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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.
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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.
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.
A patient who has been treated for HIV infection for 7 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. Which of the following topics should the nurse include in the patient teaching plan?
- A. The benefits of daily exercise
- B. Foods that are higher in protein
- C. Treatment with antifungal agents
- D. A change in antiretroviral therapy
Correct Answer: D
Rationale: A frequent first intervention for metabolic disorders is a change in ART. Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.
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.
Which of the following patients will the nurse working in an HIV testing and treatment clinic anticipate teaching about antiretroviral therapy (ART)?
- A. A patient who is currently HIV negative but has unprotected sex with multiple partners
- B. A patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/?µL.
- C. An HIV-positive patient with a CD4+ count of 120/?µL who drinks a fifth of whiskey daily
- D. A patient who tested positive for HIV 2 years ago and has cytomegalovirus (CMV) disease
Correct Answer: D
Rationale: CMV disease is an AIDS-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4 count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4 count.