NR 574 FINAL EXAM WEEK IMMUNOLOGICAL DISORDERS FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

NR 574 FINAL EXAM WEEK IMMUNOLOGICAL DISORDERS FINAL EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. A 28-year-old woman is seen in a sexually transmitted disease clinic and is diagnosed with Chlamydia trachomatis. An HIV antibody test is ordered. Which one of the following statements is TRUE regarding laboratory-based HIV antibody tests that are approved for use by the United States Food and Drug Administration? a. The IgG-sensitive antibody tests detect HIV sooner after infection than the IgM/IgG-sensitive antibody tests b. Recent inoculation with the influenza vaccine is a known cause of a false-pos-itive result c. The most common cause of a false-negative test is coinfection with hepatitis C virus d. The IgM/IgG-sensitive antibody tests detect HIV sooner after infection than HIV p24 antigen tests e. None of the IgM/IgG-sensitive antibody tests can detect HIV-2 Correct Answer Recent inoculation with the influenza vaccine is a known cause of a false-positive result (Correct answer) Rationale: The IgM/IgG-sensitive assays detect HIV sooner after infection than the IgG-sensitive assays. The laboratory-based IgG-sensitive assays detect HIV later after initial HIV acquisition than the IgM/IgG-sensitive assays. The most notable causes of a false-positive HIV antibody test are pregnancy, recent inoculation with influenza vaccine, autoimmune disorders, immunization with an investigational HIV-1 vaccine, hypergammaglobulinemia, receipt of gamma globulin, prior blood transfusions, HTLV-1/2 infection, and collagen vascular diseases. With HIV antibody tests, the most common cause of a false-negative test is acute HIV infection. 2. A 31-year-old woman has exposure to HIV after a condom broke while having vaginal sex with her partner who has HIV. She has follow-up HIV testing related to this exposure. Which one of the following best describes the window period? a. The Centers for Disease Control and Prevention (CDC) recommends using 45 days as the window period for laboratory based HIV-1/2 antigen-antibody immunoassays b. The CDC recommends using 90 days as the window period for laborato-ry-based HIV-1/2 antigen-antibody immunoassays c. The CDC recommends using 45 days as the window period for all laborato-ry-based IgM/IgG HIV-1/2 antibody immunoassays d. The window period is the time from HIV acquisition until HIV RNA becomes detectable in 10% or more of persons e. The window period is the time from HIV acquisition until HIV RNA becomes detectable in 50% or more of persons Correct Answer The CDC recommends using 45 days as the window period for all laboratory-based IgM/IgG HIV-1/2 antibody immunoassays (Correct answer) Rationale: The HIV window period is typically defined as the time between the acquisition of HIV and the time when a specific laboratory test will accurately detect HIV in almost all persons. Practically, the window period is used to rule out HIV infection after exposure. For example, the Centers for Disease Control and Prevention (CDC) recommends using 45 days as the window period for laboratory-based HIV-1/2 antigen-antibody immunoassays; this means that if the HIV-1/2 antigen-antibody test is negative 45 days after an exposure to HIV, the person is considered not infected with HIV from the related exposure. The window period depends on the diagnostic test used. 3. A 22-year-old man presents for follow-up after a recent diagnosis of HIV. He has an initial CD4 count of 390 cells/mm3 and his HIV RNA level is 46,120 copies/mL; a baseline genotype resistance assay shows no evidence of antiretroviral resistance. He is motivated to start antiretroviral therapy and states that he can take medications without issue. According to the Adult and Adolescent Antiretroviral (ARV) Guidelines, which one of the following best describes the recommendations for starting antiretroviral therapy in treatment-naïve persons with HIV? Antiretroviral therapy is recommended for all persons with HIV Antiretroviral therapy is recommended only for persons with HIV who have a documented decline in CD4 count of at least 100 cells/mm3 Antiretroviral therapy is recommended only for persons with HIV who have a CD4 count less than 350 cells/mm3 Antiretroviral therapy is recommended only for persons with HIV who have a CD4 count less than 200 cells/mm3 Antiretroviral therapy is recommended only for persons with HIV who have an HIV RNA level greater than 30,000 copies/mL Correct Answer Antiretroviral therapy is recommended for all persons with HIV (Correct answer) Rationale: The following summarizes the key recommendations in the Adult and Adolescent ARV Guidelines regarding the timing of initiation of antiretroviral therapy for treatment-naïve individuals with HIV: Antiretroviral therapy is recommended for all individuals with HIV to reduce morbidity and mortality and to prevent the transmission of HIV to others (AI). Initiate antiretroviral therapy immediately (or as soon as possible) after HIV diagnosis in order to increase the uptake of ART and linkage to care, decrease the time to viral suppression for individual clients, and improve the rate of virologic suppression among persons with HIV (AII). The recommendation to initiate therapy in all persons with HIV infection to reduce the morbidity and mortality associated with HIV infection is based on multiple earlier studies that showed benefits in persons with CD4 counts less than 500 cells/mm3 and more recent data from the NA-ACCORD, START, and TEMPRANO trials that showed the clinically-relevant benefit of starting antiretroviral therapy in persons with greater than 500 cells/mm3. The recommendations regarding the use of antiretroviral therapy to prevent HIV transmission are based on multiple studies that indicate antiretroviral therapy dramatically lowers the risk of sexual transmission of HIV. 4. A 51-year-old transgender woman (she/her/hers) with HIV has been stable for the last 3 years on an antiretroviral regimen of darunavir-cobicistat and tenofovir DF-emtricitabine. Despite changing to a healthier diet and increasing her exercise, lipid values remain elevated Correct Answer total cholesterol 268 mg/dL, low-density lipoprotein (LDL) 198 mg/dL, high-density lipoprotein (HDL) 35 mg/dL, and triglycerides 220 mg/dL. She has a strong family history of cardiovascular disease, and her father had a myocardial infarction at age 52. She does not want to consider modifying the antiretroviral regimen but agrees to start lipid-lowering therapy. Which one of the following HMG-CoA reductase inhibitors ("statins") is contraindicated for use in this woman? a. Pravastatin b. Atorvastatin c. Simvastatin d. Pitavastatin e. Rosuvastatin Correct Answer Simvastatin (Correct answer) Rationale: Significant drug interactions can occur with the concomitant use of protease inhibitors and HMG-CoA reductase inhibitors. Among the protease inhibitors, ritonavir has the most potent inhibition of the cytochrome p450 enzymes and thus is most likely to cause significant interactions with statins. Simvastatin and lovastatin are contraindicated with all protease inhibitors. Atorvastatin, pitavastatin, pravastatin, and rosuvastatin are preferred statins in clients on ritonavir containing regimens, with the caveat that with most statin and ritonavir-boosted protease inhibitor combinations, the lowest possible starting dose of the statin should be used and the dose titrated upward to the desired dose while monitoring closely for signs of toxicity.