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Exam 5: HIV/AIDS (NCLEX)

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A clinic nurse is caring for a patient admitted with AIDS. The
nurse has assessed that the patient is experiencing a progressive
decline in cognitive, behavioral, and motor functions. The nurse
A
recognizes that these symptoms are most likely related to the
HIV encephalopathy is a clinical syndrome characterized by a
onset of what complication?
progressive decline in cognitive, behavioral, and motor functions.
The other listed complications do not normally have cognitive and
A) HIV encephalopathy
behavioral manifestations
B) B-cell lymphoma
C) Kaposi's sarcoma
D) Wasting syndrome
A nurse is assessing a 28-year-old man with HIV who has been B
admitted with pneumonia. In assessing the patient, which of the In prioritizing care, the pneumonia would be assessed first by
following observations takes immediate priority? the nurse. Tachypnea and restlessness are symptoms of altered
respiratory status and need immediate priority. Weight loss of 1
A) Oral temperature of 100°F pound is probably fluid related; frequent loose stools would not
B) Tachypnea and restlessness take short-term precedence over a temperature or tachypnea and
C) Frequent loose stools restlessness. An oral temperature of 100°F is not considered a
D) Weight loss of 1 pound since yesterday fever and would not be the first issue addressed.
A patient has come into the free clinic asking to be tested for HIV
infection. The patient asks the nurse how the test works. The nurse
responds that if the testing shows that antibodies to the AIDS virus D
are present in the blood, this indicates what? Positive test results indicate that antibodies to the AIDS virus are
present in the blood. The presence of antibodies does not imply
A) The patient is immune to HIV. an intact immune system or specific immunity to HIV. This finding
B) The patient's immune system is intact. does not indicate the presence of AIDS-related complications.
C) The patient has AIDS-related complications.
D) The patient has been infected with HIV.
A hospital patient is immunocompromised because of stage 3 HIV
infection and the physician has ordered a chest radiograph. How
should the nurse most safely facilitate the test? A
A patient who is immunocompromised is at an increased risk of
A) Arrange for a portable x-ray machine to be used. contracting nosocomial infections due to suppressed immunity.
B) Have the patient wear a mask to the x-ray department. The safest way the test can be facilitated is to have a portable
C) Ensure that the radiology department has been disinfected x-ray machine in the patient's room. This confers more protection
prior to the test. than disinfecting the radiology department or using masks
D) Send the patient to the x-ray department, and have the staff in
the department wear masks.
The nurse is addressing condom use in the context of a health
D
promotion workshop. When discussing the correct use of con-
The condom should be unrolled over the hard penis before any
doms, what should the nurse tell the attendees?
kind of sex. The condom should be held by the tip to squeeze out
air. Skin lotions, baby oil, petroleum jelly, or cold cream should
A) Attach the condom prior to erection.
not be used with condoms because they cause latex deteriora-
B) A condom may be reused with the same partner if ejaculation
tion/condom breakage. The condom should be held during with-
has not occurred.
drawal so it does not come off the penis. Condoms should never
C) Use skin lotion as a lubricant if alternatives are unavailable.
be reused.
D) Hold the condom by the cuff upon withdrawal.
A nurse is planning the care of a patient with AIDS who is admitted
to the unit with Pneumocystis pneumonia (PCP). Which nursing A
diagnosis has the highest priority for this patient? Although all these nursing diagnoses are appropriate for a patient
with AIDS, Ineffective Airway Clearance is the priority nursing
A) Ineffective Airway Clearance diagnosis for the patient with Pneumocystis pneumonia (PCP).
B) Impaired Oral Mucous Membranes Airway and breathing take top priority over the other listed con-
C) Imbalanced Nutrition: Less than Body Requirements cerns.
D) Activity Intolerance
A public health nurse is preparing an educational campaign to
B
address a recent local increase in the incidence of HIV infection.
Until an effective vaccine is developed, preventing HIV by eliminat-
The nurse should prioritize which of the following interventions?
ing and reducing risk behaviors is essential. Educational interven-
tions are the primary means by which behaviors can be influenced.
A) Lifestyle actions that improve immune function
Screening is appropriate, but education is paramount. Enhancing
B) Educational programs that focus on control and prevention
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Exam 5: HIV/AIDS (NCLEX)
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C) Appropriate use of standard precautions immune function does not prevent HIV infection. Ineffective use of
D) Screening programs for youth and young adults standard precautions apply to very few cases of HIV infection.
A nurse is working with a patient who was diagnosed with HIV
several months earlier. The nurse should recognize that a patient
with HIV is considered to have AIDS at the point when the CD4+
T-lymphocyte cell count drops below what threshold? B
When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the
A) 75 cells/mm3 of blood person is said to have AIDS.
B) 200 cells/mm3 of blood
C) 325 cells/mm3 of blood
D) 450 cells/mm3 of blood
A patient's current antiretroviral regimen includes nucleoside re-
verse transcriptase inhibitors (NRTIs). What dietary counseling
will the nurse provide based on the patient's medication regimen? D
Many NRTIs exist, but all of them may be safely taken without
A) Avoid high-fat meals while taking this medication. regard to meals. Protein, fluid, and sodium restrictions play no role
B) Limit fluid intake to 2 liters a day. in relation to these drugs.
C) Limit sodium intake to 2 grams per day.
D) Take this medication without regard to meals.
A nurse is performing an admission assessment on a patient
with stage 3 HIV. After assessing the patient's gastrointestinal
system and analyzing the data, what is most likely to be the priority B
nursing diagnosis? Diarrhea is a problem in 50% to 60% of all AIDS patients. As
such, this nursing diagnosis is more likely than abdominal pain,
A) Acute Abdominal Pain incontinence, or constipation, though none of these diagnoses is
B) Diarrhea guaranteed not to apply.
C) Bowel Incontinence
D) Constipation
A patient with a recent diagnosis of HIV infection expresses an
interest in exploring alternative and complementary therapies.
How should the nurse best respond?
C
A) "Complementary therapies generally have not been approved, The nurse should approach the topic of alternative or complemen-
so patients are usually discouraged from using them." tary therapies from an open-ended, supportive approach, empha-
B) "Researchers have not looked at the benefits of alternative sizing the need to communicate with care providers. Complemen-
therapy for patients with HIV, so we suggest that you stay away tary therapies and medical treatment are not mutually exclusive,
from these therapies until there is solid research data available." though some contraindications exist. Research supports the effi-
C) "Many patients with HIV use some type of alternative therapy cacy of some forms of complementary and alternative treatment
and, as with most health treatments, there are benefits and risks."
D) "You'll need to meet with your doctor to choose between an
alternative approach to treatment and a medical approach."
A patient was tested for HIV using enzyme immunoassay (EIA)
C
and results were positive. The nurse should expect the primary
The Western blot test detects antibodies to HIV and is used to
care provider to order what test to confirm the EIA test results?
confirm the EIA test results. The viral load test measures HIV
RNA in the plasma and is not used to confirm EIA test results,
A) Another EIA test
but instead to track the progression of the disease process. The
B) Viral load test
CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but
C) Western blot test
is not used to confirm results of EIA testing.
D) CD4/CD8 ratio
The nurse's plan of care for a patient with stage 3 HIV addresses
the diagnosis of Risk for Impaired Skin Integrity Related to Can- A
didiasis. What nursing intervention best addresses this risk? Thorough mouth care has the potential to prevent or limit the
severity of this infection. Antibiotics are irrelevant because of the
A) Providing thorough oral care before and after meals fungal etiology. The patient requires adequate food and fluids, but
B) Administering prophylactic antibiotics these do not necessarily prevent candidiasis. Skin emollients are
C) Promoting nutrition and adequate fluid intake not appropriate because candidiasis is usually oral.
D) Applying skin emollients as needed
A patient with HIV infection has begun experiencing severe diar-
A
rhea. What is the most appropriate nursing intervention to help
Administering antidiarrheal agents on a regular schedule may be
alleviate the diarrhea?
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Exam 5: HIV/AIDS (NCLEX)
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more beneficial than administering them on an as-needed basis,
A) Administer antidiarrheal medications on a scheduled basis, as
provided the patient's diarrhea is not caused by an infectious
ordered.
microorganism. Increased oral fluid may exacerbate diarrhea; IV
B) Encourage the patient to eat three balanced meals and a snack
fluid replacement is often indicated. Small, more frequent meals
at bedtime.
may be beneficial, and it is unrealistic to increase activity while the
C) Increase the patient's oral fluid intake.
patient has frequent diarrhea
D) Encourage the patient to increase his or her activity level.
A patient with HIV has a nursing diagnosis of Risk for Impaired
A
Skin Integrity. What nursing intervention best addresses this risk?
Devices such as alternating-pressure mattresses and low-air-loss
beds are used to prevent skin breakdown. Activity should be
A) Utilize a pressure-reducing mattress.
promoted, not limited, and contact with synthetic fabrics does
B) Limit the patient's physical activity.
not necessary threaten skin integrity. Antibiotic ointments are not
C) Apply antibiotic ointment to dependent skin surfaces.
normally used unless there is a break in the skin surface
D) Avoid contact with synthetic fabrics.
An 18-year-old pregnant female has tested positive for HIV and
asks the nurse if her baby is going to be born with HIV. What is
the nurse's best response?
D
Mother-to-child transmission of HIV-1 is possible and may occur
A) "There is no way to know that for certain, but we do know that
in utero, at the time of delivery, or through breast-feeding. There is
your baby has a one in four chance of being born with HIV."
no evidence that the infant's risk is 25%. Deferral to the physician
B) "Your physician is likely the best one to ask that question."
is not a substitute for responding appropriately to the patient's
C) "If the baby is HIV positive there is nothing that can be done
concern. Downplaying the patient's concerns is inappropriate.
until it is born, so try your best not to worry about it now."
D) "It's possible that your baby could contract HIV, either before,
during, or after delivery."
A 16-year-old has come to the clinic and asks to talk to a nurse.
The nurse asks the teen what she needs and the teen responds
that she has become sexually active and is concerned about
getting HIV. The teen asks the nurse what she can do keep from
getting HIV. What would be the nurse's best response? D
Other than abstinence, consistent and correct use of condoms is
A) "There's no way to be sure you won't get HIV except to use the only effective method to decrease the risk of sexual transmis-
condoms correctly." sion of HIV infection. Both female and male condoms confer sig-
B) "Only the correct use of a female condom protects against the nificant protection. New prevention techniques are not commonly
transmission of HIV." discovered, though advances in treatment are constant.
C) "There are new ways of protecting yourself from HIV that are
being discovered every day."
D) "Other than abstinence, only the consistent and correct use of
condoms is effective in preventing HIV."
A patient is in the primary infection stage of HIV. What is true of
this patient's current health status?

A) The patient's HIV antibodies are successfully, but temporarily,


killing the virus.
B
B) The patient is infected with HIV but lacks HIV-specific antibod-
ies.
C) The patient's risk for opportunistic infections is at its peak.
D) The patient may or may not develop long-standing HIV infec-
tion.
A patient with HIV will be receiving care in the home setting. What
B
aspect of self-care should the nurse emphasize during discharge
Infection control is of high importance in patients living with HIV,
education?
thus personal hygiene is paramount. This is a more important topic
than signs and symptoms of one specific complication (wasting
A) Appropriate use of prophylactic antibiotics
syndrome). Drug dosages should never be independently adjust-
B) Importance of personal hygiene
ed. Prophylactic antibiotics are not normally prescribed unless the
C) Signs and symptoms of wasting syndrome
patient's CD4 count is below 50.
D) Strategies for adjusting antiretroviral dosages

The nurse is caring for a patient who has been admitted for the
treatment of AIDS. In the morning, the patient tells the nurse
that he experienced night sweats and recently "coughed up some
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Exam 5: HIV/AIDS (NCLEX)
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blood." What is the nurse's most appropriate action?
C
A) Assess the patient for additional signs and symptoms of Ka-
These signs and symptoms are suggestive of tuberculosis, not
posi's sarcoma.
Kaposi's sarcoma; prompt assessment and treatment is neces-
B) Review the patient's most recent viral load and CD4+ count.
sary. There is no indication of a need for oral suctioning and the
C) Place the patient on respiratory isolation and inform the physi-
patient's blood work will not reflect the onset of this opportunistic
cian.
infection.
D) Perform oral suctioning to reduce the patient's risk for aspira-
tion.
An HIV-infected patient presents at the clinic for a scheduled
CD4+ count. The results of the test are 45 cells/L, and the nurse
A
recognizes the patient's increased risk for Mycobacterium avium
HIV-infected adults and adolescents should receive chemopro-
complex (MAC disease). The nurse should anticipate the admin-
phylaxis against disseminated Mycobacterium avium complex
istration of what drug?
(MAC disease) if they have a CD4+ count less than 50 cells/µL.
Azithromycin (Zithromax) or clarithromycin (Biaxin) are the pre-
A) Azithromycin
ferred prophylactic agents. Vancomycin, levofloxacin, and flucona-
B) Vancomycin
zole are not prophylactic agents for MAC.
C) Levofloxacin
D) Fluconazole
A patient with AIDS is admitted to the hospital with AIDS-related
C
wasting syndrome and AIDS-related anorexia. What drug has
Megestrol acetate (Megace), a synthetic oral progesterone prepa-
been found to promote significant weight gain in AIDS patients by
ration, promotes significant weight gain. In patients with HIV in-
increasing body fat stores?
fection, it increases body weight primarily by increasing body fat
stores. Advera is a nutritional supplement that has been developed
A) Advera
specifically for people with HIV infection and AIDS. Momordi-
B) Momordicacharantia
cacharantia (bitter melon) is given as an enema and is part of
C) Megestrol
alternative treatment for HIV/AIDS. Ranitidine prevents ulcers.
D) Ranitidine
A nurse is completing a nutritional status of a patient who has ABDE
been admitted with AIDS-related complications. What compo- Nutritional status is assessed by obtaining a dietary history and
nents should the nurse include in this assessment? Select all that identifying factors that may interfere with oral intake, such as
apply. anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In
addition, the patient's ability to purchase and prepare food is
A) Serum albumin level assessed. Weight history (i.e., changes over time); anthropometric
B) Weight history measurements; and blood urea nitrogen (BUN), serum protein,
C) White blood cell count albumin, and transferrin levels provide objective measurements of
D) Body mass index nutritional status. White cell count is not a typical component of a
E) Blood urea nitrogen (BUN) level nutritional assessment.
A hospital nurse has experienced percutaneous exposure to an
HIV-positive patient's blood as a result of a needlestick injury. The B
nurse has informed the supervisor and identified the patient. What After initiating the emergency reporting system, the nurse should
action should the nurse take next? report as quickly as possible to the employee health services,
the emergency department, or other designated treatment facility.
A) Flush the wound site with chlorhexidine. Flushing is recommended, but chlorhexidine is not used for this
B) Report to the emergency department or employee health de- purpose. Applying a dressing is not recommended. Following up
partment. with the nurse's own primary care provider would require an
C) Apply a hydrocolloid dressing to the wound site. unacceptable delay
D) Follow up with the nurse's primary care provider.
The nurse care plan for a patient with AIDS includes the diagno-
sis of Risk for Impaired Skin Integrity. What nursing intervention C
should be included in the plan of care? Skin surfaces are protected from friction and rubbing by keeping
bed linens free of wrinkles and avoiding tight or restrictive clothing.
A) Maximize the patient's fluid intake. Fluid intake should be adequate, and must be monitored, but max-
B) Provide total parenteral nutrition (TPN). imizing fluid intake is not a goal. TPN is a nutritional intervention
C) Keep the patient's bed linens free of wrinkles. of last resort.
D) Provide the patient with snug clothing at all times.

A patient has been diagnosed with AIDS complicated by chronic


diarrhea. What nursing intervention would be appropriate for this D
patient? A stool culture should be obtained to determine the possible

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Exam 5: HIV/AIDS (NCLEX)
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A) Position the patient in the high Fowler's position whenever
possible.
presence of microorganisms that cause diarrhea. Patients should
B) Temporarily eliminate animal protein from the patient's diet.
generally avoid raw fruit when having diarrhea. There is no need
C) Make sure the patient eats at least two servings of raw fruit
to avoid animal protein or increase the height of the patient's bed.
each day.
D) Obtain a stool culture to identify possible pathogens.
A patient who has AIDS is being treated in the hospital and admits
A
to having periods of extreme anxiety. What would be the most
Measures such as relaxation and guided imagery may be bene-
appropriate nursing intervention?
ficial because they decrease anxiety, which contributes to weak-
ness and fatigue. Increased activity may be of benefit, but for other
A) Teach the patient guided imagery.
patients this may exacerbate feelings of anxiety or loss. Granting
B) Give the patient more control of her antiretroviral regimen.
the patient control has the potential to reduce anxiety, but the
C) Increase the patient's activity level.
patient is not normally given unilateral control of the ART regimen.
D) Collaborate with the patient's physician to obtain an order for
Hydromorphone is not used to treat anxiety.
hydromorphone.
A nurse is performing the admission assessment of a patient
who has AIDS. What components should the nurse include in this
comprehensive assessment? Select all that apply.

A) Current medication regimen ABCE


B) Identification of patient's support system
C) Immune system function
D) Genetic risk factors for HIV
E) History of sexual practices
A patient who has tested positive for the human immunodeficiency
virus (HIV) arrives at the clinic with a report of fever, nonproductive
cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How
should the healthcare provider interpret these findings?Please
choose from one of the following options.

A. The patient is diagnosed with acquired immunodeficiency syn- A


drome (AIDS).
B.The patient is now in the latent stages of HIV infection
C.These findings provide evidence that the patient has serocon-
verted.
D. This is an expected finding because the patient has tested
positive for HIV.
Which member of the health care team demonstrates reducing
the risk for infection for the client with acquired immunodeficiency
syndrome (AIDS)?
A
A) The dietary worker hands the disposable meal trays to the LPN This limits the number of health care personnel entering the
assigned to the client. room. Verbalizing stressors does not reduce the risk for infection.
B) The social worker encourages the client to verbalize about Bathrooms, not hallways, that are cleaned at least once daily by
stressors at home. housekeeping reduces infection. Vital signs, including tempera-
C) Housekeeping thoroughly cleans and disinfects the hallways ture, should be taken every 4 hours to detect potential infection.
near the client's room.
D) Health care provider orders vital signs including temperature
every 8 hours.
The nurse is instructing an unlicensed health care worker on the
care of the client with HIV who also has active genital herpes.
Which statement by the health care worker indicates effective
teaching of standard precautions?
C
A) ''I need to know my HIV status, so I must get tested before Standard precautions include whatever personal protective equip-
caring for any clients." ment (PPE) is necessary for the prevention of transmission of HIV
B) ''Putting on a gown and gloves will cover up the itchy sores on and genital herpes.
my elbows.''
C) ''Washing my hands and putting on a gown and gloves is what
I must do before starting care.''
D) ''I will wash my hands before going into the room, and then
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Exam 5: HIV/AIDS (NCLEX)
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put on gown and gloves only for direct contact with the client's
genitals."
Which statement made to the nurse by a health care worker
assigned to care for the client with HIV indicates a breach of
confidentiality and requires further education by the nurse?

A) ''I told the family members they needed to wash their hands
when they enter and leave the room.'' B
B) ''The other health care worker and I were out in the hallway Discussing this client's illness outside the client's room is a breach
discussing how we were concerned about getting HIV from our of confidentiality.
client, so no one could hear us in the client's room.''
C) ''Yes, I understand the reasons why I have to wear gloves when
I bathe my client.''
D) ''The client's spouse told me she got HIV from a blood trans-
fusion.
When preparing the newly diagnosed client with HIV and signif-
icant other for discharge, which explanation by the nurse accu-
rately describes proper condom use?

A) ''Condoms should be used when lesions on the penis are B


present.'' This allows for the collection of semen at the tip of the condom.
B) ''Always position the condom with a space at the tip of an erect
penis.''
C) ''Make sure it fits loosely to allow for penile erection.''
D) ''Use adequate lubrication such as petroleum jelly.''
Which interventions does the home health nurse teach to family
members to reduce confusion in the client diagnosed with AIDS
dementia? (Select all that apply.)

A) Report any behavior changes.


CDFG
B) Use the Glasgow Coma Scale on a daily basis.
Seasonal decorations in the home helps with maintaining orien-
C) Change the decorations in the home according to the season.
tation. This allows the client to visualize seasonal and weather
D) Put the bed close to the window.
changes and assists in orientation. Involving the client in planning
E) Write out all instructions and have the client read them over
the daily schedule helps with orientation. Using calendars and
before performing a task.
crossing off past dates helps with orientation.
F) Ask the client when he or she wants to shower or bathe.
G) Mark off the days of the calendar, leaving open the current
date.
H) For continuity, the primary caregiver should be the only person
reorienting the client.
A client with acquired immunodeficiency syndrome (AIDS) has
D
a nursing diagnosis of Imbalanced nutrition: less than body re-
The client should eat small, frequent meals throughout the day.
quirements. The nurse plans which of the following goals with this
The client also should take in nutrient-dense and high-calorie
client?
meals and snacks rather than those that are high in glucose only.
The client is encouraged to eat favorite foods to keep intake up
a) consume foods and beverages that are high in glucose
and plan meals that are easy to prepare. The client can also avoid
b) plan large menus and cook meals in advance
taking fluids with meals to increase food intake before satiety sets
c) eat low-calorie snacks between meals
in.
d) eat small, frequent meals throughout the day
A client with acquired immunodeficiency syndrome (AIDS) is ex-
periencing shortness of breath related to Pneumocystis jiroveci
pneumonia. Which measure should the nurse include in the plan
of care to assist the client in performing activities of daily living?
A
a) provide supportive care with hygiene needs
b) provide meals and snacks with high-protein, high calorie, and
high-nutritional value
c) provide small, frequent meals

A client who was tested for human immunodeficiency virus (HIV)


after a recent exposure had a negative result. During the post-test
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Exam 5: HIV/AIDS (NCLEX)
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counseling session, the nurse tells the client which of the follow-
ing?

a) the test should be repeated in 6 months


b) this ensures that the client is not infected with the HIV virus A
c) the client no longer needs to protect himself from sexual part-
ners
d) the client probably has immunity to the acquired immunodefi-
ciency virus
A client is diagnosed with human immunodeficiency virus (HIV)
infection. The nurse prepares a care plan for the client, knowing
that HIV is primarily a condition in which:
A
HIV infection causes immunosuppression and is indicated by a
a) immunosuppression occurs and is indicated by a T4 lympho-
T4 lymphocyte count of less than 200/mm3. Although bacterial,
cyte count of less than 200/mm3
fungal, and protozoal infection can occur, these occur as oppor-
b) bacterial infection occurs, causing weakness
tunistic infections as a result of the immunosuppression.
c) fungal infection occurs, causing a rash and pruritus
d) protozoan infection occurs, causing a fever and nonproductive
cough
B
SUDS screening test results are available in 30 to 60 minutes. The
Nurse Vince sustained a dirty needle stick injury. Which diagnostic
test is performed on a client to determine if the health care worker
test would be ordered on a client?
with a dirty needle stick injury should begin antiretroviral treatment.
ELISA test results indicate exposure to or infection with human
A. Enzyme-linked immunosorbent assay (ELISA)
immunodeficiency virus (HIV), but the test does not diagnose ac-
B. SUDS screening test
quired immunodeficiency syndrome (AIDS). Antibody titers would
C. Antibody titers
not be appropriate to determine whether the health care worker
D. Skin biopsy for Kaposi's sarcoma
has been exposed to HIV or hepatitis. Kaposi's sarcoma is usually
associated with AIDS but not immediately after a needle stick.
After the first injection of an immunotherapy program, the nurse
notices a large, red wheal on the client's arm, coughing, and expi- B
ratory wheezing. Which intervention should the nurse implement Immediately on noticing the client's sign and symptoms, the nurse
first? would determine that the client is experiencing anaphylaxis to
the injection. The first action is to give 0.2 to 0.5 ml of 1:1,000
A. Notifying the health care provider immediately epinephrine I.M. Notifying the health care provider, beginning oxy-
B. Administering I.M. epinephrine per protocol gen administration, and starting an I.V. line follow after the initial
C. Beginning oxygen by way of nasal cannula injection of epinephrine is administered.
D. Starting an I.V. line for medication administration
During the past 6 months, a client diagnosed with acquired im-
munodeficiency syndrome has had chronic diarrhea and has lost
18 pounds. Additional assessment findings include tented skin
turgor, dry mucous membranes, and listleness. Which nursing
diagnosis focuses attention on the client's most immediate prob-
lem?
A
A. Deficient fluid volume related to diarrhea and abnormal fluid
loss
B. Imbalanced nutrition: less than body requirements related to
nausea and vomiting
C. Disturbed thought processes related to central nervous system
effects of disease
D. Diarrhea related to the disease process and acute infection
For a male client who has acquired immunodeficiency syndrome
with chronic diarrhea, anorexia, a history of oral candidiasis, and
weight loss, which dietary instruction would be included in the
teaching plan?
D
A. "Follow a low-protein, high-carbohydrate diet."
B. "Eat three large meals per day."
C. "Include unpasteurized dairy products in the diet."
D. "Follow a high-protein, high-calorie diet.
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A client with acquired immunodeficiency syndrome has a respira-
tory infection from Pneumocystis jiroveci and a nursing diagnosis D
of Impaired Gas Exchange written in the plan of care. Which of The status of the client with a diagnosis of Impaired gas exchange
the following indicates that the expected outcome of care has not would be evaluated against the standard outcome criteria for
yet been achieved? this nursing diagnosis. These would include the client stating that
breathing is easier and is coughing up secretions effectively, and
A. Client has clear breath sounds has clear breath sounds. The client should not limit fluid intake
B. Client now limits his fluid intake because fluids are needed to decrease the viscosity of secretions
C. Client expectorates secretions easily for expectoration.
D. Client is free of complaints of shortness of breath
Human Papilloma Virus in AIDS patients is manifested as:

A. Cough, evening fever, night sweats, weight loss and anemia


B. Persistent fever, tachypnoea, hypoxia, cyanosis and tachycar-
C
dia.
C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina
and penis
D. Watery diarrhea, abdominal pain, nausea and vomiting
A client is diagnosed with oral candidiasis. Nurse Tina knows that
B
this condition in AIDS is treated with:
Oral candidiasis usually responds to topical treatments such as
clotrimazole troches and nystatin suspension (nystatin "swish and
A. Trimethoprim + sulfamethoxazole
swallow"). Systemic antifungal medication such as fluconazole or
B. Fluconazole
itraconazole may be necessary for oropharyngeal infections that
C. Acyclovir
do not respond to these treatments.
D. Zidovudine
D
The decision to begin antiretroviral therapy is based on: A person's CD4 count is an important factor in the decision to start
ART. A low or falling CD4 count indicates that HIV is advancing and
A. The CD4 cell count damaging the immune system. A rapidly decreasing CD4 count
B. The plasma viral load increases the urgency to start ART. Regardless of CD4 count,
C. The intensity of the patient's clinical symptoms there is greater urgency to start ART when a person has a high
D. All of the above viral load or any of the following conditions: pregnancy, AIDS, and
certain HIV-related illnesses and co infections.
Which client problem relating to altered nutrition is a consequence
of AIDS? B
Often the complications of the acquired immunodeficiency syn-
A. Increased appetite drome (AIDS) have a negative impact on nutritional status. Weight
B. Decreased protein absorption loss and protein depletion are commonly seen among the AIDS
C. Increased secretions of digestive juices population.
D. Decreased gastrointestinal absorption
As a knowledgeable nurse, you know that the primary goals of
antiretroviral therapy (ART) include all, EXCEPT:

A. Reduce HIV-associated morbidity and prolong the duration and


D
quality of survival
B. Restore and preserve immunologic function
C. Maximally and durably suppress plasma HIV viral load
D. Elimination of HIV entirely from the body
The nurse observes precaution in caring for Mr. X as HIV is most
easily transmitted in:

a. Vaginal secretions and urine D


b. Breast milk and tears
c. Feces and saliva
d. Blood and semen

The blood test first used to identify a response to HIV infection is:
B
a. Western blot
b. ELISA test

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Exam 5: HIV/AIDS (NCLEX)
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c. CD4+ T-cell count
d. CBC
When teaching a patient infected with HIV regarding transmission
of the virus to others, which statement made by the patient would
indicate a need for further teaching?
A
A. "I will need to isolate any tissues I use so as not to infect my HIV is not spread casually. The virus cannot be transmitted
family." through hugging, dry kissing, shaking hands, sharing eating uten-
B. "I will notify all of my sexual partners so they can get tested for sils, using toilet seats, or attending school with an HIV-infected
HIV." person. It is not transmitted through tears, saliva, urine, emesis,
C. "Unprotected sexual contact is the most common mode of sputum, feces, or sweat.
transmission."
D. "I do not need to worry about spreading this virus to others by
sweating at the gym."
The nurse is providing care for a patient who has been living
with HIV for several years. Which assessment finding most clearly
indicates an acute exacerbation of the disease?
C
A. A new onset of polycythemia
B. Presence of mononucleosis-like symptoms
C. A sharp decrease in the patient's CD4+ count
D. A sudden increase in the patient's WBC count
A pregnant woman who was tested and diagnosed with HIV
infection is very upset. What should the nurse teach this patient
about her baby's risk of being born with HIV infection?

A. "The baby will probably be infected with HIV."


C
B. "Only an abortion will keep your baby from having HIV."
C. "Treatment with antiretroviral therapy will decrease the baby's
chance of HIV infection."
D. "The duration and frequency of contact with the organism will
determine if the baby gets HIV infection."
A 25-year-old male patient has been diagnosed with HIV. The
patient does not want to take more than one antiretroviral drug.
What reasons can the nurse tell the patient about for taking more
than one drug?
B
A. Together they will cure HIV.
B. Viral replication will be inhibited.
C. They will decrease CD4+ T cell counts.
D. It will prevent interaction with other drugs
The woman is afraid she may get HIV from her bisexual husband. CDE
What should the nurse include when teaching her about preex- Using male or female condoms, having monthly HIV testing for
posure prophylaxis (select all that apply)? the patient and her husband, and the woman taking emtricitabine
and tenofovir regularly has shown to decrease the infection of
A. Take fluconazole (Diflucan). heterosexual women having sex with a partner who participates
B. Take amphotericin B (Fungizone). in high-risk behavior. Fluconazole and amphotericin B are taken
C. Use condoms for risk-reducing sexual relations. for Candida albicans, Coccidioides immitis, and Cryptococcosus
D. Take emtricitabine and tenofovir (Truvada) regularly. neoformans, which are all opportunistic diseases associate with
E. Have regular HIV testing for herself and her husband. HIV infection
The nurse was accidently stuck with a needle used on an HIV-pos-
itive patient. After reporting this, what care should this nurse first B
receive? Postexposure prophylaxis with combination antiretroviral therapy
can significantly decrease the risk of infection. Personal protective
A. Personal protective equipment equipment should be available although it may not have stopped
B. Combination antiretroviral therapy this needle stick. The needle stick has been reported. The negative
C. Counseling to report blood exposures evaluation may or may not be needed but would not occur first.
D. A negative evaluation by the manage
The HIV-infected patient is taught health promotion activities in-
cluding good nutrition; avoiding alcohol, tobacco, drug use, and
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Exam 5: HIV/AIDS (NCLEX)
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exposure to infectious agents; keeping up to date with vaccines;
A
getting adequate rest; and stress management. What is the ratio-
These health promotion activities along with mental health coun-
nale behind these interventions that the nurse knows?
seling, support groups, and a therapeutic relationship with health
care providers will promote a healthy immune system, which
A. Delaying disease progression
may delay disease progression. These measures will not cure
B. Preventing disease transmission
HIV infection, prevent disease transmission, or increase self-care
C. Helping to cure the HIV infection
activities
D. Enabling an increase in self-care activities
The patient is admitted to the ED with fever, swollen lymph glands,
sore throat, headache, malaise, joint pain, and diarrhea. What
nursing measures will help identify the need for further assess-
BD
ment of the cause of this patient's manifestations (select all that
With these symptoms, assessing this patient's sexual behavior
apply)?
and possible exposure to shared drug equipment will identify
if further assessment for the HIV virus should be made or the
A. Assessment of lung sounds
manifestations are from some other illness (e.g., lung sounds and
B. Assessment of sexual behavior
living conditions may indicate further testing for TB).
C. Assessment of living conditions
D. Assessment of drug and syringe use
E. Assessment of exposure to an ill person
Which statements accurately describe HIV infection (select all that
apply)?

a. Untreated HIV infection has a predictable pattern of progres-


sion.
b. Late chronic HIV infection is called acquired immunodeficiency
syndrome (AIDS). ABC
c. Untreated HIV infection can remain in the early chronic stage
for a decade or more.
d. Untreated HIV infection usually remains in the early chronic
stage for 1 year or less.
e. Opportunistic diseases occur more often when the CD4+ T cell
count is high and the viral load is low
Screening for HIV infection generally involves

a. laboratory analysis of blood to detect HIV antigen.


C
b. electrophoretic analysis for HIV antigen in plasma.
c. laboratory analysis of blood to detect HIV antibodies.
d. analysis of lymph tissues for the presence of HIV RNA.
Antiretroviral drugs are used to

a. cure acute HIV infection.


B
b. decrease viral RNA levels.
c. treat opportunistic diseases.
d. decrease pain and symptoms in terminal disease.
Which statement about metabolic side effects of ART is true
(select all that apply)? BCD
Some HIV-infected patients, especially those who have been in-
a. These are annoying symptoms that are ultimately harmless. fected and have received ART for a long time, develop a set of
b. ART-related body changes include central fat accumulation and metabolic disorders that include changes in body shape (e.g.,
peripheral wasting. fat deposits in the abdomen, upper back, and breasts along with
c. Lipid abnormalities include increases in triglycerides and de- fat loss in the arms, legs, and face) as a result of lipodystrophy,
creases in high-density cholesterol. hyperlipidemia (i.e., elevated triglyceride levels and decreases
d. Insulin resistance and hyperlipidemia can be treated with drugs in high-density lipoprotein levels), insulin resistance and hyper-
to control glucose and cholesterol. glycemia, bone disease (e.g., osteoporosis, osteopenia, avascular
e. Compared to uninfected people, insulin resistance and hyper- necrosis), lactic acidosis, and cardiovascular disease.
lipidemia are more difficult

The nurse is providing postoperative care for a 30-year-old female


patient after an appendectomy. The patient has tested positive for
human immunodeficiency virus (HIV). What type of precautions
should the nurse observe to prevent the transmission of this
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Exam 5: HIV/AIDS (NCLEX)
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disease?

a. Droplet precautions
D
b. Contact precautions
c. Airborne precautions
d. Standard precautions
A 52-year-old female patient was exposed to human immunod-
eficiency virus (HIV) 2 weeks ago through sharing needles with
other substance users. What symptoms will the nurse teach the
patient to report that would indicate the patient has developed an
acute HIV infection?

a. Cough, diarrhea, headaches, blurred vision, muscle fatigue D


b. Night sweats, fatigue, fever, and persistent generalized lym-
phadenopathy
c. Oropharyngeal candidiasis or thrush, vaginal candidal infection,
or oral or genital herpes
d. Flu-like symptoms such as fever, sore throat, swollen lymph
glands, nausea, or diarrhea
The nurse is monitoring the effectiveness of antiretroviral therapy
(ART) for a 56-year-old man with acquired immunodeficiency
syndrome (AIDS). What laboratory study result indicates the med-
ications have been effective?
C
a. Increased viral load
b. Decreased neutrophil count
c. Increased CD4+ T cell count
d. Decreased white blood cell count
A patient who has vague symptoms of fatigue, headaches, and
a positive test for human immunodeficiency virus (HIV) antibod-
ies using an enzyme immunoassay (EIA) test. What instructions
should the nurse give to this patient?

a. "The EIA test will need to be repeated to verify the results."


A
b. "A viral culture will be done to determine the progression of the
disease."
c. "It will probably be 10 or more years before you develop ac-
quired immunodeficiency syndrome (AIDS)."
d. "The Western blot test will be done to determine whether
acquired immunodeficiency syndrome (AIDS) has developed."
A patient who has a positive test for human immunodeficiency
virus (HIV) antibodies is admitted to the hospital with Pneu-
mocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of
less than 200 cells/L. Based on diagnostic criteria established
by the Centers for Disease Control and Prevention (CDC), which
statement by the nurse is correct?
C
Development of PCP meets the diagnostic criterion for AIDS. The
a. "The patient meets the criteria for a diagnosis of an acute HIV
other responses indicate earlier stages of HIV infection than is
infection."
indicated by the PCP infection.
b. "The patient will be diagnosed with asymptomatic chronic HIV
infection."
c. "The patient has developed acquired immunodeficiency syn-
drome (AIDS)."
d. "The patient will develop symptomatic chronic HIV infection in
less than a year."
A patient with a positive rapid antibody test result for human
immunodeficiency virus (HIV) is anxious and does not appear to
hear what the nurse is saying. What action by the nurse is most C
important at this time? After an initial positive antibody test, the next step is retesting to

a. Teach the patient about the medications available for treatment.


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Exam 5: HIV/AIDS (NCLEX)
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b. Inform the patient how to protect sexual and needle-sharing
partners.
confirm the results. A patient who is anxious is not likely to be
c. Remind the patient about the need to return for retesting to
able to take in new information or be willing to disclose information
verify the results.
about HIV status of other individuals.
d. Ask the patient to notify individuals who have had risky contact
with the patient.
The nurse palpates enlarged cervical lymph nodes on a patient C
diagnosed with acute human immunodeficiency virus (HIV) infec- Persistent generalized lymphadenopathy is common in the ear-
tion. Which action would be most appropriate for the nurse to take? ly stages of HIV infection. No antibiotic is needed because the
enlarged nodes are probably not caused by bacteria. Applying
a. Instruct the patient to apply ice to the neck. ice to the neck may provide comfort, but the initial action is to
b. Advise the patient that this is probably the flu. reassure the patient this is an expected finding. Lymphadenopathy
c. Explain to the patient that this is an expected finding. is common with acute HIV infection and is therefore not likely the
d. Request that an antibiotic be prescribed for the patient. flu.
Which information would be most important to help the nurse
determine if the patient needs human immunodeficiency virus A
(HIV) testing? The current Center for Disease Control (CDC) policy is to offer
routine testing for HIV to all individuals age 13 to 64. Although
a. Patient age lifestyle, symptoms, and sexual orientation may suggest increased
b. Patient lifestyle risk for HIV infection, the goal is to test all individuals in this age
c. Patient symptoms range.
d. Patient sexual orientation
A patient who uses injectable illegal drugs asks the nurse about
B
preventing acquired immunodeficiency syndrome (AIDS). Which
Participation in needle-exchange programs has been shown to
response by the nurse is best?
decrease and control the rate of HIV infection. Cleaning drug
equipment before use also reduces risk, but it might not be con-
a. "Avoid sexual intercourse when using injectable drugs."
sistently practiced. HIV antibodies do not appear for several weeks
b. "It is important to participate in a needle-exchange program."
to months after exposure, so testing drug users would not be
c. "You should ask those who share equipment to be tested for
very effective in reducing risk for HIV exposure. It is difficult to
HIV."
make appropriate decisions about sexual activity when under the
d. "I recommend cleaning drug injection equipment before each
influence of drugs
use."
What is the most appropriate nursing intervention to help an
HIV-infected patient adhere to a treatment regimen?

a. "Set up" a drug pillbox for the patient every week. D


b. Give the patient a video and a brochure to view and read at The best approach to improve adherence to a treatment regimen
home. is to learn about the patient's life and assist with problem solving
c. Tell the patient that the side effects of the drugs are bad but that within the confines of that life.
they go away after a while.
d. Assess the patient's routines and find adherence cues that fit
into the patient's life circumstances.
A patient who is human immunodeficiency virus (HIV)-infected
has a CD4+ cell count of 400/µL. Which factor is most important for D
the nurse to determine before the initiation of antiretroviral therapy Drug resistance develops quickly unless the patient takes ART
(ART) for this patient? medications on a strict, regular schedule. In addition, drug resis-
tance endangers both the patient and the community. The other
a. HIV genotype and phenotype information is also important to consider, but patients who are
b. Patient's social support system unable to manage and follow a complex drug treatment regimen
c. Potential medication side effects should not be considered for ART
d. Patient's ability to comply with ART schedule

Which nursing action will be most useful in assisting a college


student to adhere to a newly prescribed antiretroviral therapy
D
(ART) regimen?
The best approach to improve adherence is to learn about im-
portant activities in the patient's life and adjust the ART around
a. Give the patient detailed information about possible medication
those activities. The other actions also are useful, but they will
side effects.
not improve adherence as much as individualizing the ART to the
b. Remind the patient of the importance of taking the medications
patient's schedule.
as scheduled.
c. Encourage the patient to join a support group for students who
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Exam 5: HIV/AIDS (NCLEX)
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are HIV positive.
d. Check the patient's class schedule to help decide when the
drugs should be taken.
A patient treated for human immunodeficiency virus (HIV) infec-
tion for 6 years has developed fat redistribution to the trunk, with
C
wasting of the arms, legs, and face. What instructions will the
A frequent first intervention for metabolic disorders is a change
nurse give to the patient?
in antiretroviral therapy (ART). Treatment with antifungal agents
would not be appropriate because there is no indication of fungal
a. Review foods that are higher in protein.
infection. Changes in diet or exercise have not proven helpful for
b. Teach about the benefits of daily exercise.
this problem.
c. Discuss a change in antiretroviral therapy.
d. Talk about treatment with antifungal agents.
To evaluate the effectiveness of antiretroviral therapy (ART), which
laboratory test result will the nurse review?

a. Viral load testing A


b. Enzyme immunoassay
c. Rapid HIV antibody testing
d. Immunofluorescence assay
A nurse is assessing a client for HIV. Which of the following are
risk factors associated with this virus?(Select all that apply.)

A. Perinatal exposure
ADE
B. Pregnancy
C. Monogamous sex partner
D. Older adult woman
E. Occupational exposure
The nurse is admitting a client diagnosed with protein-calorie
malnutrition secondary to AIDS. Which intervention should be the
nurse's first intervention?

1. Assess the client's body weight and ask what the client has
been able to eat.
1
2. Place in contact isolation and don a mask and gown before
entering the room.
3. Check the HCP's orders and determine what laboratory tests
will be done.
4. Teach the client about total parenteral nutrition and monitor the
subclavianIV site.
The nurse presents a seminar on HIV testing to a group of seniors
and their caregivers in an assisted living facility. Which responses
fit the Centers for Disease Control and Prevention's (CDC's) rec-
ommendations for HIV testing? (Select all that apply.)

A) ''I am 78 years old and I was treated and cured of syphilis many
years ago.''
B) ''In 1986, I received a transfusion of platelets.'' ACF
C) ''Seven years ago, I was released from a penitentiary.''
D) ''I used to smoke marijuana 30 years ago, but I have not done
any drugs since.''
E) ''I had sex with a man with a disreputable past from New York
back in the late 1960s, but I have been happily married since
1971.''
F) ''At 68, I am going to get married for the fourth time.''

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