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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.
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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.
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 with HIV infection who has developed Mycobacterium avium complex infection. Which of the following goals is most appropriate for this patient?
- A. Be free from injury.
- B. Receive immunizations on time.
- C. Ensure adequate oxygenation.
- D. Maintain intact perineal skin.
Correct Answer: D
Rationale: The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection.
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.