Nokea
A patient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and HIV testing is positive. Based on diagnostic criteria established by the World Health Organization (WHO), which of the following diagnoses should the nurse anticipate?
- A. Acute infection
- B. Early persistent infection
- C. Intermediate persistent infection
- D. Late persistent infection or AIDS
Correct Answer: D
Rationale: Development of PCP pneumonia meets the diagnostic criterion for AIDS. The other responses indicate an earlier stage of HIV infection than is indicated by the PCP infection.
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The nurse is caring for a patient with HIV who has a CD4+ cell count of 400/?µL. Which of the following factors is most important to consider when determining whether antiretroviral therapy (ART) will be initiated for this patient?
- A. Patient social support system
- B. HIV genotype and phenotype
- C. Potential medication adverse effects
- D. Patient ability to comply with ART schedule
Correct Answer: D
Rationale: Drug resistance develops quickly unless the patient takes ART medications on a stringent schedule, and this endangers both the patient and the 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 of the following tests is used to evaluate the effectiveness of ART?
- A. Viral load testing
- B. Enzyme immunoassays
- C. Rapid HIV antibody testing
- D. Immuno-fluorescence assay
Correct Answer: A
Rationale: 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 patient who is taking antiretroviral medications is most important for the nurse to address when planning care?
- A. The patient's blood glucose level is 6.9 mmol/L.
- B. The patient complains of feeling 'constantly tired.'
- C. The patient is unable to state the adverse effects of the medications.
- D. The patient states 'sometimes I miss a dose of zidovudine (AZT).'
Correct Answer: D
Rationale: Since missing doses of ART can lead to drug resistance, this patient statement indicates the 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 patient, but this is not as important as addressing the skipped doses of AZT.
The nurse is caring for a patient whose HIV status is unknown. Which of these patient exposures is most likely to require postexposure 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 patient vaginal secretions
- D. Needle stick injury with a suture needle during a surgical procedure
Correct Answer: A
Rationale: Puncture wounds are the most common means for workplace transmission of bloodborne 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.
The nurse is preparing to give the following medications to an HIV-positive patient who is hospitalized with Pneumocystis jiroveci pneumonia (PCP). Which of the following medications is most important to administer at the right time?
- A. Nystatin tablet
- B. Oral abacavir
- C. Ventolin
- D. Oral acyclovir
Correct Answer: B
Rationale: 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.