8. In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission?
a. Transmission to women OR to men during heterosexual intercourse b. Hollow-bore needle used for vascular access OR used for IM injection c. First 2 to 4 weeks of infection OR 1 year after infection
d. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy (ART) OR HIV- infected mothers using no therapy
e. A splash exposure of HIV-infected blood on skin with an open lesion OR a needle-stick exposure to HIV-infected blood
9. Place the following events of HIV infection of a cell in sequence from 1 (first) to 7 (last).
_____ a. The release of reverse transcriptase converts HIV RNA into a single strand of DNA.
_____ b. Viral DNA is spliced into cell genome using the enzyme integrase.
_____ c. HIV binds with CD4+ T cell protein receptors on the outside of the cell (fusion).
_____ d. Viral DNA directs the cell to replicate infected daughter cells and makes more HIV.
_____ e. Viral RNA enters the host CD4+ T cell.
_____ f. Long strands of viral RNA are cut in the presence of protease and released before CD4+ T cell destruction.
_____ g. Single-stranded viral DNA replicates into double-stranded DNA.
10. Indicate below which event (from Question 9) of HIV infection of a cell is controlled by each drug. This would also be the mechanism of action of the drug.
Drug Mechanism of Action
Entry inhibitors
Reverse transcriptase inhibitors Integrase inhibitors Protease inhibitors
11. What is a primary reason that the normal immune response fails to contain the HIV infection?
a. CD4+ T cells become infected with HIV and are destroyed.
b. The virus inactivates B cells, preventing the production of HIV antibodies.
c. Natural killer cells are destroyed by the virus before the immune system can be activated.
d. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues.
12. Which characteristic corresponds with the acute stage of HIV infection?
a. Burkitt's lymphoma
b. Temporary fall of CD4+ T cells c. Persistent fevers and night sweats d. Pneumocystis jiroveci pneumonia
13. Which finding supports the diagnosis of acquired immunodeficiency syndrome (AIDS) in the individual with HIV?
a. Flu-like symptoms b. Oral hairy leukoplakia c. CD4+ T cells 200-500/µL d. Cytomegalovirus retinitis
14. Why do opportunistic diseases develop in an individual with AIDS?
a. They are side effects of drug treatment of AIDS.
b. They are sexually transmitted to individuals during exposure to HIV.
c. They are characteristic in individuals with stimulated B and T lymphocytes.
d. These infections or tumors occur in a person with an incompetent immune system.
15. Which characteristics describe Pneumocystis jiroveci infection, an opportunistic disease that can be associated with HIV?
a. May cause fungal meningitis b. Diagnosed by lymph node biopsy
c. Pneumonia with dry, nonproductive cough
d. Viral retinitis, stomatitis, esophagitis, gastritis, or colitis
16. Which opportunistic disease associated with AIDS is characterized by vascular lesions of the skin, mucous membranes, and viscera?
a. Kaposi sarcoma b. Candida albicans
c. Herpes simplex type 1 infection d. Varicella-zoster virus infection
17. A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is most important for the nurse to do?
a. Ask the patient to identify all sexual partners.
b. Determine when the patient thinks exposure to HIV occurred.
c. Explain that all test results must be repeated at least twice to be valid.
d. Discuss prevention practices to prevent transmission of the HIV to others.
18. The “rapid” HIV antibody testing is performed on a patient at high risk for HIV infection. What should the nurse explain about this test?
a. The test measures the activity of the HIV and reports viral loads as real numbers.
b. This test is highly reliable, and in 5 minutes the patient will know if HIV infection is present.
c. If the results are positive, another blood test and a return appointment for results will be necessary.
d. This test detects drug-resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs.
19. Treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI) is prescribed for a patient with HIV infection. The patient asks why so many drugs are necessary for treatment. What should the nurse explain as the primary rationale for combination therapy?
a. Cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination.
b. Combinations of antiretroviral drugs decrease the potential for development of antiretroviral- resistant HIV variants.
c. Side effects of the drugs are reduced when smaller doses of three different drugs are used rather than large doses of one drug.
d. When CD4+ T-cell counts are <500/µL, a combination of drugs that have different actions is more effective in slowing HIV growth.
20. What is one of the most significant factors in determining when to start ART in a patient with HIV infection?
a. Whether the patient has high levels of HIV antibodies b. Confirmation that the patient has contracted HIV infection
c. The patient's readiness to commit to a complex, lifelong, uncomfortable drug regimen d. Whether the patient has a support system to help manage the treatment regimen and costs 21. After teaching a patient with HIV infection about using antiretroviral drugs, the nurse
recognizes that further teaching is needed when the patient says
a. “I should never skip doses of my medication, even if I develop side effects.”
b. “If my viral load becomes undetectable, I am no longer able to transmit HIV.”
c. “I should not use any over-the-counter drugs without checking with my HCP.”
d. “If I develop a headache with nausea and vomiting, I should report it to my HCP.”
22. Prophylactic measures that are routinely used as early as possible in HIV infection to prevent
opportunistic and debilitating secondary problems include administration of a. isoniazid to prevent tuberculosis.
b. zoster virus vaccination to prevent shingles.
c. trimethoprim/sulfamethoxazole for toxoplasmosis.
d. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B.
23. Priority Decision: A patient identified as HIV antibody positive 1 year ago manifests
asymptomatic HIV infection but does not want to start ART at this time. What is the best nursing intervention for the patient at this stage of illness?
a. Assist with end-of-life issues
b. Provide care during acute exacerbations c. Provide physical care for chronic diseases d. Teach the patient about immune enhancement
24. Identify at least three methods to eliminate or reduce the risk for HIV transmission related to sexual intercourse and drug use and two methods to reduce the risk for perinatal transmission.
Sexual Intercourse Drug Use Perinatal Transmission
a. a. a.
b. b. b.
c. c.
25. Priority Decision: A patient with advanced AIDS has a nursing diagnosis of impaired memory related to neurologic changes. In planning care for the patient, what should the nurse set as the highest priority?
a. Maintain a safe patient environment
b. Provide a quiet, nonstressful environment to avoid overstimulation c. Use memory cues such as calendars and clocks to promote orientation
d. Provide written instructions of directions to promote understanding and orientation
Case Study
HIV Infection
(©Image Source Pink/Image Source/Thinkstock)
Patient Profile
A.K., a 28-yr-old single man, is seen at a health clinic for flu-like symptoms. He is worried that he may have HIV.
Subjective Data
• He states that he has a history of multiple sex partners
• Vague symptoms of fatigue and headache
• Reports occasional night sweats Objective Data
• Tests positive for HIV antibody
• Temp: 100° F (37.8° C)
• Enlarged cervical and femoral lymph nodes
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. Priority Decision: What are the priority counseling activities that should be performed by the nurse during A.K.'s visit?
2. A.K.'s CD4+ T cell count is 650/µL. What stage of HIV infection is he most likely experiencing?
3. What additional diagnostic tests may be performed at this visit?
4. What prophylactic treatments should be used at this time to prevent the development of opportunistic diseases?
5. The HCP encourages A.K. to consider starting combination ART. What can the nurse tell A.K.
about the expected effect of this therapy?
6. If A.K. does not respond to treatment with an increased CD4+ T cell count and a decreased viral load, what tests could be used to identify resistance to the antiretroviral agents?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?