Week 4: HIV/AIDS

Question 1

When does an individual with HIV experience viremia post-infection?

Answer 1

Pt experiences viremia in the blood for 2-3 weeks
Transmission is more likely when load is high

Question 2

What is the importance of CD4-cell counts?

Answer 2

-CD4 cell counts are T lymphocytes and play role in immune system function.
-CD4 levels indicate the status of the immune system of someone with HIV and the prognosis, disease progression and response to treatment

Question 3

What does HIV viral load determine?

Answer 3

Determines amount of virus in the blood of an infected person
High viral load indicates that HIV is progressing
load is used to determine progression, response to treatment and indication for treatment

Question 4

What is Pneumocystis jiroveci pneumonia

Answer 4

a fungus normally found in human lungs that rarely causes disease to healthy individuals but causes serious opportunistic infection for those with decreased immune function (CD4 <200 cells/mL)
S&S- dry cough, night sweats, sudden fever, dyspnea, weightloss

Question 5

What is Kaposi Sarcoma

Answer 5

KS is a type of cancer found in persons with acquired immunodeficiency syndrome (AIDS).
Purple cutaneous lesions frequently found on the skin but can spread to the gastrointestinal (GI) system and lungs, where it can be life threatening.

Question 6

What CD4 threshold greatly increases risk for opportunistic infection?
What indicates that an individual has progressed from HIV to AIDs?

Answer 6

• CD4 <200/mL
• Decreasing CD4, increasing viral load and opportunistic infections

Question 7

What is the CD4 count in a person within the early chronic stage of HIV?

Answer 7

CD4 T cell count remains above 500/ml
Viral load remains low
-Body still has sufficient immune response to fight pathogens

Question 8

The early chronic stage of HIV is often referred to as the “asymptomatic disease”, but what non specific symptoms may occur?

Answer 8

Fatigue, headache, low-grade fever, night sweats

Question 9

What CD4 counts and manifestations indicate progression to intermediate chronic infection?

Answer 9

-CD4 drops below 500cells/mL
-Viral load rises
-S&S that occurred earlier tend to become worse

Question 10

Genotype and Phenotype tests can be used to assess for resistance to antiretroviral therapy
True or False?
Why might an individual develop resistance to ART?

Answer 10

True
Person might become resistant due to HIV mutation, impaired medication adherence (pt must ensure to take medication daily exactly as prescribed), rapid HIV replication increases chance of mutation

Question 11

What are common adverse effects associated with ART?

Answer 11

-High cholesterol and triglycerides, hyperglycaemia, osteoporosis, cardiomyopathy, bone marrow suppression, diarrhea, rashes, fat redistribution (build up in abd and neck)

Question 12

A widely used laboratory test that measures HIV-RNA levels and tracks the body’s response to HIV infection is the:

A. CD4/CD8 ratio.
B. EIA test.
C. Viral load test.
D. Western blot.

Answer 12

Answer: C. Viral load test.

C: Viral load test measures plasma RNA levels.
A: CD4/CD8 ratio measures the number of CD4 T cells in the body.
B: EIA test identifies antibodies directed specifically against HIV.
D: Western blot is used to confirm seropositivity when the EIA result is positive

Question 13

The most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:

A. Anorexia.
B. Chronic diarrhea.
C. Nausea.
D. Vomiting.

Answer 13

Answer: B. Chronic diarrhea.

B: Chronic diarrhea occurs in up to 90% of patients with AIDS.
A: Anorexia is not as incapacitating as chronic diarrhea.
C: Nausea is not as incapacitating as chronic diarrhea.
D: Vomiting is not as incapacitating as chronic diarrhea

Question 14

A diagnosis of wasting syndrome can be initially made when involuntary weight loss exceeds what percentage of baseline body weight?

A. 10%
B. 15%
C. 20%
D. 25%

Answer 14

A: Wasting syndrome occurs when there is profound involuntary weight loss exceeding 10% of the baseline body weight

Question 15

Define cryptococcal meningitis, an opportunistic infection in AIDS
What are the S&S?

Answer 15

-Cryptococcal meningitis is a fungal infection caused by Cryptococcus neoformans, which is often found in bird droppings. If breathed in, the spores can multiply and spread from the lungs to the membranes that cover the brain or spinal cord, causing meningitis.
-S&S are headache and fever

Question 16

What is a major cause of AIDs dementia complex?

Answer 16

HIV/AIDs encephalopathy
Leads to progressive behavioural, cognitive and motor decline. Directly related to HIV infection

Question 17

Pt with AIDs presents with fever, weight loss of 6lbs, dark coloured urine, RUQ and pain and jaundiced sclera.
What opportunistic infection does the nurse suspect?

Answer 17

Hepatitis

Question 18

Pt presents with 13% weight loss, diarrhea x 4days, weakness x1 week and a temperature of 38.5C
What complication of AIDs does the nurse suspect?

Answer 18

Wasting Syndrome

Question 19

Why does the nurse perform a oropharyngeal assessment on the pt with AIDs?

Answer 19

Pts with AIDs are at higher risk for infections with oral manifestations such as
Oropharyngeal candidiasis (thrush)
and Oral hairy leukoplakia

Question 20

A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient’s CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings?
1. The pt is now in the latent stages of the HIV infection
2. The pt is diagnosed with AIDs
3. This is an expected finding because the patient has HIV
4. These findings provide evidence that the pt has seroconverted

Answer 20

2.

Question 21

The healthcare provider is teaching a patient who has been diagnosed with acquired immunodeficiency syndrome (AIDS) about the need for multi-drug therapy. Which of the following best explains the rationale for using more than one antiretroviral medication to treat AIDS?
1. This is intended to keep the virus from developing resistance
2. You will experience less side effects when you take a combination of medications
3. You will not be able to transmit the disease while taking this combination of medications
4. This combination will eliminate the risk of developing AIDs

Answer 21

1.

Question 22

A patient who is human immunodeficiency positive (HIV) positive is receiving a nucleoside reverse transcriptase inhibitor (NRTI). Which of these clinical findings would indicate the patient is experiencing an adverse effect of this medication?
1. Metabolic acidosis
2. Weight gain
3. Decreased hemoglobin
4. Increased blood glucose

Answer 22

3.

Question 23

The healthcare provider is assessing the skin of a patient who is at risk for becoming infected with the human immunodeficiency virus (HIV). Which of the following findings requires immediate follow-up by the healthcare provider?
1. Publish-red lesions
2. Numerous moles on the chest and back
3. Ecchymosis on the legs
4. Patches of dry, flaky skin

Answer 23

1.

Question 24

The healthcare provider is teaching a patient who has a diagnosis of acquired immunodeficiency syndrome (AIDS) about food safety. Which of the following foods should the patient avoid to prevent foodborne illnesses?
1. Green salad
2. Mozzarella cheese
3. Deli meats
4. Boiled eggs

Answer 24

3.

Question 25

Identify the correct statements about the anatomy of the Human Immunodeficiency Virus (HIV). Select all that apply:(Required)
A. HIV is a retrovirus.
B. Inside the virus is packaged DNA.
C. The protein projections found on the virus’ surface play a key role in attaching to the receptors on the helper t-cell.
D. The glycoproteins (specifically GP140) are vital for engaging the receptors on the targeted cell.

Answer 25

A, C
Options B is an incorrect statement, it should say “Inside the virus is packaged RNA (not DNA)”, and Option C is incorrect because it should say “The glycoproteins (specifically GP120…NOT GP140) are vital for engaging the CD4 receptor on the targeted cell.

Question 26

A 30-year-old patient is in the Acute Stage of HIV. What findings below correlate with this stage of HIV? Select all that apply:
A. CD4 level <500 cells/mm3
B. No present of Opportunistic Infections
C. High viral load
D. Patient reports flu-like symptoms
E. Patient is asymptomatic

Answer 26

B,C,D
The patient’s viral load is very HIGH during this time, but the CD4 count should be greater than 500 cells/mm3. Therefore, NO opportunistic infections are present during this time (the CD4 count is high enough to fight off these types of infections/diseases). In addition, the patient may report flu-like symptoms (aches, joint pain, headache, fever, fatigue, sore throat, swollen lymph nodes, GI upset, and rash). The patient is usually asymptomatic in the 2nd stage (Chronic Stage of HIV)

Question 27

A patient arrives to the clinic and requests an HIV test. The patient had unprotected sexual intercourse 2 days ago with a person who may have HIV. As the nurse you know there is a window period for detecting an infection of HIV. What statements should you provide to the patient about this window period and testing for HIV? Select all that apply:
A. No test is available at this time to show immediate infection.
B. The window period is the time when you become infected with HIV to when a test can deliver positive results.
C. Window periods vary depending on the type of HIV test administered.
D. The absolute earliest an HIV test can detect HIV is about 3 months.

Answer 27

A, B, C
Option D is incorrect because the NAT (nucleic acid test) can detect HIV the earliest of all the test types. It can detect around 10 days after exposure for some patients. It assesses for the virus’ genetic material and measures the amount of virus present in the blood. It is not commonly ordered and is used only for high risk patients.

Question 28

A patient, who is in the Chronic Stage of HIV, has a CD4 count ordered. What does this test measure?
A. Red blood cells
B. B cells
C. Cytotoxic T cells
D. Helper T cells

Answer 28

D. Helper T cells

Question 29

What is a normal CD4 count?
A. 200-500 cells/mm3
B. 1500-3500 cells/mm3
C. 500-1500 cells/mm3
D. <200 cells/mm3

Answer 29

C. 500-1500

Question 30

A 48-year-old patient is HIV positive. The patient has no signs and symptoms and has a CD4 count of 400 cells/mm3. In addition, no opportunistic infections or diseases are present. These findings correlate with what stage of HIV?
A. Acute
B. Chronic
C. AIDS

Answer 30

B
Signs and symptoms may not be experienced, the viral load is lower than the Acute Stage, but the virus is still replicating and destroying the cells. The patient can still transmit the virus to others. In addition, the CD4 count should be more than 200 cells/mm3 to about 500 cells/mm3. In addition, no opportunistic infections or diseases should be present.

Question 31

A patient with AIDS has developed CMV (cytomegalovirus). The nurse makes it PRIORITY to educate the patient about which of the following regarding CMV?
A. Avoiding exposure to cat feces.
B. Drinking water from clean sources only.
C. Scheduling an eye appointment.
D. Isolating for 14 days to prevent transmission of CMV to others.

Answer 31

C
CMV is an opportunistic infection that can develop in patients with AIDS. This virus can cause damage to the retina (hence retinitis) and lead to blindness. The nurse should educate the patient about scheduling an eye exam to monitor for this condition.

Question 32

What sign and symptoms in your patient with HIV indicates the disease is worsening and the immune system is severely compromised?
A. Open, oozing lesions around the mouth
B. White hair like spots on the side of the tongue
C. Cheesy white film on the tonsils and inside cheeks
D. Vision changes

Answer 32

B
This is known as oral hairy leukoplakia. It occurs when the immune system is extremely compromised like with HIV and the Epstein-Barr virus. It is a signal the HIV is getting worse.

Question 32

Which type of opportunistic infection occurs from inhaling a parasitic organism that can be found in cat and bird feces?
A. Histoplasmosis
B. Crytococcosis
C. Mycobacterium Avium Complex
D. Toxoplasmosis

Answer 32

D
Toxoplasmosis is a protozoal parasitic infection that is found in cat and bird feces along with undercook meat, such as pork and red meat.

Question 33

Which HIV test can give the earliest test results?
A. Nucleic Acid Test (NAT)
B. Antibody HIV Test
C. Combination HIV antigen/antibody test
D. CD4 count

Answer 33

A