WGU D118 OBJECTIVE ASSESSMENT VERSION A
A patient was initially treated as an outpatient for pneumonia and then after 2
weeks was hospitalized after no improvement was evident. The patient continues
to show no improvement after several antibiotic regimens have been attempted.
What is the next step in managing this patient?
a. Administration of the pneumonia vaccine b. Increasing the dose of the
antibiotics
c. Open lung biopsy
d. Performing diagnostic bronchoscopy
ANS: D
Rationale: Patients who do not respond to antibiotic therapy may have
opportunistic fungal or other infections, bronchogenic carcinoma, or other
diseases. Bronchoscopy can exclude or confirm these. The pneumonia vaccine
is preventative for pneumococcal causes and will not help this patient.
Increasing the dose of the antibiotics is not recommended. Open lung biopsy
may be performed if a bronchoscopy is inconclusive.
A pregnant woman tests positive for human immunodeficiency virus (HIV-1)
infection. What will the provider recommend?
a. Consideration of termination of the pregnancy
b. No treatment and caesarian section for delivery
c. Treatment with highly active antiretroviral therapy (HAART)
d. Treatment with standard antiretroviral therapy
ANS: C
Rationale: An absolute indication for treatment with highly active
antiretroviral therapy (HAART) is the treatment of a pregnant woman to
prevent mother-to-child transmission. Recommended regimens have no
known significant fetal toxicity and can reduce the risk of vertical
transmission from approximately 25% to less than 2%, making elective
caesarean section no longer indicated in treated pregnant women.
A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit.
Her LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago
and is adherent to her triple drug ART regimen with an undetectable viral load. At
35 weeks her viral load is still undetectable and she gives birth via normal vaginal
delivery at 39 weeks. At discharge ART regimens for the mother and child are
finalized. Which of the following recommendations about breastfeeding in HIV
positive mothers is most accurate?
A. There is no significant risk of HIV transmission via breastfeeding in mothers
under 30 years of age.
B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV
transmission
C. Maternal antibodies in breastmilk will protect the infant from HIV infection
D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable
ANS: D
Rationale: The risk of HIV Transmission from breastmilk makes
breastfeeding unadvisable. Rationale: 10%-14% of breastfeeding mothers
transmit HIV to the uninfected infant. The US official guidelines by the panel
on treatment of pregnant women with HIV infection and prevention of
perinatal infection state that HIV positive women must avoid breastfeeding as
transmission of HIV through breastmilk is still possible despite ART therapy.
In parts of the world that lack adequate resources the benefit of breastfeeding
may outweigh these risks.
A homeless patient who has human immunodeficiency virus (HIV-1) infection has
been on antiretroviral therapy (ART) for 18 months and has had normal CD4
counts and viral loads for past year. What will the provider recommend?
a. Allow for periods of time off from ART medications
b. Begin monitoring viral load and CD4 counts every 6 to 12 months
c. Consider beginning highly active antiretroviral therapy (HAART)
d. Continue monitoring viral lNoUadRaSnId NCGDT4Bco.uCntOsMevery 3 to 4
months
ANS: D
Rationale: In patients who are clinically well and highly adherent, who have
normal CD4 counts and viral loads, monitoring may begin at 6-month
intervals and sometimes annually. Those with risk factors such as
homelessness, however, must continue to be monitored every 3 to 4 months.
ART medications should never be interrupted unless there are medical
reasons for doing so. HAART is given only by clinicians with significant
training and experience in its use to patients who meet specific criteria.
A 43-year-old IV drug user who has been on ART treatment complains of
continuous diarrhea that is watery, epigastric pain, and difficulty swallowing. His
CBC shows a hemoglobin of 7.0 mg\/dl, a total leukocyte count of 2900cmm, and a
platelet count of 70,000. A CD4+ cell count was requested and it came out to be
90\/cmm. Which of the following laboratory investigations would best help with the
further evaluation of his diarrhea?
A. Stool tests for oocysts of cryptosporidium
B. Blood cultures for progressive disseminated histoplasmosis
C. Microscopy for pseudohyphae of Candida albicans
D. A stool for ova and parasites test for giardiasis
ANS: A<\/p>\n\n\n\n