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A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy?
- A. The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease.
- B. Viral load and T4-cell counts will be performed every 2 to 3 months.
- C. More antiretroviral medication will be added every 2 to 3 months.
- D. The Western blot test will be monitored every 6 months to see if the virus is still present.
Correct Answer: B
Rationale: Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus.
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A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?
- A. Rashes on the face, trunk, palms, and soles
- B. Muscle and joint pain
- C. Gynecologic problems
- D. Weight loss
Correct Answer: C
Rationale: In women with HIV, gynecologic problems, such as abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may be the focus of a majority of complaints. Acute retroviral syndrome (viremia) may be the chief complaint in one third to more than one half of those infected, not necessarily women. Its manifestations include rashes, muscle and joint pain, and weight loss.
A client on antiretroviral drug therapy informs the nurse about sometimes forgetting to take the medication for a few days. What should the nurse inform the client can occur when the medications are not taken as prescribed?
- A. The funding for the medications will cease if the client is not taking the meds correctly.
- B. The client is risking the development of drug resistance and drug failure.
- C. The client will have to take the drugs intravenously to ensure compliance.
- D. The client will have to take higher doses of the antiviral medications.
Correct Answer: B
Rationale: Clients who neglect to take antiretroviral drugs as prescribed risk development of drug resistance. When drug levels are not adequately maintained, viral replication and mutations increase. Funding will not cease for noncompliance. The medications are not all available in IV form. Taking a higher dose of the medication if missed does not resolve drug resistance.
A client with cytomegalovirus (CMV) infection reports difficulty seeing. The physician determines that the client is developing CMV retinitis. What medication does the nurse anticipate the client will receive for this?
- A. zidovudine
- B. fluconazole
- C. azithromycin
- D. foscarnet
Correct Answer: D
Rationale: The drug foscarnet is used to treat CMV retinitis. Alterations in renal function, nausea, anemia, headaches, seizures, and diarrhea are the most common adverse effects. Zidovudine is used in antiretroviral therapy to prevent the conversion of HIV to AIDS. Azithromycin is an antibiotic and not used to treat CMV retinitis.
The nurse conducts an educational in-service training on infection protection and control for staff members who will provide care to clients who are positive for human immunodeficiency virus (HIV). Which subtype of HIV does the nurse inform staff members is the most prevalent in the United States?
- A. HIV-1, Group M, subtype A
- B. HIV-1, Group M, subtype B
- C. HIV-1, Group M, subtype C
- D. HIV-1, Group M, subtype D
Correct Answer: B
Rationale: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 is composed of four groups identified as M, N, O, and P. Group M mutates easily and frequently, producing multiple substrains that are identified by letters from A through K, and circulating recombinant form (CRF), a hybrid virus formed by genetic material from various combined subtypes. HIV-2 is the primary type of infection in Western Africa. It is less transmittable, and the interval between initial infection with HIV-2 and the development of AIDS is longer. HIV-1, Group M, subtype B is more prevalent in the United States and in the rest of the world, but the distribution of subtypes changes from time to time because of the diverse merging of populations.
A teenaged client with a diagnosis of HIV presents at the public health clinic complaining of pharyngitis, rash on the palms and soles of the feet, and diarrhea. What would the nurse suspect the client is suffering from?
- A. AIDS dementia complex (ADC)
- B. Acute retroviral syndrome (ARS)
- C. Distal sensory polyneuropathy (DSP)
- D. AIDS-related complex (ARC)
Correct Answer: B
Rationale: Some manifestations of ARS include: fever; swollen and tender lymph nodes; pharyngitis; rash about the face, trunk, palms, and soles; muscle and joint pain; headache; nausea and vomiting; and diarrhea. In addition, there may be enlargement of the liver and spleen, weight loss, and neurologic symptoms such as visual changes or cognitive and motor involvement. The scenario does not describe symptoms of ARC, DSP, or ADC.