Which information about an HIV-positive patient who is taking antiretroviral medications is most important for the nurse to address when planning care?
- A. The patient's blood glucose level is 6.9 mmol/L.
- B. The patient complains of feeling 'constantly tired.'
- C. The patient is unable to state the adverse effects of the medications.
- D. The patient states 'sometimes I miss a dose of zidovudine (AZT).'
Correct Answer: D
Rationale: Since missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common adverse effects of ART. The nurse should discuss medication adverse effects with the patient, but this is not as important as addressing the skipped doses of AZT.
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A young adult who uses injectable illegal drugs asks the nurse about preventing AIDS. Which of the following information should the nurse inform the patient is the best way to reduce the risk of HIV infection from drug use?
- A. Participate in a needle-exchange program.
- B. Clean drug injection equipment before use.
- C. Ask those who share equipment to be tested for HIV.
- D. Avoid sexual intercourse when using injectable drugs.
Correct Answer: A
Rationale: Participation in needle and syringe exchange programs has been shown to control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practised by individuals in withdrawal. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.
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.
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.
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.
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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