HIV/AIDS NCLEX Questions

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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.
The patient is diagnosed with acquired immunodeficiency syn-
A. The patient is diagnosed with acquired immunodeficiency syn-
drome (AIDS).
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.
(A)
A) The dietary worker hands the disposable meal trays to the LPN
assigned to the client.
Which member of the health care team demonstrates reducing Rationale: This limits the number of health care personnel entering
the risk for infection for the client with acquired immunodeficiency the room.
syndrome (AIDS)?
Incorrect:
A) The dietary worker hands the disposable meal trays to the LPN B) The social worker encourages the client to verbalize about
assigned to the client. stressors at home.
B) The social worker encourages the client to verbalize about Rationale: Verbalizing stressors does not reduce the risk for infec-
stressors at home. tion.
C) Housekeeping thoroughly cleans and disinfects the hallways C) Housekeeping thoroughly cleans and disinfects the hallways
near the client's room. near the client's room.
D) Health care provider orders vital signs including temperature Rationale: Bathrooms, not hallways, that are cleaned at least once
every 8 hours. daily by housekeeping reduces infection. D) Health care provider
orders vital signs including temperature every 8 hours.
Rationale Vital signs, including temperature, should be taken
every 4 hours to detect potential infection.
(C)
C) ''Washing my hands and putting on a gown and gloves is what
I must do before starting care.''
Rationale: Standard precautions include whatever personal pro-
The nurse is instructing an unlicensed health care worker on the
tective equipment (PPE) is necessary for the prevention of trans-
care of the client with HIV who also has active genital herpes.
mission of HIV and genital herpes.
Which statement by the health care worker indicates effective
teaching of standard precautions?
Incorrect:
A) ''I need to know my HIV status, so I must get tested before
A) ''I need to know my HIV status, so I must get tested before
caring for any clients."
caring for any clients."
Rationale: Knowing HIV status is important for preventing trans-
B) ''Putting on a gown and gloves will cover up the itchy sores on
mission of HIV, but is not a standard precaution.
my elbows.''
B) ''Putting on a gown and gloves will cover up the itchy sores on
C) ''Washing my hands and putting on a gown and gloves is what
my elbows.''
I must do before starting care.''
Rationale: Health care workers with weeping dermatitis should not
D) ''I will wash my hands before going into the room, and then
provide direct client care regardless of the use of gown and gloves.
put on gown and gloves only for direct contact with the client's
D) ''I will wash my hands before going into the room, and then
genitals."
put on gown and gloves only for direct contact with the client's
genitals."
Rationale: Unlicensed health care workers cannot make the de-
termination of what is required for PPE or standard precaution
(B)
B) ''The other health care worker and I were out in the hallway
Which statement made to the nurse by a health care worker
discussing how we were concerned about getting HIV from our
assigned to care for the client with HIV indicates a breach of
client, so no one could hear us in the client's room.''
confidentiality and requires further education by the nurse?
Rationale: Discussing this client's illness outside the client's room
is a breach of confidentiality.
A) ''I told the family members they needed to wash their hands
when they enter and leave the room.''
Incorrect:
B) ''The other health care worker and I were out in the hallway
A) ''I told the family members they needed to wash their hands
when they enter and leave the room.'' Rationale: Instruction on
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handwashing to family members or friends is not a breach of
confidentiality. C) ''Yes, I understand the reasons why I have to
discussing how we were concerned about getting HIV from our
wear gloves when I bathe my client.''
client, so no one could hear us in the client's room.''
Rationale: This recognizes standard precautions in direct care,
C) ''Yes, I understand the reasons why I have to wear gloves when
and is not a breach of confidentiality.
I bathe my client.''
D) ''The client's spouse told me she got HIV from a blood transfu-
D) ''The client's spouse told me she got HIV from a blood trans-
sion.''
fusion.
Rationale: The health care worker assigned is relaying the con-
versation to the nurse. This is not a breach of confidentiality
B)
B) ''Always position the condom with a space at the tip of an erect
penis.''
When preparing the newly diagnosed client with HIV and signif- Rationale: This allows for the collection of semen at the tip of the
icant other for discharge, which explanation by the nurse accu- condom.
rately describes proper condom use?
Incorrect:
A) ''Condoms should be used when lesions on the penis are A) ''Condoms should be used when lesions on the penis are
present.'' present.''
B) ''Always position the condom with a space at the tip of an erect Rationale: Condoms must be used at all times with sexual activity,
penis.'' with or without the presence of lesions.
C) ''Make sure it fits loosely to allow for penile erection.'' C) ''Make sure it fits loosely to allow for penile erection.''
D) ''Use adequate lubrication such as petroleum jelly.'' Rationale: Condoms should be applied on an erect penis and
should fit snugly, leaving space without air at the tip.
D) ''Use adequate lubrication such as petroleum jelly.''
Rationale: Lubricants should be water-based only.
-(A, C, F)
A) ''I am 78 years old and I was treated and cured of syphilis many
years ago.''
Rationale: People who have had sexually transmitted diseases
should be tested for HIV.
C) ''Seven years ago, I was released from a penitentiary.''
The nurse presents a seminar on HIV testing to a group of seniors
Rationale: HIV testing is recommended for people who are or have
and their caregivers in an assisted living facility. Which responses
been in jails or prisons.
fit the Centers for Disease Control and Prevention's (CDC's) rec-
F) ''At 68, I am going to get married for the fourth time.''
ommendations for HIV testing? (Select all that apply.)
Rationale: People who are planning to get married should be
tested for HIV.
A) ''I am 78 years old and I was treated and cured of syphilis many
years ago.''
Incorrect:
B) ''In 1986, I received a transfusion of platelets.''
B) ''In 1986, I received a transfusion of platelets.''
C) ''Seven years ago, I was released from a penitentiary.''
Rationale: People who received blood transfusions between 1978
D) ''I used to smoke marijuana 30 years ago, but I have not done
and 1985 should be tested for HIV.
any drugs since.''
D) ''I used to smoke marijuana 30 years ago, but I have not done
E) ''I had sex with a man with a disreputable past from New York
any drugs since.''
back in the late 1960s, but I have been happily married since
Rationale: HIV testing is recommended only for injection drug
1971.''
users.
F) ''At 68, I am going to get married for the fourth time.''
E) ''I had sex with a man with a disreputable past from New York
G) ''Downtown was where I picked up the best hookers back in the
back in the late 1960s, but I have been happily married since
1950s.'
1971.''
Rationale: AIDS cases were extremely rare prior to the 1970s.
G) ''Downtown was where I picked up the best hookers back in the
1950s.''
Rationale: The current AIDS pandemic started in the mid to late
1970s.
-(C, D, F, G)

C) Change the decorations in the home according to the season.

Which interventions does the home health nurse teach to family Rationale: Seasonal decorations in the home helps with maintain-
members to reduce confusion in the client diagnosed with AIDS ing orientation.
dementia? (Select all that apply.) D) Put the bed close to the window.
Rationale: This allows the client to visualize seasonal and weather
changes and assists in orientation.
F) Ask the client when he or she wants to shower or bathe.
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Rationale: Involving the client in planning the daily schedule helps
with orientation.
G) Mark off the days of the calendar, leaving open the current date.
Rationale: Using calendars and crossing off past dates helps with
A) Report any behavior changes. orientation.
B) Use the Glasgow Coma Scale on a daily basis.
C) Change the decorations in the home according to the season. Incorrect:
D) Put the bed close to the window. A) Report any behavior changes.
E) Write out all instructions and have the client read them over Rationale: This does not reduce confusion.
before performing a task. B) Use the Glasgow Coma Scale on a daily basis.
F) Ask the client when he or she wants to shower or bathe. Rationale: This assessment tool is used by the home health nurse.
G) Mark off the days of the calendar, leaving open the current E) Write out all instructions and have the client read them over
date. before performing a task.
H) For continuity, the primary caregiver should be the only person Rationale: Instructions should be kept short, simple, and verbal.
reorienting the client. H) For continuity, the primary caregiver should be the only person
reorienting the client.
Rationale: Everyone caring for the client should be involved in
reorientation methods.
(B)
B) ''Is there somewhere private in the home we can go and talk?''
Rationale: A nonthreatening approach initially to find out whether
the client has informed family members or desires privacy is very
important.
The home health nurse is making an initial home visit to the client
currently living with family members after being hospitalized with Incorrect:
pneumonia and newly diagnosed with AIDS. Which statement by A) ''Do you think that I could post a sign on your bedroom door for
the nurse best acknowledges the client's fear of discovery by his everyone about the need to wash their hands?''
family? Rationale: The client has a right to privacy and can make the
decision whether to post handwashing signs. Caution signs invade
A) ''Do you think that I could post a sign on your bedroom door for the client's right to privacy.
everyone about the need to wash their hands?'' C) ''I hope that all of your family members know about your disease
B) ''Is there somewhere private in the home we can go and talk?'' and how you need to be protected, since you have been so sick.''
C) ''I hope that all of your family members know about your disease Rationale: Protection from infection is important, but this approach
and how you need to be protected, since you have been so sick.'' is not respectful of the client's right to privacy.
D) ''It is your duty to protect your family members from getting D) ''It is your duty to protect your family members from getting
AIDS.'' AIDS.''
Rationale: This statement by the nurse is rather intimidating. It is
the client's right whether he wants to make the decision to inform
or not inform family members about their illness. However, this
''nonaction'' could be grounds for a lawsuit if the client were to
infect someone inadvertently.
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- )A
periencing shortness of breath related to Pneumocystis jiroveci - Providing supportive care with hygiene needs as needed re-
pneumonia. Which measure should the nurse include in the plan duces the client's physical and emotional energy demands and
of care to assist the client in performing activities of daily living?
conserves energy resources for other functions such as breathing.
Options B, C, and D are important interventions for the client with
a) provide supportive care with hygiene needs AIDS but do not address the subject of activities of daily living.
b) provide meals and snacks with high-protein, high calorie, and Option B will assist the client in maintaining appropriate weight
high-nutritional value and proper nutrition. Option C will assist the client in tolerating
c) provide small, frequent meals meals better. Option D will decrease the client's risk of infection.

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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counseling session, the nurse tells the client which of the follow-
ing?
A
a) the test should be repeated in 6 months - A negative test result indicates that no HIV antibodies were
b) this ensures that the client is not infected with the HIV virus detected in the blood sample. A repeated test in 6 months is
c) the client no longer needs to protect himself from sexual part- recommended because false-negative test results have occurred
ners early in the infection. Options B, C, and D are incorrect.
d) the client probably has immunity to the acquired immunodefi-
ciency virus
A client is diagnosed with late stage human immunodeficiency
virus (HIV), and the client and family are extremely upset about
the diagnosis. The priority psychosocial nursing intervention for
the client and family is to:
C
a) tell the client and family to stop smoking because it will predis- - The priority psychosocial nursing intervention for the client and
pose the client to respiratory infections family is to encourage the client and family to discuss their feelings
b) tell the client and family that raw or improperly washed foods about the disease. Options A, B, and D identify physiological not
can produce microbes psychosocial concerns.
c) encourage the client and family to discuss their feelings about
the disease
d) advise the client to avoid becoming pregnant because of the
risk of transmission of the infection
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
Which intervention should the nurse implement when caring for a
client diagnosed with Pneumocystis carinii pneumonia related to
acquired immunodeficiency syndrome who is crying over the loss C
of friends and family members because they will not talk to him rying is evidence that the client is beginning to express concerns
anymore? to the nurse. In response, active, nonjudgmental listening would
most appropriate because is aids in the development of a trusting
A. Advising the client not to worry, and telling him everything will relationship. Advising the client not to worry or saying that every-
be alright thing will be alright provides false reassurance, which does not
B. Asking the health care provider for a psychiatric consult to help the client cope. Further assessment is needed to determine
assess the client's mental functioning whether a psychiatric consult should be considered. Telling the
C. Sitting down and listening to the client's concerns and frustra- client that the friends were not true friends discounts the client's
tions feeling and hinders the development of a therapeutic relationship.
D. Telling the client that the friends probably were not true friends
anyway
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
B
notices a large, red wheal on the client's arm, coughing, and expi-
Immediately on noticing the client's sign and symptoms, the nurse
ratory wheezing. Which intervention should the nurse implement
would determine that the client is experiencing anaphylaxis to
first?
the injection. The first action is to give 0.2 to 0.5 ml of 1:1,000

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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
A
diagnosis focuses attention on the client's most immediate prob-
Based on the client's assessment findings, the most immediate
lem?
problem is dehydration because of chronic diarrhea. The nursing
diagnosis of deficient fluid volume is the priority, and interventions
A. Deficient fluid volume related to diarrhea and abnormal fluid
are geared to improving the client's fluid status. Although imbal-
loss
anced nutrition, disturbed thought processes, and diarrhea are
B. Imbalanced nutrition: less than body requirements related to
involved, they assume a lower priority at this time.
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
D
weight loss, which dietary instruction would be included in the
Dietary instructions should include the need for a high-protein,
teaching plan?
high-calorie diet. The patient should be taught to eat small, fre-
quent meals and include low-microbial foods, such as pasteurized
A. "Follow a low-protein, high-carbohydrate diet."
dairy products, washed and peeled fruits and vegetables, and
B. "Eat three large meals per day."
well-cooked meats.
C. "Include unpasteurized dairy products in the diet."
D. "Follow a high-protein, high-calorie diet.
A client with acquired immunodeficiency syndrome has a respira-
tory infection from Pneumocystis jiroveci and a nursing diagnosis B
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:
C
Dermatologic human papillomavirus (HPV) infection in HIV pa-
A. Cough, evening fever, night sweats, weight loss and anemia
tients manifests as both anogenital and nongenital skin disease.
B. Persistent fever, tachypnoea, hypoxia, cyanosis and tachycar-
Cutaneous HPV-related disease in nongenital skin is also in-
dia.
creased in HIV-positive patients, in the form of benign com-
C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina
mon warts, epidermodysplasia verruciformis-like skin lesions, and
and penis
nonmelanoma skin cancers.
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.

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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:
D
Eradication of HIV infection cannot be achieved with available
A. Reduce HIV-associated morbidity and prolong the duration and
antiretroviral (ARV) regimens even when new, potent drugs are
quality of survival
added to a regimen that is already suppressing plasma viral load
B. Restore and preserve immunologic function
below the limits of detection of commercially available assays.
C. Maximally and durably suppress plasma HIV viral load
D. Elimination of HIV entirely from the body
Which is the most common HIV-related neurological complica-
C
tion?
Toxoplasmosis is the most common central nervous system in-
fection in patients with the acquired immunodeficiency syndrome
A. Tuberculosis
(AIDS) who are not receiving appropriate prophylaxis. This infec-
B. Kaposi's sarcoma
tion has a worldwide distribution and is caused by the intracellular
C. Toxoplasmosis
protozoan parasite, Toxoplasma gondii.
D. Lymphoma
Ms. X is diagnosed with acquired immunodeficiency syndrome
(AIDS). The nurse caring for this patient is aware that for a patient
to be diagnosed with HIV she should have which condition?
Answer C. The three criteria for a client to be diagnosed with AIDS
are the following:
a. Infection of HIV, have a CD4+ T-cell count of 500 cells/microliter,
• HIV positive
history of acute HIV infection
• CD4+ T-cell count below 200 cells/microliter
b. Infection with Tuberculosis, HIV and cytomegalovirus
• Have one or more specific conditions that include acute infection
c. Infection of HIV, have a CD4+ T-cell count of >200 cells/micro-
of HIV
liter, history of acute HIV infection
d. Infection with HIV, history of HIV infection and T-cell count below
200 cells/microliter
The nurse observes precaution in caring for Mr. X as HIV is most
easily transmitted in:
Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EAS-
ILY transmitted in blood, semen and vaginal secretions. However,
a. Vaginal secretions and urine
it has been noted to be found in fecal materials, urine, saliva, tears
b. Breast milk and tears
and breast milk.
c. Feces and saliva
d. Blood and semen
Nurse Jaja is giving an injection to Ms. X. After giving an injection,
the nurse accidentally stuck her finger with the needle when the
client became very agitated. To determine if the nurse became
infected with HIV when is the best time to test her for HIV anti- Answer A. Keyword: BEST TIME. Rationale: To determine if a
bodies? preexisting infection is present a test should be done immediately
and is repeated again in 3 months time (12 weeks) to detect
a. Immediately and repeat the test after 12 weeks seroconversion as a result of the needle stick.
b. Immediately and repeat the test after 4 weeks
c. After a week and repeat the test in 4 months
d. After a weeks and repeat the test in 6 months
The blood test first used to identify a response to HIV infection is:
Answer B. Keyword: FIRST. Rationale: The ELISA test is the first
screening test for HIV. A Western blot test confirms a positive
a. Western blot
ELISA test. Other blood tests that support the diagnosis of HIV
b. ELISA test
include CD4+ and CD8 + counts, CBC, immunoglobulin levels, p24
c. CD4+ T-cell count
antigen assay, and quantitative ribonucleic acid assays.
d. CBC
What is the main reason why it is difficult to develop a vaccine
Answer B. Keyword: MAIN REASON. Rationale: HIV was identified
against HIV?
in 1983, thus, A is incorrect. By 1988 two strains of HIV existed,
HIV-1 and HIV-2. Viruses spread rapidly and mature easily but
a. HIV is still unknown to human
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b. HIV mutates easily
these factors don't affect the potential for development against HIV.
c. HIV spreads rapidly throughout the body
Mutating too easily makes it hard to create a vaccine against it.
d. HIV matures easily
Human Immunodeficiency virus belongs to which classifications?

a. Rhabdovirus Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid

b. Rhinovirus dependent reverse transcriptase.
c. Retrovirus
d. Rotavirus
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. "I will need to isolate any tissues I use so as not to infect my
family."
A. "I will need to isolate any tissues I use so as not to infect my
family." HIV is not spread casually. The virus cannot be transmitted
B. "I will notify all of my sexual partners so they can get tested for through hugging, dry kissing, shaking hands, sharing eating uten-
HIV." sils, using toilet seats, or attending school with an HIV-infected
C. "Unprotected sexual contact is the most common mode of person. It is not transmitted through tears, saliva, urine, emesis,
transmission." sputum, feces, or sweat.
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 C. A sharp decrease in the patient's CD4+ count
with HIV for several years. Which assessment finding most clearly
indicates an acute exacerbation of the disease? A decrease in CD4+ count signals an exacerbation of the severity
of HIV. Polycythemia is not characteristic of the course of HIV. A
A. A new onset of polycythemia patient's WBC count is very unlikely to suddenly increase, with
B. Presence of mononucleosis-like symptoms decreases being typical. Mononucleosis-like symptoms such as
C. A sharp decrease in the patient's CD4+ count malaise, headache, and fatigue are typical of early HIV infection
D. A sudden increase in the patient's WBC count and seroconversion.
C. "Treatment with antiretroviral therapy will decrease the baby's
A pregnant woman who was tested and diagnosed with HIV
chance of HIV infection."
infection is very upset. What should the nurse teach this patient
about her baby's risk of being born with HIV infection?
On average, 25% of infants born to women with untreated HIV will
be born with HIV. The risk of transmission is reduced to less than
A. "The baby will probably be infected with HIV."
2% if the infected pregnant woman is treated with antiretroviral
B. "Only an abortion will keep your baby from having HIV."
therapy. Duration and frequency of contact with the HIV organism
C. "Treatment with antiretroviral therapy will decrease the baby's
is one variable that influences whether transmission of HIV occurs.
chance of HIV infection."
Volume, virulence, and concentration of the organism as well
D. "The duration and frequency of contact with the organism will
as host immune status are variables related to transmission via
determine if the baby gets HIV infection."
blood, semen, vaginal secretions, or breast milk.
B. Viral replication will be inhibited.
A 25-year-old male patient has been diagnosed with HIV. The
patient does not want to take more than one antiretroviral drug. The major advantage of using several classes of antiretroviral
What reasons can the nurse tell the patient about for taking more drugs is that viral replication can be inhibited in several ways,
than one drug? making it more difficult for the virus to recover and decreasing
the likelihood of drug resistance that is a major problem with
A. Together they will cure HIV. monotherapy. Combination therapy also delays disease progres-
B. Viral replication will be inhibited. sion and decreases HIV symptoms and opportunistic diseases.
C. They will decrease CD4+ T cell counts. HIV cannot be cured. CD4+ T cell counts increase with therapy.
D. It will prevent interaction with other drugs There are dangerous interactions with many antiretroviral drugs
and other commonly used drugs.

C. Use condoms for risk-reducing sexual relations.

The woman is afraid she may get HIV from her bisexual husband. D. Take emtricitabine and tenofovir (Truvada) regularly.
What should the nurse include when teaching her about preex- E. Have regular HIV testing for herself and her husband.
posure prophylaxis (select all that apply)?
Using male or female condoms, having monthly HIV testing for
A. Take fluconazole (Diflucan). the patient and her husband, and the woman taking emtricitabine
B. Take amphotericin B (Fungizone). and tenofovir regularly has shown to decrease the infection of
C. Use condoms for risk-reducing sexual relations. heterosexual women having sex with a partner who participates
in high-risk behavior. Fluconazole and amphotericin B are taken
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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-
B. Combination antiretroviral therapy
itive patient. After reporting this, what care should this nurse first
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 A. Delaying disease progression
exposure to infectious agents; keeping up to date with vaccines;
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
B. Assessment of sexual behavior
nursing measures will help identify the need for further assess-
D. Assessment of drug and syringe use
ment of the cause of this patient's manifestations (select all that
apply)?
With these symptoms, assessing this patient's sexual behavior
and possible exposure to shared drug equipment will identify
A. Assessment of lung sounds
if further assessment for the HIV virus should be made or the
B. Assessment of sexual behavior
manifestations are from some other illness (e.g., lung sounds and
C. Assessment of living conditions
living conditions may indicate further testing for TB).
D. Assessment of drug and syringe use
E. Assessment of exposure to an ill person
Transmission of HIV from an infected individual to another most
commonly occurs as a result of

a. unprotected anal or vaginal sexual intercourse. Correct answer: a

b. low levels of virus in the blood and high levels of CD4+ T cells. Rationale: Unprotected sexual contact (semen, vaginal secre-
c. transmission from mother to infant during labor and delivery and tions, or blood) with a partner
breastfeeding.
d. sharing of drug-using equipment, including needles, syringes,
pipes, and straws
During HIV infection

a. the virus replicates mainly in B-cells before spreading to CD4+

Correct answer: c
T cells.
b. infection of monocytes may occur, but antibodies quickly destroy
Rationale: Immune dysfunction in HIV disease is caused predom-
these cells.
inantly by damage to and destruction of CD4+ T cells (i.e., T helper
c. the immune system is impaired predominantly by the eventual
cells or CD4+ T lymphocytes)
widespread destruction of CD4+ T cells.
d. a long period of dormancy develops during which HIV cannot
be found in the blood and there is little viral replication

Which statements accurately describe HIV infection (select all that

apply)?
Correct answers: a, b, c
a. Untreated HIV infection has a predictable pattern of progres-
Rationale: The typical course of untreated HIV infection follows
sion.
a predictable pattern. However, treatment can significantly alter
b. Late chronic HIV infection is called acquired immunodeficiency
this pattern, and disease progression is highly individualized. Late
syndrome (AIDS).
chronic infection is another term for acquired immunodeficiency
c. Untreated HIV infection can remain in the early chronic stage
for a decade or more.
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d. Untreated HIV infection usually remains in the early chronic
stage for 1 year or less. syndrome (AIDS). The median interval between untreated HIV
e. Opportunistic diseases occur more often when the CD4+ T cell infection and a diagnosis of AIDS is about 11 years.
count is high and the viral load is low
A diagnosis of AIDS is made when an HIV-infected patient has
Correct answer: a
a. a CD4+ T cell count below 200/µL.
b. a high level of HIV in the blood and saliva. Rationale: AIDS is diagnosed when an individual with HIV infection
c. lipodystrophy with metabolic abnormalities. meets one of several criteria; one criterion is a CD4+ T cell count
d. oral hairy leukoplakia, an infection caused by Epstein-Barr below 200 cells/L. Other criteria are listed in Table 15-9.
virus.
Screening for HIV infection generally involves
Correct answer: c
a. laboratory analysis of blood to detect HIV antigen.
b. electrophoretic analysis for HIV antigen in plasma. Rationale: The most useful screening tests for HIV detect
c. laboratory analysis of blood to detect HIV antibodies. HIV-specific antibodies
d. analysis of lymph tissues for the presence of HIV RNA.
Antiretroviral drugs are used to Correct answer: b

a. cure acute HIV infection. Rationale: The goals of drug therapy in HIV infection are to (1)
b. decrease viral RNA levels. decrease the viral load, (2) maintain or raise CD4+ T cell counts,
c. treat opportunistic diseases. and (3) delay onset of HIV infection-related symptoms and oppor-
d. decrease pain and symptoms in terminal disease. tunistic diseases.
Opportunistic diseases in HIV infection
Correct answer: c
a. are usually benign.
Rationale: Management of HIV infection is complicated by the
b. are generally slow to develop and progress.
many opportunistic diseases that can develop as the immune
c. occur in the presence of immunosuppression.
system deteriorates (see Table 15-10).
d. are curable with appropriate drug interventions.
Which statement about metabolic side effects of ART is true
Correct answers: b, c, d
(select all that apply)?
Rationale: Some HIV-infected patients, especially those who have
a. These are annoying symptoms that are ultimately harmless.
been infected and have received ART for a long time, develop a set
b. ART-related body changes include central fat accumulation and
of 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
Which strategy can the nurse teach the patient to eliminate the Correct answer: a
risk of HIV transmission? Rationale: Access to sterile equipment is an important risk-elim-
ination tactic. Some communities have needle and syringe ex-
a. Using sterile equipment to inject drugs change programs (NSEPs) that provide sterile equipment to users
b. Cleaning equipment used to inject drugs in exchange for used equipment. Cleaning equipment before use
c. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy is a risk-reducing activity. It decreases the risk when equipment
d. Using latex or polyurethane barriers to cover genitalia during is shared, but it takes time, and a person in drug withdrawal may
sexual contact have difficulty cleaning equipment.
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. Correct answer: d
b. Give the patient a video and a brochure to view and read at Rationale: The best approach to improve adherence to a treatment
home. regimen is to learn about the patient's life and assist with problem
c. Tell the patient that the side effects of the drugs are bad but that solving 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.

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 HIV/AIDS NCLEX Questions
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The nurse is providing postoperative care for a 30-year-old female
patient after an appendectomy. The patient has tested positive for
d. Standard precautions
human immunodeficiency virus (HIV). What type of precautions
Standard precautions are indicated for prevention of transmission
should the nurse observe to prevent the transmission of this
of HIV to the health care worker. HIV is not transmitted by casual
disease?
contact or respiratory droplets. HIV may be transmitted through
sexual intercourse with an infected partner, exposure to HIV-in-
a. Droplet precautions
fected blood or blood products, and perinatal transmission during
b. Contact precautions
pregnancy, at delivery, or though breastfeeding.
c. Airborne precautions
d. Standard precautions
A 52-year-old female patient was exposed to human immunod- d. Flu-like symptoms such as fever, sore throat, swollen lymph
eficiency virus (HIV) 2 weeks ago through sharing needles with glands, nausea, or diarrhea
other substance users. What symptoms will the nurse teach the
patient to report that would indicate the patient has developed an Clinical manifestations of an acute infection with HIV include
acute HIV infection? flu-like symptoms between 2 to 4 weeks after exposure. Early
chronic HIV infection clinical manifestations are either asympto-
a. Cough, diarrhea, headaches, blurred vision, muscle fatigue matic or include fatigue, headache, low-grade fever, night sweats,
d. Night sweats, fatigue, fever, and persistent generalized lym- and persistent generalized lympadenopathy. Intermediate chronic
phadenopathy HIV infection clinical manifestations include candidal infections,
c. Oropharyngeal candidiasis or thrush, vaginal candidal infection, shingles, oral or genital herpes, bacterial infections, Kaposi sar-
or oral or genital herpes coma, or oral hairy leukoplakia. Late chronic HIV infection or ac-
d. Flu-like symptoms such as fever, sore throat, swollen lymph quired immunodeficiency syndrome (AIDS) includes opportunistic
glands, nausea, or diarrhea diseases (infections and cancer).
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-
c. Increased CD4+ T cell count
ications have been effective?
Antiretroviral therapy is effective if there are decreased viral loads
a. Increased viral load
and increased CD4+ T cell counts.
b. Decreased neutrophil count
c. Increased CD4+ T cell count
d. Decreased white blood cell count
A 62-year-old patient has acquired immunodeficiency syndrome
(AIDS), and the viral load is reported as undetectable. What
patient teaching should be provided by the nurse related to this
a. The patient has the virus present and can transmit the infection
laboratory study result?
to others.
a. The patient has the virus present and can transmit the infection
In human immunodeficiency virus (HIV) infections, viral loads are
to others.
reported as real numbers of copies/¼ L or as undetectable. "Unde-
b. The patient is not able to transmit the virus to others through
tectable" indicates that the viral load is lower than the test is able
sexual contact.
to report. "Undetectable" does not mean that the virus has been
c. The patient will be prescribed lower doses of antiretroviral
eliminated from the body or that the indivi
medications for 2 months.
d. The syndrome has been cured, and the patient will be able to
discontinue all medications.
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? ANS: A
After an initial positive EIA test, the EIA is repeated before more
a. "The EIA test will need to be repeated to verify the results." specific testing such as the Western blot is done. Viral cultures are
b. "A viral culture will be done to determine the progression of the not usually part of HIV testing. It is not appropriate for the nurse
disease." to predict the time frame for AIDS development. The Western blot
c. "It will probably be 10 or more years before you develop ac- tests for HIV antibodies, not for AIDS.
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
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 HIV/AIDS NCLEX Questions
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by the Centers for Disease Control and Prevention (CDC), which
statement by the nurse is correct?

a. "The patient meets the criteria for a diagnosis of an acute HIV

ANS: C
infection."
Development of PCP meets the diagnostic criterion for AIDS. The
b. "The patient will be diagnosed with asymptomatic chronic HIV
other responses indicate earlier stages of HIV infection than is
infection."
indicated by the PCP 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
important at this time?
ANS: C
After an initial positive antibody test, the next step is retesting to
a. Teach the patient about the medications available for treatment.
confirm the results. A patient who is anxious is not likely to be
b. Inform the patient how to protect sexual and needle-sharing
able to take in new information or be willing to disclose information
partners.
about HIV status of other individuals.
c. Remind the patient about the need to return for retesting to
verify the results.
d. Ask the patient to notify individuals who have had risky contact
with the patient.
A patient who is diagnosed with acquired immunodeficiency syn-
drome (AIDS) tells the nurse, "I feel obsessed with thoughts about ANS: D
dying. Do you think I am just being morbid?" Which response by More assessment of the patient's psychosocial status is needed
the nurse is best? before taking any other action. The statements, "Thinking about
dying will not improve the course of AIDS" and "It is important
a. "Thinking about dying will not improve the course of AIDS." to focus on the good things in life" discourage the patient from
b. "It is important to focus on the good things about your life now." sharing any further information with the nurse and decrease the
c. "Do you think that taking an antidepressant might be helpful to nurse's ability to develop a trusting relationship with the patient.
you?" Although antidepressants may be helpful, the initial action should
d. "Can you tell me more about the kind of thoughts that you are be further assessment of the patient's feelings.
having?"
A pregnant woman with a history of asymptomatic chronic human
immunodeficiency virus (HIV) infection is seen at the clinic. The
patient states, "I am very nervous about making my baby sick."
Which information will the nurse include when teaching the pa-
ANS: B
tient?
Only 25% of infants born to HIV-positive mothers develop HIV
infection, even when the mother does not use ART during preg-
a. The antiretroviral medications used to treat HIV infection are
nancy. The percentage drops to 2% when ART is used. Perinatal
teratogenic.
transmission can occur at any stage of HIV infection (although it is
b. Most infants born to HIV-positive mothers are not infected with
less likely to occur when the viral load is lower). ART can safely be
the virus.
used in pregnancy, although some ART drugs should be avoided.
c. Because she is at an early stage of HIV infection, the infant will
not contract HIV.
d. It is likely that her newborn will become infected with HIV unless
she uses antiretroviral therapy (ART)
Which patient exposure by the nurse is most likely to require
postexposure prophylaxis when the patient's human immunode-
ficiency virus (HIV) status is unknown? ANS: A
Puncture wounds are the most common means for workplace
a. Needle stick with a needle and syringe used to draw blood transmission of blood-borne diseases, and a needle with a hollow
b. Splash into the eyes when emptying a bedpan containing stool bore that had been contaminated with the patient's blood would
c. Contamination of open skin lesions with patient vaginal secre- be a high-risk situation. The other situations described would be
tions much less likely to result in transmission of the virus.
d. Needle stick injury with a suture needle during a surgical pro-
cedure

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