ACRN Study Set - All possible questions with verified answers

ACRN Study Set Lipoatrophy, the subcutaneous fat wasting of the face and buttocks, is believed to be caused by which of the following antiretroviral medication? - Tenofovir alafenamide (TAF) - Tenofovir (TDF) - Abacavir (ABC) - Zidivodine (ZDV) - Correct answer Zidivodine (ZDV)" "Proximal renal tubulopathy and elevated creatinine are an adverse event related to the use of what antiretroviral medication? - Tenofovir (TDF) - Tenofovir alafenamide (TAF) - Triumeq (ABC+3TC+DTG) - Dolutegravir (DTG) - Correct answer Tenofovir (TDF)" "If a person with HIV infection has painless flesh-colored papules over the face and neck, which of the following dermatological conditions should be suspected? - Molluscum contagiosum - Psoriasis - Kaposi's sarcoma - Seborrhea - Correct answer Molluscum contagiosum" "What adverse event is related to the use of Abacavir? - Myocardial infarction, ischemic stroke - Central nervous system/neuropsychiatric symptoms - Dyslipidemia - Cardiac QTc interval Prolongation - Correct answer Myocardial infarction, ischemic stroke" "You have a patient who newly diagnosed with HIV and HCV. She tells you that she is interested in pursuing treatment for HCV immediately as she has a friend who experienced complications from the disease. Which circumstance would most strongly warrant the deferment of HCV treatment for this patient? - Your patient's CD4 is 200 cells/mm3 - Your patient is an active intravenous drug user - Your patient is on opiod substitution therapy (OST) (methadone/buprenorphine) and you are concerned about potential drug-drug interactions - Your patient has advanced liver fibrosis - Correct answer Your patient's CD4 is 200 cells/mm3 Rationale: Improved immune status should be the priority for patients with a CD4 count below 200 cells/mm3. Research shows us that patients with active substance abuse do not have worse rates of SVR as compared to patients without active substance abuse. However, these patients will likely need increased support and adherence follow up. There are not significant drug-drug interactions between DAAs and OST. References: U.S. Department of Health and Human Services. 2017. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV: Considerations for Antiretroviral Use in Patients with Coinfections." "Your patient, who is co-infected with HIV/HBV, wants to know if she can start taking what she heard is the "newer, safer" version of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), instead. You explain: - TAF is not currently FDA approved for the treatment of HBV - TAF is currently FDA approved for the treatment of HIV/HBV coinfection - TAF is not currently FDA approved for the treatment of HIV/HBV coinfection - TAF is currently FDA approved only for PrEP - Correct answer TAF is currently FDA approved for the treatment of HIV/HBV coinfection Rationale: While switching from TDF to TAF is acceptable and preferable in many cases, per DHHS guidelines (2017), discontinuation of ART with anti-HBV activity may cause serious hepatocellular damage resulting from reactivation of HBV. Therefore, DHHS recommends that patients should be advised against stopping these medications and be carefully monitored during interruptions in HBV treatment. References: U.S. Department of Health and Human Services. 2017. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV: Considerations for Antiretroviral Use in Patients with Coinfections." "What antiretroviral therapy needs to be taken with a meal containing 400 calories or more? - Atripla - Triumeq - Stribild - Complera - Correct answer Complera" "Hypersensitivity reaction, or Stevens-Johnson syndrome, is an adverse event which can occur in an HLA B 5701+ patient taking which antiretroviral? - Efavirenz (EFV) - Abacavir (ABC) - Lamivudine (3TC) - Dolutegravir (DTG) - Correct answer Abacavir" "Which of the following is the first priority when admitting a patient suspected of having Mycobacterium tuberculosis? - Perform PPD testing - Initiate airborne isolation - Obtain chest X-ray - Collect sputum for acid-fast bacillus - Correct answer Initiate airborne isolation" "A woman who is HIV-positive tells the nurse that she is considering becoming pregnant and wonders if her baby will be infected. Which of the following is the most appropriate response by the nurse? - "Your baby will be HIV-positive." - "Pregnancy will make your HIV infection worse." - "Appropriate medication during pregnancy will reduce risk to your infant." - "You should not consider becoming pregnant." - Correct answer "Appropriate medication during pregnancy will reduce risk to your infant."" "Which of the following is distinctive of the secondary stage of syphilis? - Chancre - Gummas - Organ destruction - Palmer/planter rash - Correct answer Palmer/planter rash" "Emotional distress in persons living with HIV disease is most likely due to: - Dementia - Medication side effects - Suicidal ideation - Stigmatization - Correct answer Stigmatization" "The life cycle is the series of steps that HIV follows to multiply in the body. The process begins when HIV encounters a CD4 cell. Select the choice that demonstrates the correct order: - Reverse transcription, binding, assembly, budding, replication, integration - Binding, fusion, reverse transcription, integration, replication, assembly, budding - Replication, binding, fusion, assembly, budding, reverse transcription, integration - Fusion, assembly, budding, reverse transcription, integration, replication, binding - Correct answer Binding, fusion, reverse transcription, integration, replication, assembly, budding" "People living with HIV have significantly increased frequency and severity of both suicidal ideation and thoughts of death. Factors protecting against suicide include all of the following, except: - Lack of coping mechanisms - Cultural or religious beliefs against suicide - No specific plan for suicide - Strong psychosocial support - Correct answer Lack of coping mechanisms" "Using drugs or alcohol is most likely to enhance HIV transmission because: - Individuals may overdose - Drugs and alcohol directly affect the immune system - Risk reduction may not be practiced while under the influence - Drug and alcohol use may not be seen as the primary problem - Correct answer Risk reduction may not be practiced while under the influence" "This is the second of seven steps in the HIV life cycle. After HIV attaches itself to a host CD4 cell, the viral envelope ___________ with the CD4 cell membrane. - Binds - Integrates - Fuses - Replicates - Correct answer Fuses" "A male patient diagnosed two years ago with HIV infection presents for initial treatment reporting insomnia, feelings of guilt, and decreased appetite for several weeks. Which of the following should most likely be suspected? - Depression - Hypogonadism - Heroin withdrawal - Wasting syndrome - Correct answer Depression" "What is a major barrier to the retention of HIV-infected women in care? - They are often not as ill as men - They are more often in denial about their diagnosis - They more often defer their own needs to those of their families - They often do not consider health care a priority - Correct answer They more often defer their own needs to those of their families" "What is the MOST dominant co-receptor for the transmission and replication of HIV? CCR5 Gp210 Protein-coupled receptor Ligand-gated receptor H - Correct answer CCR5" "The CDC estimates that the percentage of transgender people who received a new HIV diagnosis in 2013 was more than 3 times the national average. What patient population specifics should the nurse take into account when conducting their nursing assessment? - All other responses - Unsafe injection of hormones or drugs is not uncommom - There are high rates of suicide among this patient population - Domestic violence rates are high and underreported - Correct answer All other responses" "Which of the following are the most significant reasons adolescents are at increased risk for HIV infection? - Spontaneity, experimentation, unsafe sex, single partner - Denial of mortality, experimentation, unsafe sex, single partner - Denial of mortality, inexperience, spontaneity, experimentation - Denial of mortality, inexperienced, planned sex, multiple partners - Correct answer Denial of mortality, inexperience, spontaneity, experimentation" "A diagnosis of HIV/AIDS is often unsuspected or delayed in older individuals as a result of: - The nurse's assumption that older persons are unable to remember important details - The nurse's failure to elicit an accurate sexual health history - The unwillingness of older adults to discuss their sexual health - Language barriers between the nurse and the patient - Correct answer The nurse's failure to elicit an accurate sexual health history" "In the United States, the majority of women impacted by the HIV epidemic are: - Caucasian - African American - Asian American - Hispanic/Latino - Correct answer African American" "A woman in her second trimester of pregnancy is admitted with multiple abscesses. During the history and physical, she reveals a long history of cocaine and heroin injection use. She last used a mixture of cocaine/heroin six hours ago. She has had no prenatal care during the current pregnancy. She has a history of hepatitis B, but has never been tested for HIV and would like to be tested. Which of the following is the most appropriate initial care? - Monitor for symptoms of pain and drug withdrawal - Draw blood for HIV testing and hepatitis screen - Provide genetic counseling - Recommend use of zidovudine (Retrovir) - Correct answer Monitor for symptoms of pain and drug withdrawal" "A woman in her second trimester of pregnancy is admitted with multiple abscesses. During the history and physical, she reveals a long history of cocaine and heroin injection use. She last used a mixture of cocaine/heroin six hours ago. She has had no prenatal care during the current pregnancy. She has a history of hepatitis B, but has never been tested for HIV and would like to be tested. Which of the following is indicated if the woman's HIV antibody test result is positive? - Discuss benefits and risks of antiretroviral therapy - Tell her the newborn will not be at risk for HIV - Tell her she has AIDS - Advise her to breastfeed her newborn - Correct answer Discuss benefits and risks of antiretroviral therapy" "Which of the following vaccines is contraindicated for patients living with HIV whose CD4 count is 200? - MMR (measles, mumps, rubella) - Fluzone (influenza) - Gardasil-9 (human papilloma virus) - Menactra (meningococcal) - Correct answer MMR (measles, mumps, rubella)" "Which of the following is most likely to result from administering Rifampin to a patient on Atazanavir boosted with Ritonavir? - Doubles the trough levels of Atazanavir resulting in hepatoxicity - Anemia - No drug interactions between Rifampin and Atazanavir/Ritonavir - Severe nausea - Correct answer Doubles the trough levels of Atazanavir resulting in hepatoxicity" "During initial encounters with undocumented HIV infected immigrants, which of the following interventions is most appropriate? - Recommend they return to their home country to receive HIV treatment - Refer them to the local health department to access public assistance programs - Instruct them to carry the name and telephone number of an immigration advocate at all times - Initiate a referral to Immigration and Naturalizaion Services - Correct answer Instruct them to carry the name and telephone number of an immigration advocate at all times" "Which of the following persons can legally have the HIV antibody test performed without their consent? - Minor child seeking health care - Adult in residential drug treatment - Illegal alien seeking medical care - Active member of armed forces - Correct answer Active member of armed forces" "Informed consent for HIV testing is used to: - Authorize the provider to discuss results with the patient's family. - Authorize provider to give test results over the telephone - Give permission to disclose test results to other providers - Assist patient in understanding what the test means - Correct answer Assist patient in understanding what the test means" "Which of the following is a breach of patient confidentiality? - Using code numbers to label laboratory specimens - Discussing patient's condition with family members - Placing patient charts out of public view at a nurses station - Disclosing patient's name when making social service referrals - Correct answer Discussing patient's condition with family members" "Which of the following is a parasite that causes brain lesions in people with HIV infection? - Tapeworm - Mycobacterium - Toxoplasma - Barnacles - Correct answer Toxoplasma" "The nurse must be aware that HIV specific criminal laws and policies: - Are not in existence anywhere in the U.S. at this time - Are uniform nationwide - Are only accessible to law enforcement - Vary state by state - Correct answer Vary state by state" "Health care workers who receive a deep needlestick injury should: - Encourage bleeding by milking the site - Scrub the site with povidone-iodine solution - Wash the site with soap and water - Immediately start PEP - Correct answer Wash the site with soap and water" "Which of the following solutions is recommended for use as a germicide to inactivate HIV? - 10% household bleach - 70% benzalkonium chloride - 10% povidone-iodine - 70% isopropyl alcohol - Correct answer 10% household bleach" "During the assessment of an HIV-infected patient, the nurse must be able to: - Acknowledge feelings regarding cultural, sexual, behavioral, and economic issues -Inform the patient of background in HIV and experience in the field - Assess the living arrangements of the patient - Communicate with patient's family - Correct answer Acknowledge feelings regarding cultural, sexual, behavioral, and economic issues" "HIV transmission has been most often associated with which of the following? - Blood transfusions - Injection drug use - Perinatal transmission - Unprotected sexual activity - Correct answer Unprotected sexual activity" "What is the most important nursing response for a client with a newly established AIDS diagnosis and vague thoughts about suicide? - Arrangement for constant observation - Referral for antidepressant medication - Further assessment for suicidal risk - Immediate referral to psychiatric clinician - Correct answer Further assessment for suicidal risk" "A viral load of 7,500 copies indicates - Viral suppression - Need for PCP prophylaxis - Progression of disease pathology - Presence of datable viral particles in the blood - Correct answer Progression of disease pathology" "Infants born to HIV-seropositive mothers are likely to - Not become infected in utero - Remain HIV-seropositive - Develop AIDS within the first year of life - Become seronegative if they are not infected. - Correct answer Become seronegative if they are not infected." "An infant is born and tests positive for HIV. Which of the following is true about highly active anti-retroviral therapy (HAART) for this patient? - Treatment for adults and children should be the same - Highly active anti-retroviral therapy (HAART) is highly toxic to infants and should not be started - Treatment is suggested for infants less than 1 year but the best approach is not known - Monotherapy for HIV is preferred to multiple drug regimens - Correct answer Treatment is suggested for infants less than 1 year but the best approach is not known" "A hospitalized patient presents with symptoms of agitation, dilated pupils, nausea and vomiting. He has been requesting medication for vague pain. Which of the following drugs is the patient likely to be withdrawing from? - Marijuana - Nitrous oxide - Ketamine - Opioids - Correct answer Opioids" "Cryptococcus is the most common fungal infection of which disease condition? - Sarcoidosis - Liver organ transplantation - AIDS - Multiple myeloma - Correct answer AIDS" "A patient with HIV is found to have cryptococcal meningitis. The patient should be treated with amphotericin and which other drug? - Trimethoprim - Ketoconazole - Flucytosine - Nystatin - Correct answer Flucytosine" "Which of the following antiretrovirals can cause myopathy? - Lamivudine - Zidovudine - Raltegravir - Etravirine - Correct answer Zidovudine" "Pneumocystis jiroveci pneumonia occurs most often in persons with which diagnosis? - Alcoholic liver disease - Acquired immune deficiency syndrome - Pulmonary carcinoma - Pre-existing tuberculosis - Correct answer Acquired immune deficiency syndrome" "A patient who has acquired microsporidia will most likely develop which of the following conditions? - Laryngitis - Pneumonia - Enteritis - Arthritis - Correct answer Enteritis" "Which of the following factors is most predictive of who will develop HIV associated nephropathy? - Age of seroconversion - Duration of disease - Perinatally acquired disease - African heritage - Correct answer African heritage" "What region of the world has the highest number of people living with HIV/AIDS? - South America - Southeast Asia - Sub-Saharan Africa - Central America - Correct answer Sub-Saharan Africa" "In the United States, which of the following is most characteristic of the epidemiology of HIV/AIDS? - HIV/AIDS disproportionately affects African Americans and Hispanics/Latinos - Heterosexual HIV transmission is decreasing - Heterosexual transmission is increasing more rapidly in western than in southern regions - HIV transmission among younger men who have sex with men is decreasing - Correct answer HIV/AIDS disproportionately affects African Americans and Hispanics/Latinos" "In people living with HIV, substance use is associated with all of the following, except: - Hastens the diseases progression - Has no effect on overall consequences of HIV - Increases risk of transmission - Affects adherence to ARV's - Correct answer Has no effect on overall consequences of HIV" "At the end of a nurse visit for mild knee pain, a 24-year-old married woman requests an HIV test. Review of her HIV risk factors confirms that neither she nor her husband have injected drugs. She reports multiple sex partners in college and fears that her husband may have had bisexual relationships in the past. She has had no extramarital relationships and believes that her husband is also monogamous. Which of the following is the most appropriate action? - Provide counseling and arrange for a HIV test - Get a CD4 cell count to determine need for HIV testing - Explain that the expense of an HIV test is unjustified - Get a viral polymerase chain reaction (PCR) test to assess HIV status - Correct answer Provide counseling and arrange for a HIV test" "Which of the following is the best example of the Harm Reduction Model in caring for an injecting drug user? - Referral to a methadone program - Referral to a drug rehabilitation program - Referral to a 12-step program - Referral to a needle-exchange program - Correct answer Referral to a needle-exchange program" "What region of the world has the highest number of people living with HIV/AIDS? - Central America - South America - Sub-Saharan Africa - Southeast Asia - Correct answer Sub-Saharan Africa" "In the United States, which of the following is most characteristic of the epidemiology of HIV/AIDS? - Heterosexual transmission is increasing more rapidly in western than in southern regions - HIV/AIDS disproportionately affects African Americans and Hispanics/Latinos - Heterosexual HIV transmission is decreasing - HIV transmission among younger men who have sex with men is decreasing - Correct answer HIV/AIDS disproportionately affects African Americans and Hispanics/Latinos" "Which of the following is the best example of the Harm Reduction Model in caring for an injecting drug user? - Referral to a 12-step program - Referral to a drug rehabilitation program - Referral to a methadone program - Referral to a needle-exchange program - Correct answer Referral to a needle-exchange program" "Chemoprophylaxis after occupational exposure to HIV is most strongly recommended when there is: - Contact with high volume of blood on intact skin - A puncture wound with a needle used to draw blood - Contact with vaginal secretions on open skin - Exposure of eyes to urine - Correct answer A puncture wound with a needle used to draw blood" "Which of the following proteins binds directly to the CD4 receptor? - gp120 - gp41 - p17 - p24 - Correct answer gp120" "Which of the following is the most characteristic of HIV? - It is a fragile virus outside the body - Is an extremely hardy virus outside the body - Cannot be killed by routine sterilization methods - Is transmitted by airborne pathogens - Correct answer It is a fragile virus outside the body" "Which of the following is a function of the CD4+ lymphocyte? - Phagocytize microorganisms - Activate natural killer cells - Differentiate into a plasma cell to release immunoglobulins - Increase blood flow to a cut in the skin - Correct answer Activate natural killer cells" "What is the normal ratio of CD4+ to CD8+ lymphocytes? - 1:2 - 1:3 - 2:1 - 3:1 - Correct answer 2:1" "Which of the following interpretations is MOST justifiable when a patient's CD4+ lymphocyte count is 200mm3? - This is the normal range CD4+ lymphocyte count - The goal is for all patients to have CD4+ lymphocyte counts between 100mm and 200mm - CD8+ suppressor cells have been activated - An immune dysfunction is present - Correct answer An immune dysfunction is present" "What is the Centers for Disease Control and Prevention definition of AIDS in an adult by CD4 T cell count? - 800-1000/mm3 - 201-499/mm3 - 500-799/mm3 - 0-200/mm3 - Correct answer 0-200/mm3" "Which of the following would be the most appropriate diagnostic test for infants born to HIV infected mothers? - HIV polymerase chain reaction (PCR) - p24 antigen - Western blot - Immunoglobulins - Correct answer HIV polymerase chain reaction (PCR)" "The CDC estimates that about 1/4 of HIV-infected persons in the United States are also infected with Hepatitis C virus (HCV). The nurse is aware that liver damage progresses more rapidly in this patient population. Therefore, the patient is at increased risk for all the following, except: - Cirrhosis - Insulin resistance - Hearing loss - Hepatocellular carcinoma - Correct answer Hearing loss" "Which of the following is most likely to improve medication adherence? - Engage the patient in developing the plan - Customize the medication regimen to patient's ADLs - All other responses - Simplify the medication regimen - Correct answer All other responses" "Which of the following agents is an integrase inhibitor? - Selzentry - maraviroc - Tivicay - dolutegravir - Emtriva - emtricitabine - Viread - tenofovir disproxil fumarate - Correct answer Tivicay - dolutegravir" "St. John's wort is CONTRAINDICATED when administered with: - fusion inhibitor agents - protease inhibitor agents - nonnucleoside reverse transcriptase inhibitors - nucleoside reverse transcriptase inhibitors - Correct answer protease inhibitor agents" "A patient with AIDS who has a positive Quantiferon Gold test should be: - evaluated for pulmonary tuberculosis - evaluated for treatment of Hepatitis C - treated for pneumocystis jiroveci - placed in reverse isolation when hospitalized - Correct answer evaluated for pulmonary tuberculosis" "Trimethoprin-sulfamethoxazole (Bactrim) is the prophylaxis of choice for which of the following opportunistic infections? - Pneumocystis jiroveci - Both pneumocystis jiroveci and toxoplasmosis - Toxoplasmosis - Neither pneumocystis jiroveci and toxoplasmosis - Correct answer Both pneumocystis jiroveci and toxoplasmosis" "Which of the following is commonly being used to treat hepatitis C in patients living with HIV? - Baraclude (entecavir) - Harvoni (ledipasvir/sofosbuvir), Baraclude (entecavir) and Interferon + ribavirin - Interferon + ribavirin - Harvoni (ledipasvir/sofosbuvir) - Correct answer Harvoni (ledipasvir/sofosbuvir)" "Which of the following is associated with the occurrence of Kaposi's sarcoma in people living with HIV? - Human herpesvirus 8 (HHV8) - Herpes simplex virus type II (HSVII) - Epstein-Barr virus (EBV) - Cytomegalovirus (CMV) - Correct answer Human herpesvirus 8 (HHV8)" "Patients with toxoplasmosis encephalitis could be expected to exhibit the following symptoms, except: - Seizures - Peripheral neuropathy - Confusion/altered consciousness - Severe headache - Correct answer Peripheral neuropathy" "Your patient, who is co-infected with HIV and Hepatitis C virus (HCV), just recently achieved sustained virologic response (SVR) after completing 12 weeks of directly acting antiviral (DAA) treatment for hepatitis C. He wants to know if he is immune to hepatitis C now that he is cured. You respond: - No, you can still get reinfected with HCV if you engage in high-risk behaviors - No, you will still need to get vaccinated to acquire protective immunity for HCV - It depends on what your pre-treatment HCV RNA level (viral load) was - Yes, you now have protective immunity to HCV - Correct answer No, you can still get reinfected with HCV if you engage in high-risk behaviors" "In the United States patients with low CD4 counts should avoid which of the following: - Dairy products - Peanut butter - Overcooked vegetables - Rare beef or veal - Correct answer Rare beef or veal" "You have a patient who newly diagnosed with HIV and HCV. She tells you that she is interested in pursuing treatment for HCV immediately as she has a friend who experienced complications from the disease. Which circumstance would most strongly warrant the deferment of HCV treatment for this patient? - Your patient is on opioid substitution therapy (OST) (methadone/buprenorphine) and you are concerned about potential drug-drug interactions - Your patient is an active intravenous drug user - Your patient's CD4 is 200 cells/mm3 - Your patient has advanced liver fibrosis - Correct answer Your patient's CD4 is 200 cells/mm3" "Your patient, who is co-infected with HIV/HBV, wants to know if she can start taking what she heard is the "newer, safer" version of tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), instead. You explain: - TAF is currently FDA approved for the treatment of HIV/HBV coinfection - TAF is not currently FDA approved for the treatment of HIV/HBV coinfection - TAF is not currently FDA approved for the treatment of HBV - TAF is currently FDA approved only for PrEP - Correct answer TAF is currently FDA approved for the treatment of HIV/HBV coinfection" "Hypersensitivity reaction, or Stevens-Johnson syndrome, is an adverse event which can occur in an HLA B 5701+ patient taking which antiretroviral? - Dolutegravir (DTG) - Efavirenz (EFV) - Abacavir (ABC) - Lamivudine (3TC) - Correct answer Abacavir (ABC)" "Which of the following is the first priority when admitting a patient suspected of having Mycobacterium tuberculosis? - Initiate airborne isolation - Collect sputum for acid-fast bacillus - Obtain chest X-ray - Perform PPD testing - Correct answer Initiate airborne isolation" "Which of the following is distinctive of the secondary stage of syphilis? - Chancre - Gummas - Organ destruction - Palmer/planter rash - Correct answer Palmer/planter rash" "This is the second of seven steps in the HIV life cycle. After HIV attaches itself to a host CD4 cell, the viral envelope ___________ with the CD4 cell membrane. - Integrates - Fuses - Replicates - Binds - Correct answer Fuses" "