Nokea
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.
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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.
A patient who has vague symptoms of fatigue and headaches is found to have a positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV) antibodies. In providing health teaching, which of the following information should the nurse include?
- A. The EIA test will need to be repeated to verify the results.
- B. A viral culture will be done to determine the progress of the disease.
- C. It will probably be 10 or more years before the patient develops acquired immunodeficiency syndrome (AIDS).
- D. The Western blot test will be done to determine whether AIDS has developed.
Correct Answer: A
Rationale: After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not part of HIV testing. Because the nurse does not know how recently the patient was infected, it is not appropriate to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.
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.
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.
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.