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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.
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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.
The nurse is caring for a patient with HIV infection who has developed Mycobacterium avium complex infection. Which of the following goals is most appropriate for this patient?
- A. Be free from injury.
- B. Receive immunizations on time.
- C. Ensure adequate oxygenation.
- D. Maintain intact perineal skin.
Correct Answer: D
Rationale: The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection.
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 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 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.