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A pregnant woman with a history of early persistent HIV infection is seen at the clinic. Which of the following information should the nurse include when teaching the patient?
- A. The antiretroviral medications used to treat HIV infection are teratogenic.
- B. Most infants born to HIV-positive mothers are not infected with the virus.
- C. Since she is at an early stage of HIV infection, the infant will not contact HIV.
- D. It is likely that her newborn will become infected with HIV unless she uses antiretroviral drug therapy (ART).
Correct Answer: B
Rationale: Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.
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When assessing an individual who has been diagnosed with early persistent HIV infection and has a normal CD4 count, which of the following assessments should the nurse conduct?
- A. Check neurological orientation.
- B. Ask about problems with diarrhea.
- C. Palpate the regional lymph nodes.
- D. Examine the oral mucosa for lesions.
Correct Answer: C
Rationale: Persistent generalized lymphadenopathy is common in the early stage of persistent infection. Diarrhea, oral lesions, and neurological abnormalities would occur in the later stages of HIV infection.
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.
The nurse is designing a program to teach a community group about decreasing the incidence of HIV infection in their community. Which of the following information is a priority that the nurse include in the education session?
- A. Methods to prevent perinatal HIV transmission.
- B. How to prevent transmission between sexual partners.
- C. Ways to sterilize needles used by injectable drug users.
- D. Means to prevent transmission through blood transfusions.
Correct Answer: B
Rationale: Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide education about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.
A young adult who uses injectable illegal drugs asks the nurse about preventing AIDS. Which of the following information should the nurse inform the patient is the best way to reduce the risk of HIV infection from drug use?
- A. Participate in a needle-exchange program.
- B. Clean drug injection equipment before use.
- C. Ask those who share equipment to be tested for HIV.
- D. Avoid sexual intercourse when using injectable drugs.
Correct Answer: A
Rationale: Participation in needle and syringe exchange programs has been shown to control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practised by individuals in withdrawal. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.
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.