Chapter 17: Infection and Human Immunodeficiency Virus Infection:
Lewis’s Medical-Surgical Nursing, 5th Edition
1. A young adult who uses injectable illegal drugs asks the nurse about preventing
AIDS. Which of the following information should the nurse inform the patient is the
best way to reduce the risk of HIV infection from drug use?
A. Participate in a needle-exchange program.
B. Clean drug injection equipment before use.
C. Ask those who share equipment to be tested for HIV.
D. Avoid sexual intercourse when using injectable drugs.
Answer: A
Explanation: Participation in needle and syringe exchange programs has been shown to
control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it
might not be consistently practised by individuals in withdrawal. HIV antibodies do not
appear for several weeks to months after exposure, so testing drug users would not be very
effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about
sexual activity when under the influence of drugs.
2. The nurse is caring for a patient with HIV who has a CD4+ cell count of 400/µL.
Which of the following factors is most important to consider when determining whether
antiretroviral therapy (ART) will be initiated for this patient?
A. Patient social support system
B. HIV genotype and phenotype
C. Potential medication adverse effects
D. Patient ability to comply with ART schedule
Answer: D
Explanation: Drug resistance develops quickly unless the patient takes ART medications on
a stringent schedule, and this endangers both the patient and the community. The other
information is also important to consider, but patients who are unable to manage and follow a
complex drug treatment regimen should not be considered for ART.
3. A patient who has vague symptoms of fatigue and headaches is found to have a
positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV)
antibodies. In providing health teaching, which of the following information should the
nurse include?
,A. The EIA test will need to be repeated to verify the results.
B. A viral culture will be done to determine the progress of the disease.
C. It will probably be 10 or more years before the patient develops acquired
immunodeficiency syndrome (AIDS).
D. The Western blot test will be done to determine whether AIDS has developed.
Answer: A
Explanation: After an initial positive EIA test, the EIA is repeated before more specific
testing such as the Western blot is done. Viral cultures are not part of HIV testing. Because
the nurse does not know how recently the patient was infected, it is not appropriate to predict
the time frame for AIDS development. The Western blot tests for HIV antibodies, not for
AIDS.
4. The nurse is caring for a patient who has just diagnosed with early persistent HIV
infection. Which of the following prophylactic measures should the nurse anticipate
being included in the plan of care? (Select all that apply.)
A. Hepatitis B vaccine
B. Pneumococcal vaccine
C. Influenza virus vaccine
D. Trimethoprim-sulfamethoxazole
E. Varicella-zoster immune globulin
Answer: A, B, C
Explanation: Prevention of other infections is an important intervention in patients who are
HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed.
Antibiotics and immune globulin are used to prevent and treat infections that occur later in
the course of the disease, when the CD4 count has dropped or when infection has occurred.
5. A patient who has been treated for HIV infection for 7 years has developed fat
redistribution to the trunk, with wasting of the arms, legs, and face. Which of the
following topics should the nurse include in the patient teaching plan?
A. The benefits of daily exercise
B. Foods that are higher in protein
C. Treatment with antifungal agents
D. A change in antiretroviral therapy
Answer: D
Explanation: A frequent first intervention for metabolic disorders is a change in ART.
Treatment with antifungal agents would not be appropriate because there is no indication of
fungal infection. Changes in diet or exercise have not proven helpful for this problem.
,6. The nurse is preparing to give the following medications to an HIV-positive patient
who is hospitalized with Pneumocystis jirovecii pneumonia (PCP). Which of the
following medications is most important to administer at the right time?
A. Nystatin tablet
B. Oral abacavir
C. Ventolin
D. Oral acyclovir
Answer: B
Explanation: It is important that antiretrovirals be taken at the prescribed time every day to
avoid developing drug-resistant HIV. The other medications should also be given as close as
possible to the correct time, but they are not as essential to receive at the same time every
day.
7. A patient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and
HIV testing is positive. Based on diagnostic criteria established by the World Health
Organization (WHO), which of the following diagnoses should the nurse anticipate?
A. Acute infection
B. Early persistent infection
C. Intermediate persistent infection
D. Late persistent infection or AIDS
Answer: D
Explanation: Development of PCP pneumonia meets the diagnostic criterion for AIDS. The
other responses indicate an earlier stage of HIV infection than is indicated by the PCP
infection.
8. After having a positive rapid-antibody test for HIV, a patient is anxious and does not
appear to hear what the nurse is saying. Which of the following actions should the nurse
implement?
A. Teach the patient about the medications available for treatment.
B. Inform the patient how to protect sexual and needle-sharing partners.
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.
Answer: C
Explanation: After an initial positive antibody test, the next step is retesting to confirm the
results. A patient who is anxious is not likely to be able to take in new information or be
willing to disclose information about HIV status of other individuals.
, 9. A patient who has diagnosed with AIDS tells the nurse, "I have lots of thoughts about
dying. Do you think I am just being morbid?" Which of the following responses by the
nurse is most appropriate?
A. "Thinking about dying will not improve the course of AIDS."
B. "It is important to focus on the good things about your life now."
C. "Do you think that taking an antidepressant might be helpful to you?"
D. "Can you tell me more about the kind of thoughts that you are having?"
Answer: D
Explanation: More assessment of the patient's psychosocial status is needed before taking
any other action. The statements, "Thinking about dying will not improve the course of
AIDS." and "It is important to focus on the good things in life." discourage the patient from
sharing any further information with the nurse and decrease the nurse's ability to develop a
trusting relationship with the patient. Although antidepressants may be helpful, the initial
action should be further assessment of the patient's feelings.
10. A pregnant woman with a history of early persistent HIV infection is seen at the
clinic. Which of the following information should the nurse include when teaching the
patient?
A. The antiretroviral medications used to treat HIV infection are teratogenic.
B. Most infants born to HIV-positive mothers are not infected with the virus.
C. Since 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
drug therapy (ART).
Answer: B
Explanation: Only 25% of infants born to HIV-positive mothers develop HIV infection,
even when the mother does not use ART during pregnancy. The percentage drops to 2%
when ART is used. Perinatal transmission can occur at any stage of HIV infection (although
it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy,
although some ART drugs should be avoided.
11. The nurse is caring for a patient whose HIV status is unknown. Which of these
patient exposures is most likely to require postexposure prophylaxis for the nurse?
A. Needle stick with a needle and syringe used to draw blood
B. Splash into the eyes when emptying a bedpan containing stool
C. Contamination of open skin lesions with patient vaginal secretions
D. Needle stick injury with a suture needle during a surgical procedure
Answer: A
Lewis’s Medical-Surgical Nursing, 5th Edition
1. A young adult who uses injectable illegal drugs asks the nurse about preventing
AIDS. Which of the following information should the nurse inform the patient is the
best way to reduce the risk of HIV infection from drug use?
A. Participate in a needle-exchange program.
B. Clean drug injection equipment before use.
C. Ask those who share equipment to be tested for HIV.
D. Avoid sexual intercourse when using injectable drugs.
Answer: A
Explanation: Participation in needle and syringe exchange programs has been shown to
control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it
might not be consistently practised by individuals in withdrawal. HIV antibodies do not
appear for several weeks to months after exposure, so testing drug users would not be very
effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about
sexual activity when under the influence of drugs.
2. The nurse is caring for a patient with HIV who has a CD4+ cell count of 400/µL.
Which of the following factors is most important to consider when determining whether
antiretroviral therapy (ART) will be initiated for this patient?
A. Patient social support system
B. HIV genotype and phenotype
C. Potential medication adverse effects
D. Patient ability to comply with ART schedule
Answer: D
Explanation: Drug resistance develops quickly unless the patient takes ART medications on
a stringent schedule, and this endangers both the patient and the community. The other
information is also important to consider, but patients who are unable to manage and follow a
complex drug treatment regimen should not be considered for ART.
3. A patient who has vague symptoms of fatigue and headaches is found to have a
positive enzyme immunoassay (EIA) for human immunodeficiency virus (HIV)
antibodies. In providing health teaching, which of the following information should the
nurse include?
,A. The EIA test will need to be repeated to verify the results.
B. A viral culture will be done to determine the progress of the disease.
C. It will probably be 10 or more years before the patient develops acquired
immunodeficiency syndrome (AIDS).
D. The Western blot test will be done to determine whether AIDS has developed.
Answer: A
Explanation: After an initial positive EIA test, the EIA is repeated before more specific
testing such as the Western blot is done. Viral cultures are not part of HIV testing. Because
the nurse does not know how recently the patient was infected, it is not appropriate to predict
the time frame for AIDS development. The Western blot tests for HIV antibodies, not for
AIDS.
4. The nurse is caring for a patient who has just diagnosed with early persistent HIV
infection. Which of the following prophylactic measures should the nurse anticipate
being included in the plan of care? (Select all that apply.)
A. Hepatitis B vaccine
B. Pneumococcal vaccine
C. Influenza virus vaccine
D. Trimethoprim-sulfamethoxazole
E. Varicella-zoster immune globulin
Answer: A, B, C
Explanation: Prevention of other infections is an important intervention in patients who are
HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed.
Antibiotics and immune globulin are used to prevent and treat infections that occur later in
the course of the disease, when the CD4 count has dropped or when infection has occurred.
5. A patient who has been treated for HIV infection for 7 years has developed fat
redistribution to the trunk, with wasting of the arms, legs, and face. Which of the
following topics should the nurse include in the patient teaching plan?
A. The benefits of daily exercise
B. Foods that are higher in protein
C. Treatment with antifungal agents
D. A change in antiretroviral therapy
Answer: D
Explanation: A frequent first intervention for metabolic disorders is a change in ART.
Treatment with antifungal agents would not be appropriate because there is no indication of
fungal infection. Changes in diet or exercise have not proven helpful for this problem.
,6. The nurse is preparing to give the following medications to an HIV-positive patient
who is hospitalized with Pneumocystis jirovecii pneumonia (PCP). Which of the
following medications is most important to administer at the right time?
A. Nystatin tablet
B. Oral abacavir
C. Ventolin
D. Oral acyclovir
Answer: B
Explanation: It is important that antiretrovirals be taken at the prescribed time every day to
avoid developing drug-resistant HIV. The other medications should also be given as close as
possible to the correct time, but they are not as essential to receive at the same time every
day.
7. A patient is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and
HIV testing is positive. Based on diagnostic criteria established by the World Health
Organization (WHO), which of the following diagnoses should the nurse anticipate?
A. Acute infection
B. Early persistent infection
C. Intermediate persistent infection
D. Late persistent infection or AIDS
Answer: D
Explanation: Development of PCP pneumonia meets the diagnostic criterion for AIDS. The
other responses indicate an earlier stage of HIV infection than is indicated by the PCP
infection.
8. After having a positive rapid-antibody test for HIV, a patient is anxious and does not
appear to hear what the nurse is saying. Which of the following actions should the nurse
implement?
A. Teach the patient about the medications available for treatment.
B. Inform the patient how to protect sexual and needle-sharing partners.
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.
Answer: C
Explanation: After an initial positive antibody test, the next step is retesting to confirm the
results. A patient who is anxious is not likely to be able to take in new information or be
willing to disclose information about HIV status of other individuals.
, 9. A patient who has diagnosed with AIDS tells the nurse, "I have lots of thoughts about
dying. Do you think I am just being morbid?" Which of the following responses by the
nurse is most appropriate?
A. "Thinking about dying will not improve the course of AIDS."
B. "It is important to focus on the good things about your life now."
C. "Do you think that taking an antidepressant might be helpful to you?"
D. "Can you tell me more about the kind of thoughts that you are having?"
Answer: D
Explanation: More assessment of the patient's psychosocial status is needed before taking
any other action. The statements, "Thinking about dying will not improve the course of
AIDS." and "It is important to focus on the good things in life." discourage the patient from
sharing any further information with the nurse and decrease the nurse's ability to develop a
trusting relationship with the patient. Although antidepressants may be helpful, the initial
action should be further assessment of the patient's feelings.
10. A pregnant woman with a history of early persistent HIV infection is seen at the
clinic. Which of the following information should the nurse include when teaching the
patient?
A. The antiretroviral medications used to treat HIV infection are teratogenic.
B. Most infants born to HIV-positive mothers are not infected with the virus.
C. Since 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
drug therapy (ART).
Answer: B
Explanation: Only 25% of infants born to HIV-positive mothers develop HIV infection,
even when the mother does not use ART during pregnancy. The percentage drops to 2%
when ART is used. Perinatal transmission can occur at any stage of HIV infection (although
it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy,
although some ART drugs should be avoided.
11. The nurse is caring for a patient whose HIV status is unknown. Which of these
patient exposures is most likely to require postexposure prophylaxis for the nurse?
A. Needle stick with a needle and syringe used to draw blood
B. Splash into the eyes when emptying a bedpan containing stool
C. Contamination of open skin lesions with patient vaginal secretions
D. Needle stick injury with a suture needle during a surgical procedure
Answer: A
