Clinical Judgment
A client with HIV and CD4 90 reports shortness of breath and O₂ saturation 86%. What is the first action?
Administer oxygen and assess respiratory status
Which infection most commonly occurs when CD4 < 200?
A. PCP pneumonia
B. Toxoplasmosis
C. Oral thrush
D. Cytomegalovirus
PCP is hallmark opportunistic infection below 200 CD4.
Goal of ART therapy?
A. Suppress viral load and restore immune function
B. Cure HIV infection
C. Decrease side effects only
D. Increase appetite and energy
Suppress viral load and restore immune function
Client newly diagnosed with HIV says, “Everyone will hate me.” Nurse’s best response:
A. “It sounds like you’re worried about stigma.”
B. “Don’t think that way.”
C. “You shouldn’t care what others think.”
D. “Just keep it private.”
“It sounds like you’re worried about stigma.”
Three primary transmission routes:
A. Sexual, parenteral, perinatal
B. Airborne, fecal-oral, vector
C. Droplet, contact, ingestion
D. Sweat, saliva, urine
Sexual, parenteral, perinatal
The nurse receives four HIV patients. Who should be assessed first?
A. Fever 99.8°F, CD4 600
B. Productive cough and O₂ sat 88%
C. Mild nausea, CD4 480
D. Fatigue and headache
Productive cough and O₂ sat 88%
White plaques on tongue that scrape off easily indicate:
A. Oral thrush
B. Leukoplakia
C. Herpetic lesion
D. Aphthous ulcer
Client on protease inhibitor develops jaundice and ↑AST/ALT. What’s next?
A. Hold drug and notify provider
B. Continue medication with food
C. Give acetaminophen
D. Recheck labs in a month
Hold drug and notify provider
Client with HIV expresses hopelessness. Priority?
A. Assess for suicidal ideation
B. Offer diversional activities
C. Discuss ART side effects
D. Encourage group exercise
Assess for suicidal ideation
Effectiveness of PrEP when taken daily?
A. Up to 99% reduction in sexual transmission
B. 50% reduction
C. 25% reduction
D. None—it treats HIV
Up to 99% reduction in sexual transmission
A client with HIV has temp 103°F, confusion, and neck stiffness. Priority action?
Notify provider — possible meningitis; initiate neuro checks and infection precautions
HIV client has fever, headache, photophobia, and stiff neck. Likely infection?
A. Cryptococcal meningitis
B. CMV
C. Toxoplasmosis
D. Kaposi sarcoma
Cryptococcal meningitis
Missed ART doses lead to which complication?
A. Viral resistance
B. Liver failure
C. Bone marrow suppression
D. Electrolyte imbalance
Viral resistance
Client with oral thrush and weight loss. Nursing action?
A. Administer antifungals and soft high-protein meals
B. Restrict oral intake
C. Provide mouthwash with alcohol
D. Delay meals until thrush clears
Administer antifungals and soft high-protein meals
Nurse gets needlestick from HIV-positive patient. First step?
A. Wash site and start PEP within 72 hours
B. Document only
C. Wait for serology
D. Apply alcohol and continue working
Wash site and start PEP within 72 hours
A client with HIV develops petechiae, nosebleeds, and platelets 25,000. Priority intervention?
Institute bleeding precautions
Purple, non-painful lesions on skin/mucous membranes indicate:
A. Kaposi sarcoma
B. Petechiae
C. Psoriasis
D. Drug rash
Kaposi sarcoma
Why is ART given as combination therapy?
A. Prevent viral resistance and attack multiple replication stages
B. Decrease cost of treatment
C. Shorten therapy duration
D. Reduce side effects
Prevent viral resistance and attack multiple replication stages
Stage 3 client with chronic diarrhea. Priority intervention?
A. High-calorie, high-protein small meals and monitor fluids
B. Encourage fasting to rest bowels
C. Limit fluid intake
D. Provide low-protein diet
High-calorie, high-protein small meals and monitor fluids
Pregnant client with HIV asks about breastfeeding. Nurse response?
A. Avoid breastfeeding; HIV can pass through breast milk
B. Breastfeed only if viral load is low
C. Pump milk and boil before feeding
D. Breastfeeding prevents transmission
Avoid breastfeeding; HIV can pass through breast milk
A client with AIDS is unconscious and has a DNR order. Family demands resuscitation. What should the nurse do?
Honor the DNR and explain the legal obligation to follow patient wishes
A client with CD4 < 50 reports blurred vision and floaters. Which infection is suspected?
A. Cytomegalovirus retinitis
B. Toxoplasmosis
C. HSV keratitis
D. Candidemia
Cytomegalovirus retinitis
Client on ART reports numbness and burning in feet. Nursing action?
A. Assess pain, administer analgesic, report to provider
B. Stop ART immediately
C. Encourage walking
D. Apply ice packs
Assess pain, administer analgesic, report to provider
Client refuses ART. Best approach?
A. Explore beliefs and provide education
B. Force medication administration
C. Notify ethics immediately
D. Ignore refusal
Explore beliefs and provide education
Client with undetectable viral load asks if condoms are still needed. Nurse says:
A. Yes, they protect against other STIs and viral rebound risk
B. No, it’s completely safe
C. Only with new partners
D. Only during menstruation
Yes, they protect against other STIs and viral rebound risk