Unit E-HIV INFECTION and AIDS

Question 1

The nurse is caring for a client diagnosed with HIV-II. The client’s CD4+ cell count is
399/mm3 (0.399  109/L). What action by the nurse is best?
a. Counsel the client on safer sex practices/abstinence.
b. Encourage the client to abstain from alcohol.
c. Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors.
d. Help the client plan high-protein/iron meals.

Answer 1

ANS: A
This client is in the Centers for Disease Control and Prevention HIV-II case definition group.
He or she remains highly infectious and would be counseled on either safer sex practices or
abstinence. Abstaining from alcohol is healthy but not required, although some medications
may need to be taken while abstaining. Genetic testing is not commonly done, but an
alteration on the CCR5/CXCR4 co-receptors is seen in long-term nonprogressors.
High-protein/iron meals are important for people who are immunosuppressed, but helping to
plan them does not take precedence over stopping the spread of the disease.

Question 2

The nurse is presenting information to a community group on safer sex practices. The nurse
would teach that which sexual practice is the riskiest?
a. Anal intercourse
b. Masturbation
c. Oral sex
d. Vaginal intercourse

Answer 2

ANS: A
Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating
a portal of entry for human immune deficiency virus in addition to providing mucus
membrane contact with the virus.

Question 3

The nurse providing direct client care uses specific practices to reduce the chance of acquiring
infection with human immune deficiency virus (HIV) from clients. Which practice is most
effective?
a. Consistent use of Standard Precautions
b. Double-gloving before body fluid exposure
c. Labeling charts and armbands “HIV+”
d. Wearing a mask within 3 feet (1 m) of the client

Answer 3

ANS:A
According to The Joint Commission, the most effective preventative measure to avoid HIV
exposure is consistent use of Standard Precautions. Standard Precautions are required by the
CDC. Double-gloving is not necessary. Labeling charts and armbands in this fashion is a
violation of the Health Information Portability and Accountability Act (HIPAA). Wearing a
mask within 3 feet (1 m) of the client is not necessary with every client contact.

Question 4

A client with known HIV-II is admitted to the hospital with fever, night sweats, and severe
cough. Laboratory results include a CD4+ cell count of 180/mm3 and a negative tuberculosis
(TB) skin test 4 days ago. What action would the nurse take first?
a. Initiate Droplet Precautions for the client.
b. Notify the primary health care provider about the CD4+ results.
c. Place the client under Airborne Precautions.
d. Use Standard Precautions to provide care.

Answer 4

ANS: C
Since this client’s CD4+ cell count is so low, he or she may have energy, or the inability to
mount an immune response to the TB test. The client also appears to have progressed to
HIV-III. The nurse would first place the client on Airborne Precautions to prevent the spread
of TB if it is present. Next the nurse notifies the primary health care provider about the low
CD4+ count and requests alterative testing for TB. Droplet Precautions are not used for TB.
Standard Precautions are not adequate in this case

Question 5

A nurse is talking with a client about a negative enzyme-linked immunosorbent assay
(ELISA) test for human immune deficiency virus (HIV). The test is negative and the client
states “Whew! I was really worried about that result.” What action by the nurse is most
important?
a. Assess the client’s sexual activity and patterns.
b. Express happiness over the test result.
c. Remind the client about safer sex practices.
d. Tell the client to be retested in 3 months.

Answer 5

ANS: A
The ELISA test can be falsely negative if testing occurs after the client has become infected
but prior to making antibodies to HIV. This period of time is known as the window period and
can last up to 21 days. The confirmatory Western Blot test takes an additional 7 days, so using
that testing algorithm, the client’s status may not truly be known for up to 28 days. The client
may have had exposure that has not yet been confirmed. The nurse needs to assess the client’s
sexual behavior further to determine the proper response. The other actions are not the most
important, but discussing safer sex practices is always appropriate. Testing would be
recommended every 3 months for someone engaging in high risk behaviors.

Question 6

A client with HIV-II has had a sudden decline in status with a large increase in viral load.
What action would the nurse take first?
a. Ask the client about travel to any foreign countries.
b. Assess the client for adherence to the drug regimen.
c. Determine if the client has any new sexual partners.
d. Request information about new living quarters or pets.

Answer 6

ANS: B
Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients
must take their medications on time and correctly at a minimum of 90% of the time to be
effective. Since this client’s viral load has increased dramatically, the nurse would first assess
this factor. After this, the other assessments may or may not be needed.

Question 7

A client is hospitalized with Pneumocystis jiroveci pneumonia. The client reports shortness of
breath with activity and extreme fatigue. What intervention is best to promote comfort?
a. Administer sleeping medication.
b. Perform most activities for the client.
c. Increase the client’s oxygen during activity.
d. Pace activities, allowing for adequate rest.

Answer 7

ANS: D
This client has two major reasons for fatigue: decreased oxygenation and systemic illness. The
nurse would not do everything for the client but rather let the client do as much as possible
within limits and allow for adequate rest in between. Sleeping medications may be needed but
not as the first step, and only with caution. Increasing oxygen during activities may or may
not be warranted, but first the nurse must try pacing the client’s activity.

Question 8

A client with HIV-III and wasting syndrome has inadequate nutrition. What assessment
finding by the nurse best indicates that goals have been met for this client problem?
a. Chooses high-protein food.
b. Has decreased oral discomfort.
c. Eats 90% of meals and snacks.
d. Has a weight gain of 2 lb (1 kg)/1 mo.

Answer 8

ANS: D
The weight gain is the best indicator that goals for this client problem have been met because
it demonstrates that the client not only is eating well but also is able to absorb the nutrients.
Choosing high-protein food is important, but only if the client eats and absorbs the nutrients.

Question 9

A client with HIV-III is hospitalized and has weeping Kaposi sarcoma lesions. The nurse
dresses them with sterile gauze. When changing these dressings, which action is most
important for the nurse’s safety?
a. Adhering to Standard Precautions
b. Assessing tolerance to dressing changes
c. Performing hand hygiene before and after care
d. Disposing of soiled dressings properly

Answer 9

ANS: A
All of the actions are important, but due to the infectious nature of this illness, the nurse
would ensure he or she is following Standard Precautions (and Transmission-Based
Precautions when necessary) to avoid a potential exposure.

Question 10

A client with HIV-III is admitted to the hospital with Toxoplasma gondii infection. Which
action by the nurse is most appropriate?
a. Initiate Contact Precautions.
b. Conduct frequent neurologic assessments.
c. Conduct frequent respiratory assessments.
d. Initiate Protective Precautions.

Answer 10

ANS: D
Toxoplasma gondii infection is an opportunistic infection that causes an encephalitis but poses
only a rare threat to immunocompetent individuals The nurse would perform ongoing
neurologic assessments. Contact and Protective Precautions are not needed. Good respiratory
assessments are important to the client, but toxoplasmosis will demonstrate neurologic signs
and symptoms.

Question 11

A client has just been informed of a positive HIV test. The client is distraught and does not
know what to do. What intervention by the nurse is best?
a. Assess the client for support systems.
b. Determine if a clergy member would help.
c. Explain legal requirements to tell sex partners.
d. Offer to tell the family for the client.

Answer 11

ANS: A
This client needs the assistance of support systems. The nurse would help the client identify
them and what role they can play in supporting him or her. A clergy member may or may not
be welcome. Positive HIV test results are reportable in all 50 states, Washington, D.C., and
Canada but the nurse works with the client to support his or her choices in disclosure. The
nurse would not tell the family for the client.

Question 12

A nurse is caring for a client with HIV-III who was admitted with HAND. What sign or
symptom would be most important for the nurse to report to the primary health care provider?
a. Nausea
b. Change in pupil size
c. Weeping open lesions
d. Cough

Answer 12

ANS: B
HIV-associated neurocognitive disorder (HAND) is a sign of neurologic involvement. The
nurse would report any sign of increasing intracranial pressure immediately, including change
in pupil size, level of consciousness, vital signs, or limb strength. The other signs and
symptoms are not life threatening and would be documented and reported appropriately.

Question 13

A client has been hospitalized with an opportunistic infection secondary to HIV-III. The
client’s partner is listed as the emergency contact, but the client’s mother insists that she
should be listed instead. What action by the nurse is best?
a. Contact the social worker to assist the client with advance directives.
b. Ignore the mother; the client does not want her to be involved.
c. Let the client know, gently, that nurses cannot be involved in these disputes.
d. Tell the client that, legally, the mother is the emergency contact.

Answer 13

ANS: A
The client should make his or her wishes known and formalize them through advance
directives. The nurse would help the client by contacting someone to help with this process.
Ignoring the mother or telling the client that nurses cannot be involved does not help the
situation. Legal statutes vary by state, but the nurse would be the client’s advocate and help
ensure his or her wishes are met.

Question 14

A client with HIV-II is hospitalized for an unrelated condition, and several medications are
prescribed in addition to the regimen already being used. What action by the nurse is most
important?
a. Consult with the pharmacy about drug interactions.
b. Ensure that the client understands the new medications.
c. Give the new drugs without considering the old ones.
d. Schedule all medications at standard times.

Answer 14

ANS:A
The drug regimen for someone with HIV/AIDS is complex and consists of many medications
that must be given at specific times of the day, and that have many interactions with other
drugs and food. The nurse would consult with a pharmacist about possible interactions. Client
teaching is important but does not take precedence over ensuring the medications do not
interfere with each other, which could lead to drug resistance or a resurgence of symptoms

Question 15

A client with HIV-III has been hospitalized with suspected cryptosporidiosis. What physical
assessment would be most important with this condition?
a. Auscultating the lungs
b. Assessing mucous membranes
c. Listening to bowel sounds
d. Performing a neurologic examination

Answer 15

ANS: B
Cryptosporidiosis can cause diarrhea and wasting with extreme loss of fluids and electrolytes.
The nurse would assess signs of hydration/dehydration as the priority, including checking the
client’s mucous membranes for dryness. The nurse will perform the other assessments as part
of a comprehensive assessment.

Question 16

A client with HIV-III asks the nurse why gabapentin is part of the drug regimen when the
client does not have a history of seizures. What response by the nurse is best?
a. “Gabapentin can be used as an antidepressant too.”
b. “I have no idea why you would be taking this drug.”
c. “This drug helps treat the pain from nerve irritation.”
d. “You are at risk for seizures due to fungal infections.”

Answer 16

ANS: C
Many classes of medications are used for neuropathic pain, including tricyclic antidepressants
and anticonvulsants such as gabapentin. It is not being used to prevent seizures from fungal
infections. If the nurse does not know the answer, he or she would find out for the client.

Question 17

An HIV-negative client who has an HIV-positive partner asks the nurse about receiving
tenofovir/emtricitabine. What information is most important to teach the client about this
drug?
a. Does not reduce the need for safe sex practices.
b. Has been taken off the market due to increases in cancer.
c. Reduces the number of HIV tests you will need.
d. Is only used for postexposure prophylaxis.

Answer 17

ANS:A
Tenofovir/emtricitabine is a newer drug used for preexposure prophylaxis and appears to
reduce transmission of human immune deficiency virus (HIV) from known HIV-positive
people to HIV-negative people. The drug does not reduce the need for practicing safe sex.
Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3
months. This drug has not been taken off the market and is not used for postexposure
prophylaxis.

Question 18

A nurse is learning about human immune deficiency virus (HIV) infection. Which statements
about HIV infection are correct? (Select all that apply.)
a. CD4+ cells begin to create new HIV virus particles.
b. Antibodies produced are incomplete and do not function well.
c. Macrophages stop functioning properly.
d. Opportunistic infections and cancer are leading causes of death.
e. People with HIV-I disease are not infectious to others.
f. The CD4+ T-cell is only affected when the disease has progressed to HIV-III

Answer 18

ANS: A, B, C, D
In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produce are
incomplete and do not function well. Macrophages also stop functioning properly.
Opportunistic infections and cancer are the two leading causes of death in client’s with HIV
infection. People infected with HIV are infectious in all stages of the disease. The CD4+
T-cell is the immune system cell most affected by infection with the HIV virus.

Question 19

Which findings are AIDS-defining characteristics? (Select all that apply.)
a. CD4+ cell count less than 200/mm3 (0.2  109/L) or less than 14%
b. Infection with P. jiroveci
c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune
deficiency virus (HIV)
d. Presence of HIV wasting syndrome
e. Taking antiretroviral medications
f. Confusion, dementia, or memory loss

Answer 19

ANS: A, B, D, F
A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell
count of less than 200 cells/mm3 (0.2  109/L) or less than 14% (even if the total CD4+ count
is above 200 cells/mm3) or an opportunistic infection such as P. jiroveci and HIV wasting
syndrome. Confusion, dementia, and memory loss are central nervous system indications.
Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining
characteristics.

Question 20

The nurse is teaching a client about medications for HIV-II treatment. What drugs are paired
with the correct information? (Select all that apply.)
a. Abacavir: avoid fatty and fried foods.
b. Efavirenz: take 1 hour before or 2 hours after antacids.
c. Atazanavir: check pulse daily and report pulse greater than 100 beats/min.
d. Dolutegravir: do not take this medication if you become pregnant.
e. Enfuvirtide: teach client how to operate syringe infusion pump for administration.
f. All drugs: you must adhere to the drug schedule at least 90% of the time for
effectiveness.

Answer 20

ANS: A, B, F
Abacavir is a nucleoside reverse transcriptase inhibitor and clients are taught to avoid fried
and fatty foods because they can lead to digestive upsets and even pancreatitis. Efavirenz is a
nonnucleoside reverse transcriptase inhibitor and clients are taught to take them (doraverene)
all except spaced 1 hour before or 2 hours after antacids to avoid inhibiting drug absorption.
Atazanavir is a protease inhibitor and can cause bradycardia which should be reported.
Dolutegravir is an integrase inhibitor and can cause birth defects. Enfuvirtide is a fusion
inhibitor and is given subcutaneously. All drugs must be taken as scheduled 90% of the time
in order to remain effective.

Question 21

A client with HIV-III is hospitalized with P. jiroveci pneumonia and is started on the drug of
choice for this infection. What laboratory values would be most important for the nurse report
to the primary health care provider? (Select all that apply.)
a. Aspartate transaminase, alanine transaminase: elevated
b. CD4+ cell count: 180/mm3
c. Creatinine: 1.0 mg/dL (88 mcmol/L)
d. Platelet count: 80,000/mm3 (80  109/L)
e. Serum sodium: 120 mEq/L (120 mmol/L)
f. Serum potassium: 3.4 mEq/L (3.4 mmol/L)

Answer 21

ANS: A, D, E
The drug of choice to treat P. jiroveci pneumonia is trimethoprim with sulfamethoxazole. Side
effects of this drug include hepatitis, hyponatremia, and thrombocytopenia. The elevated liver
enzymes, low platelet count, and low sodium would all be reported. The CD4+ cell count is
within the expected range for a client with an AIDS-defining infection. The creatinine level is
normal and the potassium is just below normal.

Question 22

A client with HIV-III has oral thrush and difficulty eating. What actions does the nurse
delegate to the assistive personnel (AP)? (Select all that apply.)
a. Apply oral anesthetic gels before meals.
b. Assist the client with oral care every 2 hours.
c. Offer the client frequent sips of cool drinks.
d. Provide the client with alcohol-based mouthwash.
e. Remind the client to use only a soft toothbrush.
f. Offer the client soft foods like gelatin or pudding.

Answer 22

ANS: B, C, E, F
The AP can help the client with oral care, offer fluids, and remind the client of things the
nurse (or other professional) has already taught. Soft foods and liquids are tolerated better
than harder foods. Applying medications is performed by the nurse. Alcohol-based
mouthwashes are harsh and drying and would not be used.

Question 23

A client with HIV-III is in the hospital with severe diarrhea. What actions does the nurse
delegate to assistive personnel (AP)? (Select all that apply.)
a. Assessing the client’s fluid and electrolyte status
b. Assisting the client to get out of bed to prevent falls
c. Obtaining a bedside commode if the client is weak
d. Providing gentle perianal cleansing after stools
e. Reporting any perianal abnormalities

Answer 23

ANS: B, C, D, E
The AP can assist the client with getting out of bed, obtain a bedside commode for the client’s
use, cleanse the client’s perianal area after bowel movements, and report any abnormal
observations such as redness or open areas. The nurse assesses fluid and electrolyte status.

Question 24

The nurse is educating a client with HIV-II and the partner on self-care measures to prevent
infection when blood counts are low. What information does the nurse provide? (Select all
that apply.)
a. Do not work in the garden or with houseplants.
b. Do not empty the kitty litter boxes.
c. Clean your toothbrush in the dishwasher daily.
d. Bathe daily using antimicrobial soap.
e. Avoid people who are sick and large crowds.
f. Make sure meat, fish, and eggs are cooked well.

Answer 24

ANS: A, B, D, E, F
Ways to avoid infection when immunocompromised include not working in the garden or
with houseplants; not emptying litter boxes; running the toothbrush through the dishwasher at
least weekly; bathing daily using antimicrobial soap; avoiding sick people and large crowds;
and making sure meat, fish, and eggs are cooked well prior to eating them.

Question 25

A nurse is providing education about HIV risks at a health fair. What groups would the nurse
include as needing to be tested for HIV on an annual basis? (Select all that apply.)
a. Anyone who received a blood product in 1989
b. Couples planning on getting married
c. Those who are sexually active with multiple partners
d. Injection drugs users
e. Sex workers and their customers
f. Adults over the age of 65 years

Answer 25

ANS: B, C, D, E
The CDC recommends that HIV testing would be performed on those who received a
transfusion between 1978 and 1985 only. People planning on getting married should be tested
and all sexually active people should know their HIV status. Those engaged in sex work and
their customers should also be tested, as well as injection drug users. Those over the age of 65
years need a one-time screen.

Question 26

A nurse begins a job at a Veterans Administration Hospital and asks why so much emphasis is
on HIV testing for the veterans. What reasons is this nurse given? (Select all that apply.)
a. Veterans have a high prevalence of substance abuse.
b. Many veterans may engage in high risk behaviors.
c. Many older veterans may not know their risks.
d. Everyone should know their HIV status.
e. Belief that the VA has tested them and would notify them if positive.

Answer 26

ANS: A, B, C, D, E
All options are correct for the veteran population. The nurse interacting with veteran would
ensure they know about the HIV testing offered by the VA.