Nokea
The nurse conducts an educational in-service training on infection protection and control for staff members who will provide care to clients who are positive for human immunodeficiency virus (HIV). Which subtype of HIV does the nurse inform staff members is the most prevalent in the United States?
- A. HIV-1, Group M, subtype A
- B. HIV-1, Group M, subtype B
- C. HIV-1, Group M, subtype C
- D. HIV-1, Group M, subtype D
Correct Answer: B
Rationale: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 is composed of four groups identified as M, N, O, and P. Group M mutates easily and frequently, producing multiple substrains that are identified by letters from A through K, and circulating recombinant form (CRF), a hybrid virus formed by genetic material from various combined subtypes. HIV-2 is the primary type of infection in Western Africa. It is less transmittable, and the interval between initial infection with HIV-2 and the development of AIDS is longer. HIV-1, Group M, subtype B is more prevalent in the United States and in the rest of the world, but the distribution of subtypes changes from time to time because of the diverse merging of populations.
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The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick?
- A. Have the client placed in restraints.
- B. Ask for assistance.
- C. Refuse to start the IV.
- D. Give the client a sedative prior to starting the IV.
Correct Answer: B
Rationale: If a client is uncooperative, the nurse should request assistance when starting IV therapy. Restraints can cause the client to become more agitated and less cooperative. Sedation can be considered chemical restraint and can have side effects that are undesirable. Refusing to start the IV will not allow the client to receive the care required.
A client with cytomegalovirus (CMV) infection reports difficulty seeing. The physician determines that the client is developing CMV retinitis. What medication does the nurse anticipate the client will receive for this?
- A. zidovudine
- B. fluconazole
- C. azithromycin
- D. foscarnet
Correct Answer: D
Rationale: The drug foscarnet is used to treat CMV retinitis. Alterations in renal function, nausea, anemia, headaches, seizures, and diarrhea are the most common adverse effects. Zidovudine is used in antiretroviral therapy to prevent the conversion of HIV to AIDS. Azithromycin is an antibiotic and not used to treat CMV retinitis.
A client on antiretroviral drug therapy informs the nurse about sometimes forgetting to take the medication for a few days. What should the nurse inform the client can occur when the medications are not taken as prescribed?
- A. The funding for the medications will cease if the client is not taking the meds correctly.
- B. The client is risking the development of drug resistance and drug failure.
- C. The client will have to take the drugs intravenously to ensure compliance.
- D. The client will have to take higher doses of the antiviral medications.
Correct Answer: B
Rationale: Clients who neglect to take antiretroviral drugs as prescribed risk development of drug resistance. When drug levels are not adequately maintained, viral replication and mutations increase. Funding will not cease for noncompliance. The medications are not all available in IV form. Taking a higher dose of the medication if missed does not resolve drug resistance.
A client is informed of needing to start on antiretroviral therapy, and the client is concerned about the possibility of not being able to afford the therapy. What can the nurse inform the client is the largest source of public funding for HIV/AIDS care?
- A. Medicaid
- B. Medicare
- C. Blue Cross/Blue Shield
- D. AIDS Drug Assistance Program
Correct Answer: A
Rationale: Medicaid, a state-based medical assistance program for low-income clients, is the largest source of public funding for HIV/AIDS care. Medicare is for clients who are over age 65 years or disabled. Blue Cross/Blue Shield is a private insurance with a cap on coverage. AIDS Drug Assistance Program is the third largest source of funding for HIV in the United States for individuals who do not have health insurance that pays for drug therapy.
A client tells the nurse, 'You know I have AIDS. I still cannot afford to tell my employer because they will probably cancel my health insurance, then what would I do?' What is the best response by the nurse?
- A. An employer cannot cancel your currently active health insurance on the basis of AIDS.'
- B. I just wouldn't tell them. It is none of their business.'
- C. You have to tell them, it is not your right to allow them exposure to you. What if you give it to someone?'
- D. I understand your dilemma, but I think you should tell them. I would want to know.'
Correct Answer: A
Rationale: Despite HIV-specific confidentially laws, clients infected with AIDS fear that disclosure of their condition will affect employment, health insurance coverage, and even housing. An employer cannot cancel a client's currently active health insurance policy on the basis of AIDS. However, employers are more apt to dismiss a worker with a known HIV-positive status from employment to reduce future insurance premiums and death payments. The other answers are nontherapeutic and not based in fact.