Nokea
Which of the following nursing actions will be most useful in assisting a young adult college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen?
- A. Give the patient detailed information about possible medication adverse effects.
- B. Remind the patient of the importance of taking the medications as scheduled.
- C. Encourage the patient to join a support group for students who are HIV positive.
- D. Check the patient's class schedule to help decide when the ART should be taken.
Correct Answer: D
Rationale: The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.
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The nurse is preparing to give the following medications to an HIV-positive patient who is hospitalized with Pneumocystis jiroveci pneumonia (PCP). Which of the following medications is most important to administer at the right time?
- A. Nystatin tablet
- B. Oral abacavir
- C. Ventolin
- D. Oral acyclovir
Correct Answer: B
Rationale: It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day.
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.
The nurse is caring for a patient who has just been diagnosed with early persistent HIV infection. Which of the following prophylactic measures should the nurse anticipate being included in the plan of care?
- A. Hepatitis B vaccine
- B. Pneumococcal vaccine
- C. Influenza virus vaccine
- D. Trimethoprim-sulfamethoxazole
- E. Varicella-zoster immune globulin
Correct Answer: A,B,C
Rationale: Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease, when the CD4 count has dropped or when infection has occurred.
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.
Which of the following tests is used to evaluate the effectiveness of ART?
- A. Viral load testing
- B. Enzyme immunoassays
- C. Rapid HIV antibody testing
- D. Immuno-fluorescence assay
Correct Answer: A
Rationale: The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.