• Detects HIV within 7–10 days of exposure (before antibodies appear).
• Prevents false negatives in early infection (window period)
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. Participate in a needle-exchange program.
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 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. Check the client’s class schedule to help decide when the ART should be taken.
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 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 impact perineal skin.
d. Maintain impact perineal skin.
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.)
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 benefit of daily exercise
b. Foods that are higher in protein
c. Treatment with antifungal agents
d. A change in antiretroviral therapy
d. A change in antiretroviral therapy
This question describes a classic case of lipodystrophy, a metabolic side effect associated with certain older antiretroviral therapy (ART) medications used to treat HIV.
What is Lipodystrophy?
Lipodystrophy in HIV is a fat distribution disorder that occurs due to long-term ART use. It includes:
✔ Fat accumulation (lipohypertrophy) → Increased fat in the trunk, abdomen, buffalo hump, and breasts.
✔ Fat loss (lipoatrophy) → Wasting of the arms, legs, face, and buttocks.
This condition is most commonly linked to older ART drugs, especially:
• Nucleoside reverse transcriptase inhibitors (NRTIs) – e.g., Stavudine (d4T), Zidovudine (AZT).
• Protease inhibitors (PIs) – e.g., Lopinavir, Ritonavir.
Why is Changing ART the Best Option?
• First-line intervention: If lipodystrophy develops, switching to newer ART regimens (such as integrase inhibitors) can reduce symptoms.
• Newer ART drugs (like Dolutegravir, Bictegravir) have a lower risk of causing fat redistribution.
Why Not the Other Options?
1. (a) The Benefit of Daily Exercise ❌
• While exercise is good for overall health, it does not reverse lipodystrophy.
• Fat redistribution is not due to lifestyle factors but rather ART-induced metabolic changes.
2. (b) Foods That Are Higher in Protein ❌
• Diet and nutrition do not significantly improve lipodystrophy.
• Protein intake won’t restore lost fat in the face and limbs or reduce trunk fat accumulation.
3. (c) Treatment with Antifungal Agents ❌
• No evidence of a fungal infection in this case.
• Antifungal agents have nothing to do with fat redistribution.
Which of the following tests is used to evaluate the effectiveness of ART?
a. Viral load testing
b. Enzyme immunoassay
c. Rapid HIV antibody testing
d. Immuno-fluorescence assay
a. Viral load testing
The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.
Which information about an HIV-positive client who is taking antiretroviral medication is most important for the nurse to address when planning care?
a. The client’s blood glucose level is 16.8
b. The client complains of feeling “constantly tired”
c. The client is unable to state the adverse effects of the medications.
d. The client states “sometimes I miss a dose of zidovudine.
d. The client states “sometimes I miss a dose of zidovudine.”
Since missing doses of ART can lead to drug resistance, this client statement indicates that need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common adverse effects of ART. The nurse should discuss medication adverse effects with the client, but this not as important as addressing the skipped doses of zidovudine.
Ten years after seroconversion, an HIV-infected client has a CD4+ cell count of 800 cells/uL and an undetectable viral load. Which of the following actions is the priority nursing interventions at this time?
a. Monitor for symptoms of AIDS
b. Teach about the effects of antiretroviral agents
c. Encourage adequate nutrition, exercise, and sleep.
d. Discuss likelihood of increased opportunistic infections.
c. Encourage adequate nutrition, exercise, and sleep.
The CD4+ level for this client is in the normal range, indicating that the client is the early chronic stage of infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although initiation of ART is highly individual, it would not be likely that a client with a normal CD4+ level would receive ART.
The nurse is designing a program to teach a community group about decreasing the incidence of HIV infection in their community. Which of the following information is a priority that the nurse include in the education session?
a. Methods to prevent perinatal HIV transmission
b. How to prevent transmission between sexual partners
c. Ways to sterilize needles used by injectable drug users
d. Means to prevent transmission through blood transfusions
b. How to prevent transmission between sexual partners
Sexual transmission is the most common way that HIV is transmitted. The nurse should also [provide education about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.
The nurse is caring for a client who has just diagnosed with early chronic HIV infection. Which of the following prophylactic measures would not be included in the plan of care for the client at this time?
a. Hepatitis B vaccine
b. Pneumococcal vaccine
c. Influenza vaccine
d. Varicella-zoster immune globulin
d. Varicella-zoster immune globulin
The nurse is caring for a pregnant patient who has recently diagnosed with HIV. The patient asks the nurse “how soon after delivery of my baby can ART treatment be started?” Which of the following provide the basis for the nurses response?
A. It can be initiated while you are pregnant.
B. It will start as soon as your baby is born.
C. It depends upon whether you are breastfeeding your baby or not.
D. It cannot begin until 7 days postpartum.
A. It can be initiated while you are pregnant.
Women infected with HIV should receive optimal ART immediately, regardless of whether or not they are pregnant.
