Question 1

The nurse explains that currently the drug that is best for treating HIV wasting syndrome is
A) human growth hormone.
B) megestrol acetate.
C) dronabinol.
D) thalidomide.

Accepted Answer

The drug used most successfully to treat wasting is human growth hormone. Both megestrol acetate and dronabinol can increase appetite and are used in wasting syndrome, but are secondary to human growth hormone. Thalidomide is not used for appetite enhancement.

Question 2

A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) whose CD4+ cell count is 100. The nurse should be aware that the most effective way to prevent Pneumocystis carinii pneumonia in this client is to
A) administer prescribed oral trimethoprim-sulfamethoxazole.
B) encourage a high fluid intake.
C) place the client in protective isolation.
D) restrict the client's visitors.

Accepted Answer

Maintenance lifetime suppressive therapy for P. carinii is required with trimethoprim-sulfamethoxazole, pentamidine aerosol, atovaquone, dapsone, or clindamycin-primaquine.

Question 3

The nurse counsels other co-workers that the suggested treatment for HIV exposure is
A) a single retroviral medication for 2 weeks.
B) combination retroviral medications for 2 weeks.
C) determined by the severity of the exposure and other factors.
D) "watching and waiting" for 12 weeks post-exposure.

Accepted Answer

The current response to occupational exposures is determined by the severity of the exposure and patient-related factors. The U.S. Public Health Service has a stratified algorithm for treatment, with most cases requiring a two-drug approach for 4 weeks.

Question 4

A nurse should plan further evaluation of an HIV-positive client when the client exhibits which early manifestation of toxoplasmosis infection?
A) Cardiac dysrhythmias
B) Discoloration of the mucous membranes
C) Headache
D) Lymphadenopathy

Accepted Answer

Clinical manifestations of central nervous system (CNS) infections include headache, impaired cognition, hemiparesis, aphasia, ataxia, vision loss, cranial nerve palsies, motor problems, and seizures.

Question 5

A client with an HIV infection is receiving zidovudine (Retrovir). The nurse counsels the client about the major problem with this medication, which is/are
A) cost.
B) long-term administration schedule.
C) noncompliance with its complex regimen.
D) side effects.

Accepted Answer

Noncompliance relative to the complexity of the regimen is the major concern about the use of this drug.

Question 6

When the AIDS client refuses pain medication because he or she is not in pain presently, the nurse should explain that
A) refraining from using the medication makes its effectiveness last longer.
B) skipping a dose will decrease diarrhea.
C) taking the medication on schedule keeps the blood level constant.
D) using the drug will increase the appetite.

Accepted Answer

Taking pain medication on a schedule keeps the blood level constant and incidentally helps control diarrhea by the side effect of constipation. Refraining from using the medications will not make its effects last longer, and skipping a dose does not cause diarrhea. Side effects of most pain medications do not include increased appetite.

Question 7

The nurse understands the most significant laboratory study for the client who is HIV positive is the
A) CD4+ cell count.
B) enzyme-linked immunosorbent assay (ELISA) test.
C) total white blood cell count.
D) Western blot test.

Accepted Answer

The most recent classification system for HIV disease in adults and adolescents is based on two monitoring parameters used to follow a client: (1) laboratory data (CD4⁺ cell count) and (2) clinical presentation (the person's clinical manifestations of diseases). The Western blot test would be used to confirm the diagnosis of HIV, which is done with the enzyme-linked immunosorbent assay test. The total white blood cell count can indicate infection, but is not specific for HIV.

Question 8

When planning a community teaching event, the nurse should recognize that the group in which HIV infection is growing most rapidly is
A) adults older than 50 years.
B) blacks and Hispanics.
C) black teenagers.
D) gay white men.

Accepted Answer

An overlooked population of rapidly growing HIV-positive people are those older than the age of 50. In 2004 they represented 16% of all new cases. Minorities are also heavily affected by HIV infection. Teenagers do not have a high rate of HIV infection overall. Gay white men have high rates of infection, but their rates of infection are decreasing as a percentage of the overall population of HIV infected individuals.

Question 9

A client with AIDS is experiencing fever with night sweats. A suggestion the nurse could make is to
A) drink all liquids in the morning.
B) keep liquids at the bedside to drink.
C) limit fluid intake after supper.
D) take aspirin if awakened in the night.

Accepted Answer

Teach the client how to manage chronic recurrent night fever and night sweats by taking the antipyretic of choice before going to sleep; having a change of bedclothes nearby; keeping a plastic cover on the pillow; placing a towel over the pillow in case of profuse diaphoresis; and keeping liquids at the bedside to drink. Limiting fluids in any manner might contribute to hypovolemia.

Question 10

The problem the nurse should plan for when a client with AIDS is infected with the Cryptosporidium parasite is
A) delirium.
B) painful open lesions.
C) profuse, watery diarrhea.
D) severe respiratory tract infection.

Accepted Answer

Clinical presentation includes profuse diarrhea, steatorrhea (1 L/day), flatulence, abdominal cramping and pain, anorexia, nausea, vomiting, profound weight loss, fever, fatigue, myalgia, and electrolyte imbalance.

Question 11

When a client with AIDS experiences pain while swallowing, the nurse could suggest
A) avoiding the use of straws while drinking.
B) drinking acidic juices such as orange juice.
C) eating very cold foods.
D) increasing the intake of well-cooked eggs and noodle dishes.

Accepted Answer

Encourage the client to eat foods at room temperature; choose mild foods and drinks, such as apple juice rather than orange juice; eat nonabrasive foods that are easy to swallow (well-cooked eggs, noodle dishes); and use a straw while drinking.

Question 12

The client who has a positive enzyme immunoassay test asks the nurse if that means that he is HIV positive. The nurse's most helpful response would be
A) "No, many people have positive enzyme immunoassays."
B) "No, you need to have the Western blot test to confirm that you are positive."
C) "Yes, but antiretrovirals will probably combat the infection now."
D) "Yes, you should seek medical care for antiretroviral drugs."

Accepted Answer

If the enzyme immunoassay is positive, the Western blot test is needed to confirm an HIV-positive status.

Question 13

Which of the following information related to medications should the nurse include in the teaching plan for a client who is positive for the human immunodeficiency virus (HIV)?
A) Do not skip a dose. If a dose is missed, double the next dose.
B) Take this medication at any time after eating.
C) Tell the prescriber if you decide to stop treatment.
D) Wait until the next visit before reporting significant side effects.

Accepted Answer

Instruct all clients taking retrovirals as follows: Take the drug at specified intervals. Do not skip a dose. Do not increase or decrease the number of pills you take. If side effects occur, tell your physician or nurse. If you do not want to take the drugs, tell your primary care provider. If you take the drugs only periodically, it would be better not to take them at all.

Question 14

A client with AIDS has the nursing diagnosis Fatigue. To conserve energy, the nurse encourages the client to
A) bathe before eating breakfast.
B) rest after every third major activity.
C) sit down while showering.
D) use easy-to-clean forks and knives.

Accepted Answer

Promote rest and activity by developing a plan of daily activities that alternates short activities with rest periods. Evaluate the client's needs and point out ways to conserve energy, such as sitting down while dressing, shaving, or preparing food; sitting on a shower chair while bathing; or using disposable items for eating so that no cleanup is needed. Bathing before breakfast would not help conserve energy. Resting after every third major activity is not individualized to what each client can tolerate.

Question 15

The nurse is counseling an HIV-positive woman who has just given birth to a baby. The nurse should advise the client to
A) anticipate the needs of her child immediately and make arrangements for placement in a setting where her child's life will be comfortable.
B) avoid breast-feeding her infant if she has access to a safe water supply to decrease the chances of vertical transmission.
C) report all of her sexual partners to the infectious disease department in order to break the chain of transmission of the disease.
D) seek professional counseling to deal with the guilt associated with the almost certain passing of the disease to her child.

Accepted Answer

Perinatal HIV exposure can occur during pregnancy, during vaginal delivery, and postpartum through breast-feeding. In places where the water supply is safe, bottle- feeding should be encouraged. In areas of the world where the risk of dying from contaminated water is high, breast-feeding is a better option. Advising the mother to place the child elsewhere is premature and judgmental. Reporting sexual partners for tracking purposes is an important activity, but is not more of a priority than keeping her baby safe. The use of zidovudine in pregnant women has drastically reduced vertical transmission.

Question 16

The nurse is assessing a client with AIDS for the presence of Kaposi's sarcoma (KS). The manifestation the nurse should look for is a
A) crusty lesion on the back and groin.
B) purple-red lesion on the body.
C) pustular lesion with yellow exudate.
D) thick, white exudate in the mouth.

Accepted Answer

Clinical presentation generally starts with an initial "patch" that is flat and pink, looks like a bruise, and is symmetrical on both sides of the body. Later it turns into dark violet or black plaques.

Question 17

A client with AIDS has the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements. The nurse should
A) encourage sweet foods and desserts that appeal to the taste.
B) encourage the client to dine alone to focus on food intake.
C) instruct the client to prepare meals, then divide and freeze them.
D) tell the client to eat large meals to result in greater intake.

Accepted Answer

Interventions include eating small meals frequently throughout the day; preparing meals ahead of time so they can be divided into individual servings and frozen until ready to use; encouraging the client to dine with family and friends; and consuming more nutrient-dense foods and beverages rather than filling up on low-calorie items. Sweet foods, while providing calories, do not provide the nutrition a client with AIDS needs. Dining alone may seem depressing to some clients as eating is a social activity. Clients may not be able to tolerate large meals.

Question 18

A client is afraid of a recent possible HIV exposure. The nurse should explain that the period of time it takes before HIV antibodies can be detected by laboratory tests is generally
A) 1 to 3 days.
B) 7 to 10 days.
C) 1 to 3 weeks.
D) 4 to 12 weeks.

Accepted Answer

There is a "window" for seroconversion (the time it takes for a newly infected person to develop antibodies that can be detected in a laboratory specimen). On average, antibodies can be detected in 4 to 12 weeks.

Question 19

The situation that would be least helpful to manage pain in the AIDS client who is an injecting drug user is
A) carefully rationing narcotic prescriptions.
B) having multiple practitioners prescribing medications.
C) limiting rescue doses of narcotic analgesics on a monthly basis.
D) refusing to fill lost prescriptions.

Accepted Answer

Helpful guidelines include having a single practitioner prescribe medications. Rationing medications is unethical as clients who are drug addicts still experience pain and need to be treated for it. Rescue pain medications need to be available for breakthrough pain. Clients who frequently "lose" prescriptions can be managed by phoning in prescriptions if the provider is worried about abuse. The major point is that clients deserve to have their pain managed.

Question 20

When teaching a client who is HIV positive, the nurse should explain that the virus can be transmitted
A) as soon as manifestations of illness appear.
B) once the diagnosis has been made.
C) only to another susceptible host.
D) to anyone having contact with blood or semen.

Accepted Answer

Modes of transmission have remained constant throughout the course of the HIV pandemic. The virus is spread through certain sexual practices, through exposure to blood, and through perinatal transmission. Transmission can occur via asymptomatic partners to a normal, healthy individual.

Quiz 78: Management of Clients with Acquired Immunodeficiency Syndrome

The nurse explains that currently the drug that is best for treating HIV wasting syndrome is

A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) whose CD4+ cell count is 100. The nurse should be aware that the most effective way to prevent Pneumocystis carinii pneumonia in this client is to

The nurse counsels other co-workers that the suggested treatment for HIV exposure is

A nurse should plan further evaluation of an HIV-positive client when the client exhibits which early manifestation of toxoplasmosis infection?

A client with an HIV infection is receiving zidovudine (Retrovir) . The nurse counsels the client about the major problem with this medication, which is/are

When the AIDS client refuses pain medication because he or she is not in pain presently, the nurse should explain that

The nurse understands the most significant laboratory study for the client who is HIV positive is the

When planning a community teaching event, the nurse should recognize that the group in which HIV infection is growing most rapidly is

A client with AIDS is experiencing fever with night sweats. A suggestion the nurse could make is to

The problem the nurse should plan for when a client with AIDS is infected with the Cryptosporidium parasite is

When a client with AIDS experiences pain while swallowing, the nurse could suggest

The client who has a positive enzyme immunoassay test asks the nurse if that means that he is HIV positive. The nurse's most helpful response would be

Which of the following information related to medications should the nurse include in the teaching plan for a client who is positive for the human immunodeficiency virus (HIV) ?

A client with AIDS has the nursing diagnosis Fatigue. To conserve energy, the nurse encourages the client to

The nurse is counseling an HIV-positive woman who has just given birth to a baby. The nurse should advise the client to

The nurse is assessing a client with AIDS for the presence of Kaposi's sarcoma (KS) . The manifestation the nurse should look for is a

A client with AIDS has the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements. The nurse should

A client is afraid of a recent possible HIV exposure. The nurse should explain that the period of time it takes before HIV antibodies can be detected by laboratory tests is generally

The situation that would be least helpful to manage pain in the AIDS client who is an injecting drug user is

When teaching a client who is HIV positive, the nurse should explain that the virus can be transmitted