Nokea
A patient 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?
Correct Answer: D
Rationale: More assessment of the patient's psychosocial status is needed before taking any other action. The statements, 'Thinking about dying will not improve the course of AIDS' and 'It is important to focus on the good things in life' discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.
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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.
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 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.
Ten years after seroconversion, an HIV-infected patient has a CD4+ cell count of 800 cells per microlitre and an undetectable viral load. Which of the following actions is the priority nursing intervention 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.
Correct Answer: C
Rationale: The CD4+ level for this patient is in the normal range, indicating that the patient is in the early persistent 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 patient with a normal CD4+ level would receive ART.
After having a positive rapid-antibody test for HIV, a patient 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 patient about the medications available for treatment.
- B. Inform the patient how to protect sexual and needle-sharing partners.
- C. Remind the patient about the need to return for retesting to verify the results.
- D. Ask the patient to notify individuals who have had risky contact with the patient.
Correct Answer: C
Rationale: After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.