Chapter 16 Care of the Patient with HIV/AIDS

Chapter 16  Care of the Patient with HIV/AIDS

MULTIPLE CHOICE

1. When assigned to a newly admitted patient with AIDS, the nurse says, “I’m pregnant. It is not safe for me or my baby if I am assigned to his case.” Which is the most appropriate response by the charge nurse?

1. “This patient would not be a risk for your baby if you use standard precautions and

   avoid direct contact with blood or body fluids.”

2. “You should ask for a transfer to another unit because contact with this patient

   would put you and your baby at risk for AIDS.”

3. “Wear a mask, gown, and gloves every time you go into his room and use

   disposable trays, plates, and utensils to serve his meals.”

4. “We should recommend that this patient be transferred to an isolation unit.”

ANS: A
HIV is transmitted from human to human through infected blood, semen, cervicovaginal secretions, and breast milk. The use of Standard Precautions by all staff members for all patients all the time simplifies this issue.

DIF: Cognitive Level: Application REF: Pages 769-770,Box 16–6 OBJ: 6 TOP: Transmission of AIDS
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment

2. The anxious male patient is fearful that he has been exposed to a person with an HIV infection. He states he does not want to go to a laboratory for the ELISA tests because he does not want to be identified. What would be the nurse’s most helpful response?

1. “There really is not an option, you will need to get the Western blot test first.”
2. “There is an FDA-approved home test called OraQuick.”
3. “The rapid test Reveal can identify all the HIV strains.”
4. “You can be tested anonymously for ELISA. If you are seronegative, your

   concerns are over.”

ANS: B
The OraQuick is a home OTC test approved by the FDA. One seronegative on the ELISA is not evidence because seroconversion may not have taken place. The Western blot test follows if the ELISA is positive.

DIF: Cognitive Level: Application REF: Page 783 OBJ: 6 TOP: HIV testing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The patient, age 21, has been treated for chlamydia and has a history of recurrent herpes. What should the nurse counsel this patient about?

1. Sexual history, risk reduction measures, and testing for HIV
2. Getting an appointment at a family planning clinic
3. Testing for HIV and what the test results mean
4. Abstinence and a monogamous relationship

ANS: A

Chlamydia is considered a sexually transmitted disease (STD). As such it requires further testing and a sexual history to advise the sexual partners.

DIF: Cognitive Level: Analysis REF: Page 783 OBJ: 6
TOP: Risk for infection KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

4. A patient has just been diagnosed as HIV-positive. He asks the nurse, “Does this mean I have AIDS?” Which response would be most informative?

1. “Most people get AIDS within 3 to 12 weeks after they are infected with HIV.”
2. “Don’t worry. You may never get AIDS if you eat properly, exercise, and get

   plenty of rest.”

3. “It varies with every individual, but the average time is 8 to 10 years from the time

   a person is infected, and some go much longer.”

4. “You can expect to develop signs and symptoms of AIDS within 6 months.”

ANS: C
Typical progress of HIV includes a period of relative clinical latency, occurring immediately after the primary infection, which can last for several years. Long-term nonprogressors remain symptom-free for 8 to10 years.

DIF: Cognitive Level: Analysis REF: Page 763 OBJ: 4
TOP: Progression of disease KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

5. Which of the following is a CDC criterion for the progression of HIV infection to AIDS?

1. Increase in viral load
2. Decreased ratio of CD8 to CD4
3. Increase in white blood cells
4. Increased reactivity to skin tests

ANS: A
AIDS is the end stage of an HIV infection. The CDC has developed criteria for the diagnosis of AIDS, which are: increase in viral load even with pharmacologic interventions, increase in the ratio of CD8 to CD4, decline in the WBCs, and a decreased reactivity to skin tests.

DIF: Cognitive Level: Analysis REF: Page 764 OBJ: 7
TOP: AIDS diagnostic criteria KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

6. What should the nurse look for when reviewing a patient’s chart to determine whether she has progressed from HIV disease to AIDS?

1. CD4+ count below 500, chronic fatigue, night sweats
2. HIV-positive test result, CD4+ count below 200, history of opportunistic disease
3. Weight loss, persistent generalized lymphadenopathy, chronic diarrhea
4. Fever, chills, CD4+ count below 200

ANS: B
Patients who have progressed from HIV disease to AIDS will have the condition in which the CD4+ cell count drops to less than 200 cells/mm3 and have a history of opportunistic diseases.

DIF: Cognitive Level: Comprehension REF: Page 760-761, Table 16-1

OBJ: 9 TOP: Progression of disease
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity