The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse

The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient

• has an increased risk of transmitting the HIV infection.
• is less likely to develop AIDS than younger persons with HIV infection.
• is less likely to respond to antiretroviral agents.
• may have comorbid illnesses that can complicate HIV.

D ~ Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing

• acute retroviral syndrome.
• AIDS.
• an increased viral load.
• an opportunistic infection.

A ~ Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome.AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.A patient with HIV infection has been receiving antiretroviral therapy for 2 months. At the initiation of treatment, the patient had a viral load (VL) of 60 copies/mL and a CD4 count of 450 cells/mm3. Todays lab results reveal a VL of 20 copies/mL and a CD4 cell count of 800 cells/mm3. How will the nurse interpret the patient's results?

• A drug-resistant strain is likely.
• The patient is progressing as expected.
• The patient's treatment goals have been met.
• Treatment failure has occurred.

B ~ The treatment goal would be a VL of < 20 copies/mL and a CD4 cell count between 800 and 1200 cells/mm3. This goal should be achieved in 16 to 24 weeks. Since this patient has shown improvement, progress has been made, and treatment should continue. A drug-resistant strain is not likely to respond to therapy. Treatment failure is not evident.A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patient's provider to order?

• Abacavir/lamivudine/zidovudine (Trizivir)
• Efavirenz/emtricitabine/tenofovir (Atripla)
• Lamivudine/zidovudine (Combivir)
• Rilpivirine/emtricitabine/tenofovir (Complera)

C ~ Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patient's creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action?

• Instruct the patient to take the medication 60 minutes prior to meals.
• Notify the provider to discuss single-dose NRTI products.
• Request an order for once-daily dosing of this medication.
• Suggest that the patient increase fluid intake.

B ~ Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily.Increasing fluid intake will not affect this patient's symptoms.A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to

• avoid development of psychiatric comorbidities.
• prevent dizziness, sedation, and nightmares.
• reduce viral resistance.
• prevent severe rash and hepatotoxicity.

C ~ Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication.The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir

• allows decreasing the dosing from 3 times daily to twice daily.
• can lead to increased cholesterol and triglycerides.
• may worsen insulin resistance.
• will require increased dietary restrictions.

A ~ Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes?

• Consume a low-cholesterol diet.
• Consume more acidic foods.

• Take the pill on an empty stomach.
• Take the pill with fatty foods.

A ~ Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order?

• Administration of a high dose of corticosteroids
• Changing the regimen to a single antiretroviral drug
• Temporarily discontinuing the antiretroviral therapy
• Treating an underlying opportunistic infection

D ~ IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated.Changing or discontinuing the antiretroviral therapy regimen is not indicated.A patient who will begin antiretroviral therapy reports having trouble sticking with drug regimens in the past. Which action will the nurse take?

• Ask the patient's family members to administer the medications.
• Avoid discussing adverse effects to prevent focus on negative aspects of ART.
• Give a detailed list of medications and stress the need to adhere to the schedule.
• Offer written and verbal information about each drugs purpose.

D ~ Patients often are more motivated to adhere to a drug regimen if they understand the purpose of the medications. Patients should be encouraged to take responsibility for their medications. Side effects need to be discussed so patients can plan ways to manage these before they occur.The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patient's blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond?

• No treatment is necessary since the patient is receiving antiretroviral therapy.
• We will treat you if the patients VL is > 20 copies/mL.
• You will require 4 weeks of antiretroviral therapy.
• You will undergo HIV testing and will be treated if you are positive.

C ~ Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.A client with clinical AIDS is treated with a protease inhibitor. The highest priority nursing intervention

based on this medication is to monitor for incidence of:

• hepatic steatosis.
• hyperglycemia.
• urinary retention.
• coma.

B ~ An adverse reaction with the protease inhibitors is hyperglycemia and the development of diabetes mellitus.A client with HIV is treated with the nonnucleoside reverse transcriptase inhibitor (NNRTI) efavirenz (Sustiva). The nurse is aware that other agents may be used because of which significant problem with NNRTIs?

• Alopecia
• Resistance
• Coma
• Hepatic dysfunction

B ~ Resistance is a problem with the NNRTIs; therefore combination therapy is indicated.A client with a very low T4 count is placed on several medications to prevent infections. The nurse instructs the client to expect to be placed on which medication as a prophylactic agent to prevent herpes simplex?

• Ciprofloxacin (Cipro)
• Fluconazole (Diflucan)
• Acyclovir (Zovirax)
• Pentamidine (Nebupent)

C ~ Acyclovir is given to prevent herpetic infections.Which is important to consider when developing a plan with the client receiving antiretroviral therapy to ensure adherence to the therapeutic regimen?

• Make no association between taking medications with daily routine.
• Avoid discussing management of anticipated side effects.
• Ensure client has understanding of the purpose for each drug.
• Avoid confusing clients by telling them about drug actions.

C ~ Clients need to have a good understanding of the purpose, actions, side effects, and need for the medication. Clients will be more compliant if this information is worked into their daily routine.A child with AIDS is placed on antiretroviral therapy. The nurses instructions to the child and family

are based on the premise that the goals of antiretroviral therapy include:

• increasing viral load to detectable levels.
• slowing the decline in the number of CD4 cells.
• increasing resistance to opportunistic infections.
• decreasing the severity of opportunistic infections.

B ~ The goal of antiretroviral therapy includes slowing the decline in the number of CD4 cells.In teaching the client about Enfuvirtide (Fuzeon), the nurse would instruct the patient to watch for

and report:

• chronic diarrhea.
• injection site irritation.
• persistent arthralgia.
• heart block.