Acquired Immuno Deficiency Syndrome (AIDS) - Answers and Rationale

1.     Answer D

The human immunodeficiency virus (HIV) is transmitted from mother to child via the transplacental route, but a Cesarean section delivery isn't necessary when the mother is HIV-positive. The use of birth control will prevent the conception of a child who might have HIV. It's true that a mother who is HIV-positive can give birth to a baby who is HIV-negative.

2.      Answer C

Most children infected with HIV develop symptoms within the first 9 months of life. The remainder of these infected children become symptomatic sometime before age 3. Children, with their immature immune systems, have a much shorter incubation period than adults. Options A, B, and D are incorrect.

3.    Answer B

A positive antibody test in a child younger than 18 months indicates only that the mother is infected because maternal immunoglobulin G antibodies persist in infants for 6 to 9 months and, in some cases, as long as 18 months. A positive enzyme-linked immunosorbent assay (ELISA) does not indicate true infection.

4.    Answer D

QUESTION: What does it mean if a person is HIV positive?
STRATEGY: Think about each answer choice. Is it true about AIDS?
NEEDED INFO: AIDS (acquired immunodeficiency syndrome): caused by immunodeficiency virus (HIV). Alters functioning of immune system. Transmission: contact with blood, and body fluids (semen). Test which detects presence of antibodies: enzyme-linked immunosorbent assay (ELISA). Test that confirms presence of virus: Western Blot.
CORRECT ANSWER: (D) HIV virus is considered infected and infectious (A) not true; AIDS: defined as presence of complications (such as opportunistic infections--Pneumocystis pneumonia) from HIV virus (B) not completely certain; Aids Related Complex (ARC) has symptoms (fever, drenching night sweats, weight loss, fatigue, lymphadenopathy) without opportunistic infections (C) no test determines exposure; only detects infection

5.    Answer A

While all these nursing diagnoses are appropriate for the client with AIDS, Impaired gas exchange is the priority nursing diagnosis for the client with P. carinii pneumonia. Airway, breathing, and circulation take top priority with any client. 

6.   Answer C

C: The nurse recognizes the client's pain, hopelessness, and sense of loss related to his condition and the loss of his friend and encourages him to express his feelings. Giving the client permission to talk about his feelings of sadness, loss, and hopelessness and listening to him is an important nursing intervention for the dying client. 
A: This statement diverts attention from the content of the client's statements and blocks expression of feelings. 
B: "Don't give up" is a type of pep talk that ignores the client's feelings. 
D: This statement ignores the client's needs and inhibits his expression of feelings.

7.     Answer C

The preschool child will begin to conceptualize the death process as involving physical harm. A child from birth to 2 years of age will be unable to grasp the concept of illness and death. A school-aged child will begin to understand that something is wrong. An adolescent will express fear, withdrawal, and denial.

8.     Answer A

The AIDS virus is spread by direct contact with blood or blood products and by sexual contact. Children with hemophilia are at risk for AIDS because of the factor VIII concentrate infusions they receive. These concentrates are derived from larger quantities of pooled plasma, exposing recipients to thousands of blood donors. However, current testing of blood and blood products has reduced the risk of AIDS virus transmission. 

There is no evidence that casual contact between infected and uninfected people transmits the HIV virus. 

All venipunctures for blood specimens in hospitals and clinics are performed with sterile disposable needles. Because the needles are sterile, they cannot be a source of HIV transmission.

Exposure to others in a waiting room is considered casual contact. There is no evidence that casual contact between infected and uninfected people transmits the HIV virus. 

9.     Answer A

This statement reflects values and beliefs regarding homosexuality as being bad and deserving of punishment.

There is not enough evidence presented to justify drawing this conclusion.

There is not enough evidence presented to justify drawing this conclusion.

Although this may be true, no information is given to suggest that the nursing assistant has been assigned to care for this client.

10.   Answer B

Nebulizer pieces are cleaned with warm water after each treatment and allowed to air dry. They are soaked in white vinegar and water for 30 minutes at the end of each day. Options A, C, and D are inaccurate and would damage the nebulizer equipment.

11.  Answer A

The client is in the anger or "why me" stage; encouraging the expression of feelings will help the client resolve them and move toward acceptance. 

This does not reflect on what the client said; introducing the topic of death may not be therapeutic. 

This abdicates the responsibility of talking with the client; suggesting speaking with a minister ignores the client's present concerns. 

This is judgmental, which may precipitate feelings of guilt and block the nurse-client relationship.

12.   Answer D

True infections in infants are confirmed by the detection of HIV by a p24 antigen assay, virus culture of HIV, or polymerase chain reaction. A Western blot confirms the presence of HIV antibodies. The CD4-i- count indicates how well the immune system is working. A chest x-ray evaluates the presence of other manifestations associated HIV infection such as pneumonia. 

13.   Answer B

The risk would depend on the spouse's prior behavior. 

Equipment used is disposable; the donor does not come into contact with anyone else's blood.

An individual may be infected for many weeks before testing positive for the antibodies; the individual could still transmit the virus. 

Condoms offer some protection but are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. " (SR 1403)

14.   Answer D

With AZT toxicity, the child would demonstrate agitation, restlessness, and insomnia, not fatigue and lethargy. 

This is usually a response to the disease rather than the therapy. 

Urinary output is unrelated to AZT toxicity; a decreased urinary output can be related to a decreased fluid intake, vomiting, and diaphoresis associated with fever.

AZT can cause life-threatening blood dyscrasias including thrombocytopenia. " 

15.   Answer C

Anergy testing determines the level of immune response an individual has to common microbes. A normal response is a local skin reaction to all the antigens injected intradermally. Absence of a response within 3 days suggests the individual is immunodeficient and can't produce a normal immune response. It doesn't imply nonexposure to the antigens, which are environmentally prevalent. Demonstration of antibodies to the antigens would be a positive skin reaction. An expected reaction to the antigens isn't considered an allergic or hypersensitive reaction. 

16.   Answer C

The most common opportunistic infection of children infected with HIV is Pneumocystis carinii pneumonia, which occurs most frequently between the ages of 3 and 6 months, when HIV status may be indeterminate. Lymphoid interstitial pneumonia is a form of chronic pneumonitis and is also characteristic of HIV infection; however, it is not the most common opportunistic infection. Although gastrointestinal disturbances and neurological abnormalities may occur in the child with HW infection, options A and B are not specific opportunistic infections noted in the HIV-infected child. 

17.   Answer B

All children have a high risk for injury because of their curiosity, inexperience, and lack of judgment. 

Children with AIDS have a dysfunction of the immune system (depressed or ineffective T cells, B cells, and immunoglobulins) and are susceptible to opportunistic infections. 

Although children with AIDS are most likely small for their ages, altered growth and development are not as life threatening as an infection. 

Although this can occur in children with AIDS, the prevention of infection is the priority.

18.   Answer C

AIDS clients must follow safer-sex practices to prevent transmission of the human immunodeficiency virus. Although avoiding the use of alcohol and illicit drugs is helpful, the most important point the nurse can make is that drug users can best avoid transmission by using clean needles and disposing of used needles. The AIDS client has no legal obligation to tell anyone about an AIDS diagnosis.

19.   Answer A

A: Pneumocystis carinii pneumonia (PCP) is an opportunistic infection that develops in patients with AIDS because the regulators of the immune system are destroyed by the HIV virus. The pathogens responsible for opportunistic infection are ubiquitous. Pneumocystis carinii pneumonia is in the air we breathe. People with intact immune systems do not become sick from this organism. Morbidity and mortality from this complication has been reduced by prophylactic drug treatment.

B: Most opportunistic infections result from secondary reactivation of previously acquired pathogens rather than from a new or primary infection. Most people become infected with Pneumocystis carinii pneumonia in the pre-school years and the child's intact immune system brings it under control. The organism remains dormant in the person's body and can be reactivated when immunodeficiency occurs.

C: The pathogen responsible for PCP is airborne and can be found in the lungs of humans and animals. Lifetime suppressive therapy with antibiotics is given to people with PCP to keep the infection under control. Helping patients comply with the antibiotic regimen is an essential part of the nursing care plan. 

D: PCP is an airborne organism. It is not acquired from unprotected sex with an infected individual.

20.   Answer D

In a client with AIDS, deterioration of the central nervous system (CNS) can lead to AIDS-related dementia. Because this type of dementia impairs cognition and judgment, it places the client at risk for injury. Although self-care deficit and dysfunctional grieving can be associated with AIDS, they don't take precedence for a client with AIDS-related dementia. Because CNS deterioration results from infection — not altered tissue perfusion — Ineffective cerebral tissue perfusion isn't an appropriate diagnosis.

21.   Answer D

Transmission of HIV can occur through breast milk, so breast-feeding should be discouraged in this case.

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