Nokea
The nurse is gathering data from laboratory studies for a client who has HIV. The client's T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?
- A. The client has converted from HIV infection to AIDS.
- B. The client has advanced HIV infection.
- C. The client's T4-cell count has decreased due to the Pneumocystis pneumonia.
- D. The client has another infection present that is causing a decrease in the T4-cell count.
Correct Answer: A
Rationale: AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/mm3 and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.
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A client who is HIV/AIDS positive has a prescription for laboratory tests to be performed. What precautions should the nurse observe whenever there is a risk of exposure to the blood and body fluids of an infected client?
- A. Avoid any physical contact with the client.
- B. Avoid cleaning up spilled urine and feces.
- C. Wear barrier garments for as long as possible after leaving a client's room.
- D. Transport the specimens of body fluids in leak-proof containers.
Correct Answer: D
Rationale: Whenever there is a risk of exposure to the blood and body fluids of an infected client, the nurse should transport these specimens in leak-proof containers. The nurse need not avoid physical contact with the client or cleaning the client's urine or stools. Barrier garments, such as face shields and glasses, should be removed soon after leaving a client's room.
A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus?
- A. diarrhea
- B. hearing impairment
- C. blindness
- D. fatigue
Correct Answer: C
Rationale: CMV can infect the choroid and retinal layers of the eye, leading to blindness. It does not lead to hearing impairment. Fatigue and diarrhea may occur but are not as critical as blindness.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
- A. Sign a refusal of blood transfusion form so the client will not receive the transfusion.
- B. Bank autologous blood.
- C. Ask people to donate blood.
- D. Use volume expanders in case blood is needed.
Correct Answer: B
Rationale: Banking autologous blood that is self-donated is the safest option for the client. Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
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.
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy?
- A. The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease.
- B. Viral load and T4-cell counts will be performed every 2 to 3 months.
- C. More antiretroviral medication will be added every 2 to 3 months.
- D. The Western blot test will be monitored every 6 months to see if the virus is still present.
Correct Answer: B
Rationale: Viral load testing is used to guide drug therapy and follow the progression of the disease. Viral load tests and T4-cell counts may be performed every 2 to 3 months once it is determined that a person is HIV positive. The medication should be adhered to and not discontinued. There is no cure for the disease at this time. Antiretroviral therapy is not generally changed or added to without reason or lack of response. The Western blot is used for confirmation of the presence of the HIV virus.