Chapter 34: HIV/AIDS

MULTIPLE CHOICE

1. The school nurse uses a chart to demonstrate that according to statistics from the Centers for
Disease Control and Prevention (CDC), the population with the greatest incidence of HIV
infection in the United States is:
1. Asian-Americans.
2. Blacks.
3. Latinos.
4. Whites.
ANS: 2
Of those with HIV infection in the United States, blacks comprise 40%, whites 37%, and
Latinos 22%. Asian-Americans were not reported.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 613, Table 34-2

OBJ: 2 TOP: HIV Incidence in the United States
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

2. The nurse explains that the enzyme reverse transcriptase transcribes:

1. DNA to mimic CD4 cells.
2. T4 helper cells to RNA.
3. RNA to DNA.
4. gp 120 to gp 41.
ANS: 3
Reverse transcriptase reverses the normal process and allows the RNA to be transcribed to
the DNA rather than the DNA to be transcribed to the RNA.

PTS: 1 DIF: Cognitive Level: Analysis REF: 619

OBJ: 2 TOP: Pathophysiology
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. The nurse takes into consideration in planning care for a patient with AIDS that the common
form of transmission of the HIV virus is:
1. injection drug use.
2. heterosexual contact.
3. exposure to contaminated blood products.
4. male to male.
ANS: 4
Male to male transmission is still the most common mode.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 613, Table 34-4

OBJ: 3 TOP: Transmission of HIV
KEY: Nursing Process Step: Planning
 MSC: NCLEX: Health Promotion and Maintenance

4. In assessing a patient with AIDS for risk factors, the nurse recognizes the most risky
behavior that the patient reported as:
1. oral sex without contact with glans penis.
2. oral sex with condom.
3. use of sex toys.
4. anal sex with condom.
ANS: 4
Anal sex, even with a condom, is a higher risk behavior than the other three options.

PTS: 1 DIF: Cognitive Level: Analysis REF: 614, Table 34-6

OBJ: 3 TOP: Risk Factors KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance

5. The nurse clarifies that a patient with HIV does not necessarily have AIDS until:
1. two or more opportunistic infections are diagnosed.
2. the appearance of Kaposi’s sarcoma.
3. the CD4 cell level drops to 200.
4. there is a positive ELISA.
ANS: 3
A person with an HIV infection is not diagnosed with AIDS until the CD4 count falls to 200.
There are other AIDS markers as well.

PTS: 1 DIF: Cognitive Level: Application REF: 620

OBJ: 5 TOP: Diagnosis of AIDS
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

6. The very anxious young man comes to the clinic believing that he may have HIV infection
because of his persistent flu-like symptoms and his risky sexual behavior. The nurse
anticipates that a positive blood analysis would show:
1. low levels of CD8 cells.
2. high levels of HIV virus.
3. low levels of T cells.
4. low levels of antibodies.
ANS: 2
In the initial phase of HIV infection, there are high levels of virus, high levels of T cells, and
high levels of antibodies as the body attempts to rid the body of the virus through the
immune response.

PTS: 1 DIF: Cognitive Level: Analysis REF: 614

OBJ: 2 TOP: Diagnosis of AIDS
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. The nurse explains that the initial stage of an HIV infection usually lasts from:
1. 2 to 4 weeks.
 2. 4 to 8 weeks.
3. 8 to 12 weeks.
4. 12 to 16 weeks.
ANS: 2
The initial phase of an HIV infection lasts from 4 to 8 weeks.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 614

OBJ: 2 TOP: Initial Phase of HIV Infection
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

8. The young man at the HIV clinic tells the nurse how relieved he is that he doesn’t have HIV,
because he now has no symptoms at all when just a few weeks ago he felt awful. The
nurse’s most helpful response would be:
1. “Flu-like symptoms frequently are misdiagnosed as HIV.”
2. “In the latent stage the physical symptoms are reduced, but the HIV is still present
in the lymph nodes.”
3. “A high antibody count can overwhelm HIV infection in the early stage.”
4. “Antiretroviral drugs are very effective in the first stage in reducing symptoms.”
ANS: 2
In the latent stage, the symptoms are reduced as the virus enters the lymph nodes.

PTS: 1 DIF: Cognitive Level: Application REF: 614

OBJ: 2 TOP: Stages of HIV Infection
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

9. The nurse evaluates that teaching relative to the progression of HIV infections has been
effective when the patient with HIV in the latent stage says:
1. “I had better get my affairs in order. I don’t have a lot of time left.”
2. “Whew! I thought when I got AIDS that I was a ‘goner’.”
3. “Now I won’t have to take all those expensive drugs that I have been using.”
4. “I can still enjoy life and live pretty much as I want for the next several years.”
ANS: 3
The latent stage may last as long as 12 years without developing into AIDS. Medications
will be continued.

PTS: 1 DIF: Cognitive Level: Application REF: 614

OBJ: 7 TOP: Latent Stage of HIV Infection
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

10. The nurse caring for a patient with HIV infection who is taking Retrovir, a nucleoside
antiviral that is a reverse transcriptase inhibitor, should be especially observant for
symptoms of:
1. decreased urine output.
2. hypertensive episodes.
3. jaundice.
 4. edema of the face.
ANS: 3
Retrovir has the potential of causing a fatal hepatoxic reaction. Jaundice is a possible sign of
hepatic impairment.

PTS: 1 DIF: Cognitive Level: Application

REF: 621, Drug Therapy table OBJ: 6 TOP: Drug Side Effects
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

11. The nurse is aware that the patient has entered the third stage of HIV infection when the
patient has:
1. a TH CD4 cell count of 500.
2. a rise in antibody count.
3. a drop in viral load.
4. an increase in T4 helper cells.
ANS: 1
In the third stage of HIV infection, TH CD4 cells drop to around 500. Antibodies are always
high throughout the infection, but are ineffective. The viral count is high.

PTS: 1 DIF: Cognitive Level: Application REF: 615

OBJ: 2 TOP: Third Stage of HIV Infection
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

12. The patient who is to have a blood transfusion for the treatment of anemia states that she is
fearful of contracting HIV through the blood. The nurse assures her that transfusion blood
has been put through special HIV screening since:
1. 1980.
2. 1984.
3. 1986.
4. 1999.
ANS: 3
Blood donors and blood products have been very carefully screened for HIV since 1986.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 615

OBJ: 7 TOP: HIV Screening of Transfusion Blood
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity

13. When the patient with HIV infection confesses that he has missed 10 days of his dose of 400
mg of nevirapine, the nurse informs him that the physician will most likely order:
1. a dose of 800 mg of the drug for the next 10 days to make up the difference.
2. a second antiviral agent to be taken with the nevirapine.
3. a restart of the nevirapine protocol, beginning with 200 mg/day.
4. the initiation of an entirely different drug.
ANS: 3
After a significant period of no medication, this drug is usually restarted at the beginning of
the protocol at 200 mg/day and then increased to higher doses.
 PTS: 1 DIF: Cognitive Level: Application
REF: 621, Drug Therapy table OBJ: 6 TOP: Nevirapine
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

14. The patient with HIV complains to the home health nurse that he has been having watery
diarrhea for the last 10 days. Because the nurse suspects toxoplasmosis, a significant
question for the nurse to ask would be:
1. “Have you stopped taking your antiviral medication?”
2. “Have you been drinking alcohol?”
3. “Have you been eating aged cheese or organ meats?”
4. “Do you have a cat?”
ANS: 4
Cat litter boxes and undercooked meats are the major sources of toxoplasmosis, which
causes a persistent watery diarrhea.

PTS: 1 DIF: Cognitive Level: Analysis REF: 616

OBJ: 4 TOP: Toxoplasmosis
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

15. The nurse, in planning care, considers that the two most common opportunistic infections
and malignant neoplasms in the HIV-positive patient are:
1. Streptococcal pneumonitis and myeloma.
2. Streptococcus pneumoniae and malignant melanoma.
3. Pneumocystis jiroveci pneumonitis and Kaposi’s sarcoma.
4. Mycoplasmal pneumonia and Kaposi’s sarcoma.
ANS: 3
The most common infection seen in HIV infection is P. jiroveci. Kaposi’s sarcoma is
common in AIDS.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 616

OBJ: 4 TOP: HIV KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity

16. The nursing diagnosis that would take priority in the care of an outpatient with AIDS would
be:
1. Ineffective Therapeutic Regimen Management.
2. Impaired Physical Mobility.
3. Impaired Skin Integrity.
4. Social Isolation.
ANS: 1
Failure to take HIV drugs as scheduled can encourage resistant strains of HIV.

PTS: 1 DIF: Cognitive Level: Analysis REF: 625

OBJ: 7 TOP: Nursing Diagnosis: AIDS
KEY: Nursing Process Step: Nursing Diagnosis
 MSC: NCLEX: Psychosocial Integrity

17. The nurse removes a pot plant from the room of a patient with HIV as a preventive measure
against:
1. aspergillosis.
2. candidiasis.
3. coccidioidomycosis.
4. cytomegalovirus.
ANS: 1
Aspergillosis can be contracted from the potting soil in and around the plant in the pot.

PTS: 1 DIF: Cognitive Level: Application REF: 616-617

OBJ: 4 TOP: Aspergillosis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

18. The nurse explains that the painful shingles experienced by the patient with HIV is related to
his childhood exposure to:
1. measles.
2. mumps.
3. impetigo.
4. chickenpox.
ANS: 4
Chickenpox can be reactivated as shingles.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 618

OBJ: 4 TOP: Shingles KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

19. One of the implementations that the nurse could use to increase the comfort of a patient with
oral hair leukoplakia is to:
1. allow aspirin to melt in the mouth and then wash out with warm water.
2. encourage warm salt water mouth rinses several times a day.
3. limit intake of ice cream and other cold foods.
4. offer fluids through a straw.
ANS: 4
Using a straw keeps fluids from flooding the entire oral cavity. Warm or acidic items are to
be discouraged because they add to the discomfort.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 618

OBJ: 4 TOP: Oral Hair Leukoplakia
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

20. In addition to hand washing, which of the following precautions must the nurse take when
changing the dressing of an AIDS patient?
1. Masks, gloves, gowns, and goggles should be worn when there is a possibility of
blood splattering.
 2. This is strictly left to the discretion of the health care provider.
3. Every situation is different and must be considered on an individual basis.
4. The patient and nurse jointly decide on what the patient is most comfortable with.
ANS: 1
Gloves are recommended when handling any body fluid. Masks, gowns, and goggles should
be worn when there is a possibility of blood splattering.

PTS: 1 DIF: Cognitive Level: Application REF: 620

OBJ: 7 TOP: Prevention KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment

21. When caring for the patient with AIDS who has cutaneous Kaposi’s sarcoma, the nurse
would report signs of:
1. nausea.
2. fatigue.
3. abdominal pain.
4. weight loss.
ANS: 3
Abdominal pain may be an indication of organ involvement from Kaposi’s sarcoma.

PTS: 1 DIF: Cognitive Level: Application

REF: 619, Patient Teaching Plan OBJ: 2 TOP: Kaposi’s Sarcoma
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

22. If an individual has one positive ELISA, then:

1. the diagnosis of AIDS is confirmed.
2. the test is repeated in 6 to 8 months.
3. another blood sample must be obtained for testing.
4. a Western blot test is performed on the same sample.
ANS: 3
If the ELISA is positive, the ELISA is repeated. If the second ELISA is positive, a Western
blot test is performed.

PTS: 1 DIF: Cognitive Level: Synthesis REF: 619-620

OBJ: 5 TOP: HIV Laboratory Tests
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment

23. The nurse would suspect an infection by a cytomegalovirus when the patient with AIDS
says:
1. “I need to get glasses, I can’t see as well as I did a few months ago.”
2. “I need to drink more water. This diarrhea has really dehydrated me.”
3. “I need to get smaller clothes. I have lost 10 pounds in the last 6 weeks.”
4. “I need to take some pep pills. I don’t have any energy.”
ANS: 1
 Visual changes indicate the presence of CMV retinitis, which will eventually lead to
blindness. Diarrhea is indicative of a fungal infection and decreases in weight and energy
are expected manifestations of AIDS.

PTS: 1 DIF: Cognitive Level: Analysis REF: 618, Table 34-8

OBJ: 4 TOP: Assessing Cytomegalovirus
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

24. The nurse cautions a patient with HIV infection who is on HAART (highly active retroviral
therapy) that inconsistent administration of the drug can result in:
1. the HIV strain becoming resistant to the drug.
2. the decrease in antibodies in the circulating volume.
3. the addition of another antiretroviral agent to the protocol.
4. a rapid increase in symptoms of AIDS.
ANS: 1
Inconsistent administration of HAART drugs can cause the HIV strain to become resistant to
the drug.

PTS: 1 DIF: Cognitive Level: Application REF: 620

OBJ: 6 TOP: HAART KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

25. The nurse explains that HIV patients who have the best results from HAART are those with
a:
1. viral load of 60,000 and CD4 count of 150.
2. viral load of 50,000 and CD4 count of 200.
3. viral load of 40,000 and CD4 count of 300.
4. viral load of 30,000 and CD4 count of 300.
ANS: 4
HIV patients who respond best to HAART are those with a viral load of 5000 to 30,000 and
a CD4 count of 300 to 500.

PTS: 1 DIF: Cognitive Level: Application REF: 620

OBJ: 6 TOP: HAART Criteria
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. The nurse reminds a group of high school students that although gay men are stereotyped as
HIV victims, the disease is also seen in (select all that apply):
1. health care workers who mishandle infected sharps.
2. breast-fed infants of HIV-infected mothers.
3. persons sharing living quarters with an HIV-infected person.
4. heterosexual partners of an HIV-infected person.
5. newborns of an HIV-infected mother.
ANS: 1, 2, 4, 5
 Sharing living quarters without intimate contact does not expose persons to HIV infection.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 611

OBJ: 2 TOP: Prevalence of HIV
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

2. In designing a teaching plan for an AIDS patient relative to food preparation precautions,
the nurse would include the need to (select all that apply):
1. check expiration dates on frozen foods.
2. leave produce unwashed to preserve protective spray.
3. drink a small glass of red wine prior to meal to stimulate appetite.
4. eat three large well-balanced meals daily.
5. avoid leftovers.
ANS: 1, 4
Using food before the expiration date and avoiding leftovers reduce the risk of food
contamination. Persons with AIDS should wash all fresh produce to get rid of contaminants,
eat several small meals daily, and avoid alcohol and caffeine.

PTS: 1 DIF: Cognitive Level: Analysis

REF: 624, Nutrition Concepts box OBJ: 7
TOP: Nutritional Precautions KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

1. The nurse explains that the HIV virus is introduced to the systemic circulation by the
____________________, which are found in the mucous membranes.

ANS: Macrophage

PTS: 1 DIF: Cognitive Level: Comprehension REF: 614

OBJ: 2 TOP: Macrophage KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

2. The nurse explains to a pregnant AIDS patient that her baby will be treated with
antiretroviral drugs for ____________________ weeks after birth.

ANS: 6

PTS: 1 DIF: Cognitive Level: Comprehension

REF: 620, Health Promotion Considerations box OBJ: 7
TOP: Treatment of Newborns of AIDS Patients
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance