Nursing Care of Patients With HIV Disease and AIDS

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is caring for a patient who has AIDS. Which outcome should receive priority?
a. Remain socially active.
b. Report high self-esteem.
c. Remain free of infection.
d. Maintain baseline weight.
____ 2. A patient with HIV asks the nurse if thinking about dying frequently is common with HIV. What is an appropriate response by the nurse?
a. “HIV is a serious disease that results in death.”
b. “Thinking about death will not change the prognosis.”
c. “HIV is now considered a chronic disease with treatment.”
d. “HIV has a very high mortality rate, so it is realistic to plan for death.”
____ 3. The nurse is caring for a patient with HIV. For which common opportunistic infection should the nurse observe when caring for this patient?
a. Toxoplasmosis
b. Cryptococcosis
c. Candida albicans
d. Cryptosporidiosis
____ 4. The nurse contributed to a staff education program about transmission precautions to use when caring for a patient who has AIDS. Which statement by a staff member indicates a correct understanding of the teaching?
a. “Wear a mask for any patient contact.”
b. “Wear a waterproof gown at all times.”
c. “Wear clean gloves for body fluid contact.”
d. “Wear sterile gloves for any patient contact.”
____ 5. The nurse is reinforcing teaching on transmission of HIV for a family of a patient diagnosed with HIV. Which explanation by the nurse would be correct?
a. “HIV can be spread by casual contact.”
b. “HIV lives for long periods outside the body.”
c. “HIV is most commonly transmitted via tears and saliva.”
d. “HIV enters the body through breaks in the skin or mucous membranes.”
____ 6. The nurse is monitoring a patient with AIDS. Which manifestation should the nurse expect to observe in this patient?
a. Diarrhea
b. Chest pain
c. Hypertension
d. Pustular skin lesions
____ 7. The nurse is assisting in a teaching plan for the family of a patient with HIV. Which explanation about the transmission of HIV should the nurse include in this plan?
a. HIV is spread by casual contact with others.
b. HIV spreads by contact with infected blood.
c. HIV can be spread by sharing eating utensils.
d. HIV is commonly transmitted by tears or saliva.
____ 8. A patient who has AIDS expresses concern about telling others about the illness. Which response would be appropriate by the nurse?
a. “It would be best to tell everyone you know.”
b. “You should tell those who have a reason to know.”
c. “Your diagnosis will be discovered anyway by those you know.”
d. “Secrecy is a poor idea because it will erode your self-esteem.”
____ 9. The nurse is providing care to a patient who has had diagnostic testing for HIV. Which test should the nurse review to monitor the response to antiretroviral therapy?
a. Western blot
b. Viral load testing
c. P24 antigen testing
d. Enzyme-linked immunosorbent assay
____ 10. The nurse is preparing to care for a patient who is HIV positive. Which action should the nurse take when following standard precautions for protection from HIV exposure?
a. Put on gloves before touching body fluids.
b. Recap intramuscular needles after injection.
c. Wash own open skin lesion after providing care.
d. Remove one finger on a glove during venipuncture.
____ 11. A patient who has HIV asks the nurse why blood work has to be done so frequently. Which response should the nurse make to the patient?
a. “B-lymphocyte levels increase if you have an acute infection.”
b. “Phagocytes are decreased when the disease is in an active phase.”
c. “Neutrophil counts help the doctor titrate medication levels to keep you healthy.”
d. “CD4+ lymphocyte counts are monitored to determine the progression of the disease.”
____ 12. The nurse is contributing to a teaching plan. What should the nurse emphasize as being the most effective method known to control the spread of HIV infection?
a. Premarital serological screening
b. Prophylactic exposure treatment
c. HIV screening for pregnant women
d. Education about preventive behaviors
____ 13. The nurse is collecting data for a patient with suspected exposure to HIV. Which symptoms would be most concerning in this patient?
a. Tremors, edema, coughing
b. Fever, diarrhea, sore throat
c. Urticaria, sneezing, pruritus
d. Abdominal pain, anorexia, and vomiting
____ 14. The nurse is reviewing laboratory results for a patient who has HIV. Which result would be strongly suggestive of a diagnosis of AIDS?
a. CD4+ = 180/µL
b. CD4+ percentage = 68%
c. CD8+ = 650/µL
d. CD4+/CD8+ ratio = 1.5
____ 15. A patient asks, “What is the main purpose of these medications I take for my HIV?” Which response should the nurse make?
a. “They encapsulate the virus-infected cells.”
b. “They mark the virus for natural killer cells to destroy.”
c. “They attract macrophages to the cells making the virus.”
d. “They inhibit enzymes to interfere with viral production.”
____ 16. The nurse is participating in the planning of care for a patient who has HIV. Which therapeutic action should the nurse recognize as the treatment goal for HIV?
a. Stimulating the immune system
b. Treating opportunistic infections
c. Killing the virus with medication
d. Keeping the virus from replicating
____ 17. The nurse provides teaching on nevirapine (Viramune) for a patient who is HIV positive. Which patient statement indicates that teaching has been effective?
a. Monitor for rash.
b. Observe urine color.
c. Report extremity pain.
d. Monitor for flulike symptoms.
____ 18. The family of a patient with AIDS has been instructed on patient manifestations to report to the health care provider (HCP). Which manifestation should be reported indicating that teaching has been effective?
a. Fever
b. Dry mouth
c. Night sweats
d. Constipation
____ 19. The nurse is reviewing the use of a condom to prevent the transmission of HIV with a young adult patient seeking testing for HIV. Which patient statement indicates an understanding of how to use a condom?
a. Use a non-latex condom.
b. Apply adequate oil-based lubricant.
c. Apply condom before penile erection occurs.
d. Withdraw from partner while the penis is erect.
____ 20. A patient with AIDS-related wasting syndrome is very weak, lies listlessly in bed, has an intravenous (IV) drip, and receives antiretroviral medications via injection. What should be the priority nursing diagnosis for this patient?
a. Pain related to immobility
b. Ineffective Individual Coping due to terminal stage of HIV
c. Risk for Injury due to impaired mobility, weakness, and weight loss
d. Risk for Infection due to weak immune system and parenteral therapy
____ 21. An HIV-infected patient reports being a cat lover and says, “I always get my pets from a known sanitary source.” What should the nurse instruct the patient about cats and the risk of infection?
a. “Keep cats outdoors most of the time.”
b. “Obtain only cats that are less than 1 year old.”
c. “Remove all pets from your home. Avoid all contact with cats.”
d. “Be sure all the cats have up-to-date immunizations, and avoid their feces.”
____ 22. The nurse is caring for a patient who has AIDS. For which opportunistic lung infection caused by a fungus should the nurse monitor in this patient?
a. Tuberculosis
b. Cytomegalovirus
c. Candida albicans
d. Pneumocystis jiroveci pneumonia
____ 23. The nurse is caring for the newborn of a mother who is HIV positive. What treatment should the nurse expect to be prescribed for the infant?
a. Bacitracin
b. Erythromycin
c. Protease inhibitor
d. Zidovudine (AZT)
____ 24. A health care worker is exposed to blood from a patient who has HIV. What action should the worker take after the exposure?
a. Apply alcohol to the site.
b. Cleanse the site with soap and water.
c. Flush the site with hot running water.
d. Apply a topical antibiotic to the site.
____ 25. The nurse notes that a patient with AIDS is prescribed trimethoprim-sulfamethoxazole (Bactrim). For which opportunistic infection should the nurse realize that is this medication indicated?
a. Tuberculosis
b. Cytomegalovirus retinitis
c. Mycobacterium avium complex
d. Pneumocystis jiroveci pneumonia
____ 26. The nurse is preparing to read the Mantoux tuberculin skin test placed on the forearm of a patient with HIV. Which finding should the nurse report as a positive test for this patient?
a. 2 mm
b. 3 mm
c. 4 mm
d. 5 mm
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 27. A patient who has AIDS has been instructed on foods to eat to reduce the risk of infection. Which foods should the patient select that indicates correct understanding of this teaching? (Select all that apply.)
a. Rare meat
b. Raw seafood
c. Soft egg yolks
d. Pasteurized milk
e. Well-cooked meat
____ 28. The nurse is contributing to a teaching plan. What information should the nurse include that identifies the methods in which HIV can be transmitted? (Select all that apply.)
a. Urine
b. Sweat
c. Saliva
d. Semen
e. Breast milk
f. Vaginal secretions
____ 29. The nurse has been discussing actions to prevent AIDS-related wasting syndrome with a patient being treated for AIDS. Which patient statements indicate an understanding of this teaching? (Select all that apply.)
a. Eat a low-residue diet.
b. Drink liquids before meals.
c. Enjoy food odors to stimulate appetite.
d. Numb painful oral sores with ice or popsicles.
e. Eat three high-calorie, high-protein meals a day, plus snacks.
f. Increase consumption of caffeine-containing foods and fluids.
____ 30. The nurse is contributing to a nutrition and hydration teaching plan for a patient who has AIDS. What recommendations should the nurse include in this plan? (Select all that apply.)
a. Avoid soft cheeses.
b. Avoid Caesar salad.
c. Avoid public drinking fountains.
d. Avoid all beers and all soft drinks.
e. Avoid leftovers or heat until steaming.
f. Cook red meat until internal temperature is 165°F with no trace of pink.
____ 31. The nurse is reinforcing teaching on the rising incidence of HIV in adults over the age of 50 with a group of senior community members. Which factors should the nurse include? (Select all that apply.)
a. Older adults are less likely to use condoms than younger at-risk adults.
b. At-risk individuals over the age of 50 are less likely to be tested for HIV.
c. Society continues to age with larger numbers of people entering this age group.
d. A decline in the function of the immune system increases the risk of HIV infection.
e. Decreased vaginal dryness and friability of tissues increases the risk of HIV in older women.
f. Treatments for erectile dysfunction have increased the number of older individuals who are sexually active.
____ 32. The nurse is preparing to provide education related to HIV transmission at a local community health fair. Which statements should the nurse recommend for inclusion in the teaching? (Select all that apply.)
a. Use oil-based lubricants.
b. Use a new condom for each sex act.
c. Use condoms that are not made of latex.
d. Fit condom tightly over the tip of the penis.
e. Check condom package for expiration date.
f. Apply the condom before touching partner with the penis.
____ 33. A patient with AIDS is prescribed the nucleoside reverse transcriptase inhibitor lamivudine (Epivir). What information should the nurse ensure that the patient receives about this medication? (Select all that apply.)
a. Report any onset of bleeding.
b. Report any yellowing of the skin.
c. Report any change in urine output.
d. Report any symptoms similar to having the flu.
e. Report any numbness or tingling of the hands or feet.
____ 34. A patient with AIDS is planning a trip to Mexico. What teaching should the nurse provide to this patient to prevent the development of an opportunistic infection? (Select all that apply.)
a. Use beach towels.
b. Do not walk barefoot.
c. Do not eat raw fruits or vegetables.
d. Clean bathroom supplies with bleach.
e. Take an antimicrobial agent if diarrhea occurs.
____ 35. While collecting admission data, the nurse suspects a patient with AIDS is experiencing an HIV-associated neurocognitive disorder. What observations did the nurse make to come to this conclusion? (Select all that apply.)
a. Audible bowel sounds
b. Inappropriate laughter
c. Inability to state home address
d. Knee buckling while walking
e. Asking if the bugs could be removed from the walls

Chapter 20. Nursing Care of Patients With HIV Disease and AIDS
Answer Section

MULTIPLE CHOICE

1. ANS: D
The immune system is damaged by HIV, and ability to combat infections may be severely compromised. A minor infection for most people may kill a person who has AIDS. The priority goal for patients with HIV is to remain free of infections. A. Remaining socially active could lead to an infection. B. Having a high self-esteem is important although not the priority for nursing care. D. Maintaining baseline weight is more likely to occur if the patient remains free of infection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

2. ANS: C
HIV disease is characterized as a chronic disease rather than a life-ending illness. “Cocktails” of multiple antiretroviral drugs have reduced viral loads in the bloodstream and increased CD4+ T-lymphocyte counts, resulting in prolonged survival. A. B. D. Not everyone who is HIV positive develops AIDS and dies. The patient should be encouraged to think about the positive treatment available and not about the possibility of dying.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

3. ANS: C
Candida albicans is a fungus normally found in the gastrointestinal (GI) tract that does not infect a person with a healthy immune system. It is one of the common infections that can occur with AIDS.A. Toxoplasmosis is associated with cleaning cat litter. B. Cryptococcus is transmitted through contact with birds. D. Cryptosporidiosis can be transmitted through working with animals.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

4. ANS: C
Use standard precautions and wear clean gloves for body fluid contact to protect the health care worker. A. HIV is not an airborne disease. B. A waterproof gown is only necessary if splashes are likely. D. Sterile gloves are not necessary for protection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Analysis

5. ANS: D
HIV enters the body through breaks in the skin or mucous membranes. A. B. C. HIV is not spread by casual contact, does not live outside the body for long periods, and is not most commonly transmitted via tears and saliva. It is transmitted mainly by infected blood exposure.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

6. ANS: A
Many factors interfere with nutrition in HIV/AIDS such as anorexia, oral lesions, nausea and vomiting, or wasting syndrome. Diarrhea is a common manifestation in patient with AIDS. B. C. D. Chest pain, hypertension, and pustular skin lesions are not common manifestations associated with AIDS.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

7. ANS: B
HIV is transmitted by infected blood exposure. A, C, D. HIV is not spread by casual contact, such as with shared eating utensils, and is not most commonly transmitted via tears and saliva.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

8. ANS: B
The patient should tell those who have a reason to know to prevent risk of infection and to provide appropriate treatment. A. C. D. Others do not need to be told confidential information. Sharing this information will not erode the patient’s self-esteem.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

9. ANS: B
Viral load testing measures the amount of HIV RNA in plasma and is extremely important for determining prognosis and monitoring the response to antiretroviral therapy. A. The Western blot test is done to detect the presence of antibodies to four major HIV antigens C. D. These tests are not used to measure the response to antiretroviral therapy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

10. ANS: A
Gloves should be worn before touching body fluids, as all patients are considered to be infected per standard precautions. B. Do not recap needles. C. A nurse should not provide care with open lesions. D. Do not remove one glove finger as it defeats the purpose of glove protection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

11. ANS: D
A low ratio of CD4 cells to CD8 cells is seen as HIV/AIDS progresses. It is recommended that CD4/CD8 T-lymphocyte counts be performed at 3-month intervals for most patients. A. B. C. The other responses do not appropriately explain the need for frequent blood analyses in the patient with HIV.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

12. ANS: D
Prevention and education are the best ways to manage the HIV/AIDS epidemic. Education should begin with older school-age children through older adults. A. B. C. Premarital screening, prophylactic exposure treatment, and screening for pregnant women are not the best approaches to control the spread of HIV infection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

13. ANS: B
Initially after HIV infection, there may be no symptoms or mononucleosis-like symptoms such as extreme fatigue, headache, fever, lymphadenopathy, diarrhea, or a sore throat. A. C. D. Tremors, edema, coughing, urticaria, sneezing, pruritis, abdominal pain, anorexia, and vomiting are manifestations that might be associated with a different health problem or as a result of opportunistic infections associated with being HIV positive.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis

14. ANS: A
AIDS is diagnosed when CD4+ T-lymphocyte counts are below 200 cells per microliter, or the CD4+ T-lymphocyte percentage is under 14 of total lymphocytes. As HIV/AIDS progresses, the CD4+ count is decreased while the CD8+ count remains unchanged and the ratio of CD4+/CD8+ becomes smaller.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

15. ANS: D
Antiretroviral drugs that inhibit reproduction of the virus in various ways by blocking enzyme action are used to treat HIV infection. A. B. C. Antiretroviral drugs do not encapsulate the virus-infected cells, mark the virus to be destroyed, or attract macrophages to the cells making the virus.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

16. ANS: D
Keeping the virus from replicating is the treatment goal for HIV to prevent or delay development of opportunistic diseases, as there is no cure for this disease. A. B. Treatment goals do not focus on stimulating the immune system or treating opportunistic infections.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Application

17. ANS: B
When taking nevirapine (Viramune), the patient should be instructed to monitor for a rash especially during the first month because it may be life-threatening and require stopping the medication immediately. B. C. D. The patient does not need to monitor urine color, extremity pain, or flulike symptoms when taking Nevirapine (Viramune).

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

18. ANS: C
Instruct family to monitor temperature daily and to report a new fever higher than 100°F (38.5°C) or a change in fever pattern if low-grade fevers are commonly present to an HCP immediately. B. Dry mouth could be a side effect of medication or a need for more hydration. C. Night sweats are a common manifestation of the individual who has a moved from being HIV positive to having AIDS. D. Constipation is not likely to occur in the patient who has AIDS.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

19. ANS: D
When using a condom, withdraw from partner by holding condom against base of erect penis to avoid semen leakage. A. Use latex condom (or polyurethane if allergic to latex), because other materials have large pores that allow HIV to pass. B. Use water-soluble lubricants, as oil-based lubricants can damage latex condoms. C. Apply condom after erection for correct fit.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Analysis

20. ANS: D
In considering priority, the life-threatening risk is for infection due to weak immune system and parenteral therapy, so this is the priority. C. Risk for injury would be the priority after the Risk for infection. A. Additional information is needed to determine if the patient is experiencing pain. B. Ineffective coping can be the focus after life-threatening risks are addressed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

21. ANS: D
Counsel on pet contact risks but recognize the emotional benefits of pets. Pets should have up-to-date immunizations, and patients should avoid pet feces. If the patient must clean the litter box, wear mask and gloves, and wash hands well afterwards. A. B. C. Keeping the cats outdoors, having cats less than 1 year old, or preventing all contact with cats would be extreme. The patient can reduce the risk of infection by avoiding pet feces and ensuring for the cats’ health.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

22. ANS: D
Pneumocystis jiroveci pneumonia is a common opportunistic lung infection in AIDS. It is caused by a fungus. A. Tuberculosis is caused by a bacterial infection. B. Cytomegalovirus is a viral infection. C. Candida albicans is fungal infection that effects that gastrointestinal tract.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

23. ANS: D
The infant of a mother with HIV is given zidovudine (AZT) for 6 weeks. A. B. C. These medications are not used as prophylaxis after exposure to HIV through vaginal delivery.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

24. ANS: B
After exposure to HIV, the site should be immediately washed with soap and water and then seek immediate medical care for assessment and treatment. A. B. D. Alcohol should not be applied to the site. Flushing the site with hot running water is not sufficient. Soap is needed. A topical antibiotic should not be applied to the site.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

25. ANS: D
Trimethoprim-sulfamethoxazole (Bactrim) is indicated for the treatment of Pneumocystis jiroveci pneumonia. A. Pyrazinamide, isoniazid (Laniazid, and ethambutol (Myambutol) are indicated in the treatment of tuberculosis. B. Ganciclovir (Cytovene) is indicated in the treatment of Cytomegalovirus retinitis. C. Azithromycin, clarithromycin, ethambutol are indicated in the treatment of Mycobacterium avium complex.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

26. ANS: D
Mantoux tuberculin skin test (TST) with tuberculin purified protein derivative should be performed at least yearly in patients with HIV infection. Induration of 5 mm or more is defined as a positive result in patients with HIV infection. A. B. C. D. Induration of less than 5 mm is not a positive test.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Analysis

MULTIPLE RESPONSE

27. ANS: D, E
Pasteurized milk and well-cooked meat indicates understanding. To reduce risk of infection, avoid unpasteurized milk, other dairy products, fruit juice, and raw seed sprouts. Avoid raw and undercooked eggs, meats, and seafood.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

28. ANS: D, E, F
HIV is a fragile virus that is transmitted from human to human only through infected blood, semen, vaginal secretions, or breast milk. A. B. C. The HIV virus is not transmitted through urine, sweat, or saliva.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

29. ANS: A, D, E
To prevent AIDS-related wasting syndrome the patient should eat a low-residue diet to control diarrhea, numb painful oral sores with ice or popsicles so eating is not painful, and eat three high-calorie, high-protein meals a day, plus snacks, to maintain weight. B. C. F. Drinking before meals may fill patients up so they do not want to eat. Food odors may cause anorexia. Caffeine and alcohol should be avoided to help prevent diarrhea.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis

30. ANS: A, B, C, E, F
The patient should be instructed to avoid foods that may harbor bacteria: soft cheeses, raw/undercooked eggs and foods with raw eggs, such as Caesar dressing, undercooked meat, and leftovers. Public drinking fountains should be avoided because they may harbor germs. D. Beer and soft drinks are safe, so they do not need to be avoided.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application

31. ANS: A, B, C, D, F
Numbers will continue to rise as the older population increases. At-risk people older than age 50 are less likely than younger at-risk adults to use condoms during sex or to be tested for HIV. The availability of treatments for erectile dysfunction has also contributed to the number of older adults who are sexually active. A decline in the older adult’s immune system increases the risk for infection with exposure to HIV. E. Increased vaginal dryness and friability further increase an older woman’s susceptibility to HIV infection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

32. ANS: B, E, F
Condoms should be new for each sexual act, not past their expiration date, and applied before partner is touched. A. Only water-soluble lubricants should be used. C. Condoms should be made of latex (or polyurethane if allergic to latex), because other materials have large pores that allow HIV to pass. D. Room should be allowed at the tip for semen collection.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

33. ANS: B, C, D, E
When taking this medication, the patient should monitor and report any skin yellowing which could indicate jaundice or liver failure, changes in urine output which could indicate kidney failure, flu-like symptoms which would be life-threatening when taking this medication, and numbness or tingling of the hands or feet which could indicate the onset of peripheral neuropathy. A. Bleeding is not an adverse reaction to this medication.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application

34. ANS: A, B, C, E
To prevent the development of opportunistic infections when traveling, the patient should be instructed to use beach towels and avoid soil and/or contact with sand by wearing shoes. Raw fruits and vegetables should also be avoided. The patient should also be instructed to carry a supply of antimicrobial agent to take for diarrhea. D. Bathroom supplies do not need to be cleaned with bleach.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

35. ANS: B, C, D, E
Symptoms of an HIV-associated neurocognitive disorder include memory impairment, personality changes, hallucinations, and leg weakness. Inappropriate laughter could indicate personality changes. Inability to state the home address could indicate memory impairment. Knee buckling while walking could indicate leg weakness. Asking for the bugs to be removed from the walls could indicate hallucinations. A. Audible bowel sounds are not a manifestation of HIV associated neurocognitive disorder.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological Integrity—Physiological Adaptation | Cognitive Level: Analysis