HIV/AIDS Nclex Questions

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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 C) ''Washing my hands and putting on a gown and gloves is what
caring for any clients." I must do before starting care.''
B) ''Putting on a gown and gloves will cover up the itchy sores on Rationale: Standard precautions include whatever personal pro-
my elbows.'' tective equipment (PPE) is necessary for the prevention of trans-
C) ''Washing my hands and putting on a gown and gloves is what mission of HIV and genital herpes.
I must do before starting care.''
D) ''I will wash my hands before going into the room, and then
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?
(B)
A) ''I told the family members they needed to wash their hands
B) ''The other health care worker and I were out in the hallway
when they enter and leave the room.''
discussing how we were concerned about getting HIV from our
B) ''The other health care worker and I were out in the hallway
client, so no one could hear us in the client's room.''
discussing how we were concerned about getting HIV from our
Rationale: Discussing this client's illness outside the client's room
client, so no one could hear us in the client's room.''
is a breach of confidentiality.
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?
B)
B) ''Always position the condom with a space at the tip of an erect
A) ''Condoms should be used when lesions on the penis are
penis.''
present.''
Rationale: This allows for the collection of semen at the tip of the
B) ''Always position the condom with a space at the tip of an erect
condom.
penis.''
C) ''Make sure it fits loosely to allow for penile erection.''
D) ''Use adequate lubrication such as petroleum jelly.''
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- (A, C, F)
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.''
A) ''I am 78 years old and I was treated and cured of syphilis many Rationale: People who have had sexually transmitted diseases
years ago.'' should be tested for HIV.
B) ''In 1986, I received a transfusion of platelets.'' C) ''Seven years ago, I was released from a penitentiary.''
C) ''Seven years ago, I was released from a penitentiary.'' Rationale: HIV testing is recommended for people who are or have
D) ''I used to smoke marijuana 30 years ago, but I have not done been in jails or prisons.
any drugs since.'' 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 Rationale: People who are planning to get married should be
back in the late 1960s, but I have been happily married since tested for HIV.
1971.''
F) ''At 68, I am going to get married for the fourth time.''
Which interventions does the home health nurse teach to family (C, D, F, G)
members to reduce confusion in the client diagnosed with AIDS
dementia? (Select all that apply.) C) Change the decorations in the home according to the season.
Rationale: Seasonal decorations in the home helps with maintain-
A) Report any behavior changes. ing orientation.
B) Use the Glasgow Coma Scale on a daily basis. D) Put the bed close to the window.
C) Change the decorations in the home according to the season. Rationale: This allows the client to visualize seasonal and weather
D) Put the bed close to the window. changes and assists in orientation.
E) Write out all instructions and have the client read them over F) Ask the client when he or she wants to shower or bathe.
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before performing a task.
Rationale: Involving the client in planning the daily schedule helps
F) Ask the client when he or she wants to shower or bathe.
with orientation.
G) Mark off the days of the calendar, leaving open the current
G) Mark off the days of the calendar, leaving open the current date.
date.
Rationale: Using calendars and crossing off past dates helps with
H) For continuity, the primary caregiver should be the only person
orientation.
reorienting the client.
The home health nurse is making an initial home visit to the client
currently living with family members after being hospitalized with
pneumonia and newly diagnosed with AIDS. Which statement by
the nurse best acknowledges the client's fear of discovery by his
family? (B)
B) ''Is there somewhere private in the home we can go and talk?''
A) ''Do you think that I could post a sign on your bedroom door for Rationale: A nonthreatening approach initially to find out whether
everyone about the need to wash their hands?'' the client has informed family members or desires privacy is very
B) ''Is there somewhere private in the home we can go and talk?'' important.
C) ''I hope that all of your family members know about your disease
and how you need to be protected, since you have been so sick.''
D) ''It is your duty to protect your family members from getting
AIDS.''
The nurse is caring for a patient newly diagnosed with HIV. The
B. CD4+ T cell count below 200/µL
patient asks what would determine the actual development of
AIDS. The nurse's response is based on the knowledge that what
Diagnostic criteria for AIDS include a CD4+ T cell count below
is a diagnostic criterion for AIDS?
200/µL and/or the development of specified opportunistic infec-
A. Presence of HIV antibodie
tions, cancers, wasting syndrome, or dementia. The other options
B. CD4+ T cell count below 200/µL
may be found in patients with HIV disease but do not define the
C. Presence of oral hairy leukoplakia
advancement of HIV infection to AIDS.
D. White blood cell count below 5000/µl
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.

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A 25-year-old male patient has been diagnosed with HIV. The The major advantage of using several classes of antiretroviral
patient does not want to take more than one antiretroviral drug. drugs is that viral replication can be inhibited in several ways,
What reasons can the nurse tell the patient about for taking more making it more difficult for the virus to recover and decreasing
than one drug? the likelihood of drug resistance that is a major problem with
monotherapy. Combination therapy also delays disease progres-
A. Together they will cure HIV. sion and decreases HIV symptoms and opportunistic diseases.
B. Viral replication will be inhibited. HIV cannot be cured. CD4+ T cell counts increase with therapy.
C. They will decrease CD4+ T cell counts. There are dangerous interactions with many antiretroviral drugs
D. It will prevent interaction with other drugs and other commonly used drugs.
C. Use condoms for risk-reducing sexual relations.
D. Take emtricitabine and tenofovir (Truvada) regularly.
The woman is afraid she may get HIV from her bisexual husband.
E. Have regular HIV testing for herself and her husband.
What should the nurse include when teaching her about preex-
posure prophylaxis (select all that apply)?
Using male or female condoms, having monthly HIV testing for
the patient and her husband, and the woman taking emtricitabine
A. Take fluconazole (Diflucan).
and tenofovir regularly has shown to decrease the infection of
B. Take amphotericin B (Fungizone).
heterosexual women having sex with a partner who participates
C. Use condoms for risk-reducing sexual relations.
in high-risk behavior. Fluconazole and amphotericin B are taken
D. Take emtricitabine and tenofovir (Truvada) regularly.
for Candida albicans, Coccidioides immitis, and Cryptococcosus
E. Have regular HIV testing for herself and her husband.
neoformans, which are all opportunistic diseases associate with
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 manager
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

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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-
sion.
Rationale: The typical course of untreated HIV infection follows
b. Late chronic HIV infection is called acquired immunodeficiency
a predictable pattern. However, treatment can significantly alter
syndrome (AIDS).
this pattern, and disease progression is highly individualized. Late
c. Untreated HIV infection can remain in the early chronic stage
chronic infection is another term for acquired immunodeficiency
for a decade or more.
syndrome (AIDS). The median interval between untreated HIV
d. Untreated HIV infection usually remains in the early chronic
infection and a diagnosis of AIDS is about 11 years.
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
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 to treat in HIV-infected patients

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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.

b. Give the patient a video and a brochure to view and read at
home. Correct answer: d
c. Tell the patient that the side effects of the drugs are bad but that Rationale: The best approach to improve adherence to a treatment
they go away after a while. regimen is to learn about the patient's life and assist with problem
d. Assess the patient's routines and find adherence cues that fit solving within the confines of that life.
into the patient's life circumstances.
Correct answer: d
Rationale: The best approach to improve adherence to a treat-
ment regimen is to learn about the patient's life and assist with
problem solving within the confines of that life.
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 a. The patient has the virus present and can transmit the infection
patient teaching should be provided by the nurse related to this to others.
laboratory study result?
In human immunodeficiency virus (HIV) infections, viral loads are
a. The patient has the virus present and can transmit the infection reported as real numbers of copies/¼ L or as undetectable. "Un-
to others.
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b. The patient is not able to transmit the virus to others through
sexual contact. detectable" indicates that the viral load is lower than the test is
c. The patient will be prescribed lower doses of antiretroviral able to report. "Undetectable" does not mean that the virus has
medications for 2 months. been eliminated from the body or that the individual can no longer
d. The syndrome has been cured, and the patient will be able to transmit HIV to others.
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
by the Centers for Disease Control and Prevention (CDC), which
statement by the nurse is correct?
ANS: 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
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-
tient?
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a. The antiretroviral medications used to treat HIV infection are ANS: B

teratogenic. Only 25% of infants born to HIV-positive mothers develop HIV
b. Most infants born to HIV-positive mothers are not infected with infection, even when the mother does not use ART during preg-
the virus. nancy. The percentage drops to 2% when ART is used. Perinatal
c. Because she is at an early stage of HIV infection, the infant will transmission can occur at any stage of HIV infection (although it is
not contract HIV. less likely to occur when the viral load is lower). ART can safely be
d. It is likely that her newborn will become infected with HIV unless used in pregnancy, although some ART drugs should be avoided.
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
ANS: C
A young adult female patient who is human immunodeficiency
Efavirenz can cause fetal anomalies and should not be used in
virus (HIV)-positive has a new prescription for efavirenz (Sustiva).
patients who may be pregnant. The drug should not be used during
Which information is most important to include in the medication
pregnancy because large doses could cause fetal anomalies.
teaching plan?
Once-a-day doses should be taken at bedtime (at least initially)
to help patients cope with the side effects that include dizziness
a. Driving is allowed when starting this medication.
and confusion. Patients should be cautioned about driving when
b. Report any bizarre dreams to the health care provider.
starting this drug. Patients should be informed that many people
c. Continue to use contraception while on this medication.
who use the drug have reported vivid and sometimes bizarre
d. Take this medication in the morning on an empty stomach.
dreams
A patient who is human immunodeficiency virus (HIV)-infected
has a CD4+ cell count of 400/µL. Which factor is most important for ANS: 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
The nurse will most likely prepare a medication teaching plan
about antiretroviral therapy (ART) for which patient? ANS: D
CMV retinitis is an acquired immunodeficiency syndrome
a. Patient who is currently HIV negative but has unprotected sex (AIDS)-defining illness and indicates that the patient is appropriate
with multiple partners for ART even though the HIV infection period is relatively short.
b. Patient who was infected with HIV 15 years ago and now has a An HIV-negative patient would not be offered ART. A patient with
CD4+ count of 840/µL a CD4+ count in the normal range would not typically be started
c. HIV-positive patient with a CD4+ count of 160/µL who drinks a on ART. A patient who drinks alcohol heavily would be unlikely to
fifth of whiskey daily be able to manage the complex drug regimen and would not be
d. Patient who tested positive for HIV 2 years ago and now has appropriate for ART despite the low CD4+ count.
cytomegalovirus (CMV) retinitis
The nurse palpates enlarged cervical lymph nodes on a patient ANS: 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

ANS: A
determine if the patient needs human immunodeficiency virus
The current Center for Disease Control (CDC) policy is to offer
(HIV) testing?
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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
ANS: 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."
Which nursing action will be most useful in assisting a college
student to adhere to a newly prescribed antiretroviral therapy
(ART) regimen?
ANS: D
a. Give the patient detailed information about possible medication The best approach to improve adherence is to learn about im-
side effects. portant activities in the patient's life and adjust the ART around
b. Remind the patient of the importance of taking the medications those activities. The other actions also are useful, but they will
as scheduled. not improve adherence as much as individualizing the ART to the
c. Encourage the patient to join a support group for students who patient's schedule.
are HIV positive.
d. Check the patient's class schedule to help decide when the
drugs should be taken.
A patient with human immunodeficiency virus (HIV) infection has
developed Mycobacterium avium complex infection. Which out-
ANS: D
come would be appropriate for the nurse to include in the plan of
The major manifestation of M. avium infection is loose, watery
care?
stools, which would increase the risk for perineal skin breakdown.
The other outcomes would be appropriate for other complications
a. The patient will be free from injury.
(pneumonia, dementia, influenza, etc.) associated with HIV infec-
b. The patient will receive immunizations.
tion.
c. The patient will have adequate oxygenation.
d. The patient will maintain intact perineal skin.
A patient treated for human immunodeficiency virus (HIV) infec-
tion for 6 years has developed fat redistribution to the trunk, with
ANS: 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.
The nurse prepares to administer the following medications to a
hospitalized patient with human immunodeficiency (HIV). Which ANS: B
medication is most important to administer at the right time? It is important that antiretrovirals be taken at the prescribed time
every day to avoid developing drug-resistant HIV. The other med-
a. Oral acyclovir (Zovirax) ications should also be given as close as possible to the correct
b. Oral saquinavir (Invirase) time, but they are not as essential to receive at the same time
c. Nystatin (Mycostatin) tablet every day
d. Aerosolized pentamidine (NebuPent)
To evaluate the effectiveness of antiretroviral therapy (ART), which
laboratory test result will the nurse review? ANS: A
The effectiveness of ART is measured by the decrease in the
a. Viral load testing amount of virus detectable in the blood. The other tests are used
b. Enzyme immunoassay to detect HIV antibodies, which remain positive even with effective
c. Rapid HIV antibody testing ART.
d. Immunofluorescence assay

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The nurse cares for a patient who is human immunodeficiency
virus (HIV) positive and taking antiretroviral therapy (ART). Which
ANS: D
information is most important for the nurse to address when
Because missing doses of ART can lead to drug resistance,
planning care?
this patient statement indicates the need for interventions such
as teaching or changes in the drug scheduling. Elevated blood
a. The patient's blood glucose level is 142 mg/dL.
glucose and fatigue are common side effects of ART. The nurse
b. The patient complains of feeling "constantly tired."
should discuss medication side effects with the patient, but this is
c. The patient is unable to state the side effects of the medications.
not as important as addressing the skipped doses of AZT.
d. The patient states, "Sometimes I miss a dose of zidovudine
(AZT)."
Eight years after seroconversion, a human immunodeficiency
ANS: B
virus (HIV)-infected patient has a CD4+ cell count of 800/µL and
The CD4+ level for this patient is in the normal range, indicating
an undetectable viral load. What is the priority nursing intervention
that the patient is the stage of asymptomatic chronic infection,
at this time?
when the body is able to produce enough CD4+ cells to maintain a
normal CD4+ count. AIDS and increased incidence of opportunis-
a. Teach about the effects of antiretroviral agents.
tic infections typically develop when the CD4+ count is much lower
b. Encourage adequate nutrition, exercise, and sleep.
than normal. Although the initiation of ART is highly individual, it
c. Discuss likelihood of increased opportunistic infections.
would not be likely that a patient with a normal CD4+ level would
d. Monitor for symptoms of acquired immunodeficiency syndrome
receive ART.
(AIDS).
Which of these patients being seen at the human immunodefi-
ciency virus (HIV) clinic should the nurse assess first? ANS: C
The nurse should assess the patient for dehydration and hy-
a. Patient whose latest CD4+ count is 250/µL povolemia. The other patients also will require assessment and
b. Patient whose rapid HIV-antibody test is positive possible interventions, but do not require immediate action to
c. Patient who has had 10 liquid stools in the last 24 hours prevent complications such as hypovolemia and shock
d. Patient who has nausea from prescribed antiretroviral drugs
An older adult who takes medications for coronary artery disease
has just been diagnosed with asymptomatic chronic human im-
ANS: A
munodeficiency virus (HIV) infection. Which information will the
The nurse will teach the patient about potential interactions be-
nurse include in patient teaching?
tween antiretrovirals and the medications that the patient is using
for chronic health problems. Treatment and monitoring of HIV
a. Many medications have interactions with antiretroviral drugs.
infection is not affected by age. A patient with asymptomatic HIV
b. Less frequent CD4+ level monitoring is needed in older adults.
infection is not a candidate for hospice. Progression of HIV is not
c. Hospice care is available for patients with terminal HIV infection.
affected by age, although it may be affected by chronic disease
d. Progression of HIV infection occurs more rapidly in older pa-
tients.
The registered nurse (RN) caring for an HIV-positive patient ad-
mitted with tuberculosis can delegate which action to unlicensed
assistive personnel (UAP)?
ANS: B
A patient diagnosed with tuberculosis would be placed on airborne
a. Teach the patient about how to use tissues to dispose of respi-
precautions. Because all health care workers are taught about the
ratory secretions.
various types of infection precautions used in the hospital, the UAP
b. Stock the patient's room with all the necessary personal pro-
can safely stock the room with personal protective equipment. Ob-
tective equipment.
taining contact information and patient teaching are higher-level
c. Interview the patient to obtain the names of family members and
skills that require RN education and scope of practice.
close contacts.
d. Tell the patient's family members the reason for the use of
airborne precautions.
The nurse designs a program to decrease the incidence of hu-
man immunodeficiency virus (HIV) infection in the adolescent
and young adult populations. Which information should the nurse ANS: C
assign as the highest priority? Sexual transmission is the most common way that HIV is trans-
mitted. The nurse should also provide teaching about perinatal
a. Methods to prevent perinatal HIV transmission transmission, needle sterilization, and blood transfusion, but the
b. Ways to sterilize needles used by injectable drug users rate of HIV infection associated with these situations is lower.
c. Prevention of HIV transmission between sexual partners
d. Means to prevent transmission through blood transfusions

The nurse cares for a patient infected with human immunodefi- ANS: A, B, C
ciency virus (HIV) who has just been diagnosed with asympto- Asymptomatic chronic HIV infection is a stage between acute HIV
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infection and a diagnosis of symptomatic chronic HIV infection. Al-
matic chronic HIV infection. Which prophylactic measures will the
though called asymptomatic, symptoms (e.g., fatigue, headache,
nurse include in the plan of care (select all that apply)?
low-grade fever, night sweats) often occur. Prevention of other
infections is an important intervention in patients who are HIV
a. Hepatitis B vaccine
positive, and these vaccines are recommended as soon as the HIV
b. Pneumococcal vaccine
infection is diagnosed. Antibiotics and immune globulin are used
c. Influenza virus vaccine
to prevent and treat infections that occur later in the course of the
d. Trimethoprim-sulfamethoxazole
disease when the CD4+ counts have dropped or when infection
e. Varicella zoster immune globulin
has occurred.
A. CORRECT: The nurse should perform a physical assessment
to gather data about the client's
A nurse working in an outpatient clinic is assessing a client who condition. This is an appropriate action by the nurse.
reports night sweats and fatigue. He states B. CORRECT: The nurse should gather more data to determine
he has had a cough along with nausea and diarrhea. His temper- whether the clinical manifestations
ature is 38.1° C (100.6° F) orally. The client is are acute or chronic. This is an appropriate action by the nurse.
afraid he has HIV. Which of the following actions should the nurse C. INCORRECT: Teaching the client about HIV transmission is not
take? (Select all that apply.) an appropriate action by the nurse
at this time. This is not a priority action for the nurse to include at
A. Perform a physical assessment. this time.
B. Determine when current symptoms began. D. INCORRECT: Drawing blood for HIV testing is not an appropri-
C. Teach the client about HIV transmission. ate action by nurse at this time. This
D. Draw blood for HIV testing. is not a priority action for the nurse to include at this time.
E. Obtain a sexual history. E. CORRECT: The nurse should obtain a sexual history to deter-
mine how the virus was transmitted.
This is an appropriate action by the nurse.
A. CORRECT: Positive results of a Western blot test confirm the
A nurse is caring for a client who is suspected of having HIV. Which
presence of HIV infection.
of the following diagnostic tests
B. CORRECT: Positive results of an indirect immunofluorescence
and laboratory values are used to confirm HIV infection? (Select
assay confirm the presence of
all that apply.)
HIV infection.
C. INCORRECT: CD4+ T-lymphocyte count assists with classify-
A. Western blot
ing the stage of HIV infection.
B. Indirect immunofluorescence assay
D. INCORRECT: CD4+ T-lymphocyte percentage of total lympho-
C. CD4+ T-lymphocyte count
cytes assists with classifying the stage
D. CD4+ T-lymphocyte percentage of total lymphocytes
of HIV infection.
E. Cerebrospinal fluid (CSF) analysis
E. INCORRECT: CSF analysis can be used to confirm meningitis.
A. CORRECT: Perinatal exposure is a risk factor associated with
HIV. Women who are pregnant should
take cautionary measures to prevent HIV exposure.
A nurse is assessing a client for HIV. Which of the following are
B. INCORRECT: Women who are pregnant should be tested for
risk factors associated with this virus?
HIV, but pregnancy is not a risk factor
(Select all that apply.)
associated with this virus.
C. INCORRECT: Having a monogamous sex partner is not a risk
A. Perinatal exposure
factor associated with the HIV virus.
B. Pregnancy
D. CORRECT: Being an older adult woman is a risk factor asso-
C. Monogamous sex partner
ciated with the HIV virus due vaginal
D. Older adult woman
dryness and the thinning of the vaginal wall.
E. Occupational exposure
E. CORRECT: Occupational exposure, such as being a health
care worker, is a risk factor associated
with the HIV virus.

A. INCORRECT: A client who has AIDS should avoid changing the

A nurse is completing discharge instructions with a client who has pet litter box to prevent
AIDS. Which of the following statements by the client indicates an acquiring toxoplasmosis.
understanding of the teaching? B. INCORRECT: A client who has AIDS should avoid consuming
raw fruits due to the presence of
A. "I will wear gloves while changing the pet litter box." bacteria that can cause opportunistic infections.
B. "I will rinse raw fruits with water before eating them." C. INCORRECT: Due to compromised immune response, a client
C. "I will wear a mask when around family members who are ill." who has AIDS should avoid contact
D. "I will cook vegetables before eating them." with family members who are ill.
D. CORRECT: A client who has AIDS should cook vegetables

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before eating to kill bacteria that cause
opportunistic infections.
A. INCORRECT: In stage 1, there are no defining conditions.
A nurse is caring for a client who has HIV and has been newly B. INCORRECT: In stage 2, there are no defining conditions.
diagnosed with Burkitt's lymphoma. Which of the following HIV C. CORRECT: In stage 3, there are one or more defining condi-
infection stages is the client in? tions present. These can include
candidiasis of the esophagus, bronchi, trachea, or lungs; chronic
A. Stage 1 ulcers of herpes simplex;
B. Stage 2 HIVrelated encephalopathy; disseminated or extrapulmonary
C. Stage 3 histoplasmosis; Kaposi's sarcoma;
D. Stage 4 and Burkitt's lymphoma.
D. INCORRECT: In stage 4, there is no information available.
1. Birth control pills provide protection
against unwanted pregnancy but they do
not protect females from getting sexually
transmitted diseases. In fact, because of
The school nurse is preparing to teach a health class to ninth the reduced chance of becoming pregnant,
graders regarding sexually transmitted diseases. Which infor- some women may find it easier to become
mation regarding acquired immunodeficiency syndrome (AIDS) involved with multiple partners, increasing
should be included? the chance of contracting a sexually transmitted
disease.
1. Females taking birth control pills are protected from becoming 2. There is no vaccine or cure for the HIV
infected with HIV. virus.
2. Protected sex is no longer an issue because there is a vaccine 3. Adolescents are among the fastest-growing
for the HIV virus. population to be newly diagnosed with
3. Adolescents with a normal immune system are not at risk for HIV and AIDS.
developing AIDS. *4. Abstinence is the only guarantee the
4. Abstinence is the only guarantee of not becoming infected with client will not contract a sexually transmitted
sexually disease, including AIDS. An
transmitted HIV. individual who is HIV negative in a
monogamous relationship with another
individual who is HIV negative and
committed to a monogamous relationship
is the safest sexual relationship.
The nurse is admitting a client diagnosed with protein-calorie
*1. The client has a malnutrition syndrome.
malnutrition secondary to AIDS. Which intervention should be the
The nurse assesses the body and what
nurse's first intervention?
the client has been able to eat.*
2. Standard Precautions are used for clients
1. Assess the client's body weight and ask what the client has
diagnosed with AIDS, the same as for
been able to eat.
every other client.
2. Place in contact isolation and don a mask and gown before
3. The nurse should check the orders but not
entering the room.
before assessing the client.
3. Check the HCP's orders and determine what laboratory tests
4. The client will probably be placed on total
will be done.
parenteral nutrition and will need to be
4. Teach the client about total parenteral nutrition and monitor the
taught these things, but this is not the first
subclavian
action.
IV site.

1. This client probably has oral candidiasis, a

fungal infection of the mouth and esophagus.
The client diagnosed with AIDS is complaining of a sore mouth
Brushing the teeth and patchy areas
and tongue. When the nurse assesses the buccal mucosa, the
will not remove the lesions and will cause
nurse notes white, patchy lesions covering the hard and soft
considerable pain.
palates and the right inner cheek. Which interventions should the
*2. This most likely is a fungal infection
nurse implement?
known as oral candidiasis, commonly
1. Teach the client to brush the teeth and patchy area with a
called thrush. An antifungal medication
soft-bristle toothbrush.
is needed to treat this condition.*
2. Notify the HCP for an order for an antifungal swish-and-swallow
3. Antiseptic-based mouthwashes usually contain
medication.
alcohol, which is painful for the client.
3. Have the client gargle with an antiseptic-based mouthwash
4. The foods the client has eaten did not
several times a day.
cause this condition.
TEST-TAKING HINT: The client is complaining
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of a "sore mouth." The test taker
must notice all the important information
4. Determine what types of food the client has been eating for the
in the stem before attempting to choose
last 24 hours.
an answer. How are brushing the area, an
antiseptic mouthwash, or the
*1. Retroviruses never die; the virus
may become dormant, only to be
reactivated at a later time.*
2. "Eradicated" means to be completely
cured or done away with. HIV cannot be
The nurse is describing the HIV virus infection to a client who has eradicated.
been told he is HIV positive. Which information regarding the virus 3. The HIV virus originated in the green
is important to teach? monkey, in whom it is not deadly. HIV in
humans replicates readily using the CD4
1. The HIV virus is a retrovirus, which means it never dies as long cells as reservoirs.
as it has a host to live in. 4. The HIV virus uses the CD4 cells of the
2. The HIV virus can be eradicated from the host body with the immune system as reservoirs to replicate
correct medical regimen. itself.
3. It is difficult for the HIV virus to replicate in humans because it TEST-TAKING HINT: If the test taker is not
is a monkey virus. aware of the definition of a word, the individual
4. The HIV virus uses the client's own red blood cells to reproduce monitoring the test may be able
the virus in the body. to define the word, but this is not possible
on the NCLEX-RN examination. Of the
answer options, option "1" has the most
important information regarding prognosis
and potential spread to noninfected
individuals.
1. The client may be in the primary infection
stage when the body has not had time to
develop antibodies to the HIV virus.
2. Repeated exposure to HIV increases the
The client who has engaged in needle-sharing activities has de- risk of infection, but it only takes one
veloped a flu-like infection. An HIV antibody test is negative. Which exposure to develop an infection.
statement best describes the scientific rationale for this finding? *3. The primary phase of infection ranges
from being asymptomatic to severe
1. The client is fortunate not to have contracted HIV from an flu-like symptoms, but during this
infected needle. time, the test may be negative although
2. The client must be repeatedly exposed to HIV before becoming the individual is infected with HIV.*
infected. 4. The client may or may not have a different
3. The client may be in the primary infection phase of an HIV virus, but this is not the reason the test
infection. is negative.
4. The antibody test is negative because the client has a different TEST-TAKING HINT: Answer options "1"
flu virus. and "4" assume the client is negative for
the HIV virus. Therefore, these options
should be eliminated as correct answers
unless the test taker is completely sure
the statement is correct.

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