Nokea
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.
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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.
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.
A pregnant woman with a history of early persistent HIV infection is seen at the clinic. Which of the following information should the nurse include when teaching the patient?
- A. The antiretroviral medications used to treat HIV infection are teratogenic.
- B. Most infants born to HIV-positive mothers are not infected with the virus.
- C. Since she is at an early stage of HIV infection, the infant will not contact HIV.
- D. It is likely that her newborn will become infected with HIV unless she uses antiretroviral drug therapy (ART).
Correct Answer: B
Rationale: Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.
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.