Nokea
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.
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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.
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.
The nurse is caring for a pregnant patient who has recently been diagnosed with HIV. The patient asks the nurse, 'How soon after delivery of my baby can ART treatment be started?' Which of the following provide the basis for the nurse's response?
- A. It can be initiated while you are pregnant.
- B. It will start as soon as your baby is born.
- C. It depends upon whether you are breastfeeding your baby or not.
- D. It cannot begin until 7 days postpartum.
Correct Answer: A
Rationale: Women infected with HIV should receive optimal ART immediately, regardless of whether or not they are pregnant.
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.