Adult-Gerontology Acute Care Nurse
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
1. A 28-year-old male patient presents to his infectious disease specialist
with complaint of headaches, malaise, fever, and night sweats for the past
week. He is homosexual and has one monogamous partner. He believes his
partner is monogamous as well. He has been diagnosed with HIV in the past
6 months and his last CD4 count was 400 cells/μL 3 months prior. His current
treatment includes dolutegravir, abacavir, and lamivudine. On exam, he is
found to have nontender skin lesions with firm, nodular, purplish
appearance. His labs reveal a CD4 count of 85 cells/μL. Which of the
following is the diagnosis of his skin lesion?
1. Kaposi sarcoma.
2. Erythema multiform.
3. Seborrheic dermatitis.
4. Drug reaction. - correct answer ✅✅1. Kaposi sarcoma.
Rationale: Kaposi sarcoma is related to human herpesvirus 8. The rash is
characterized by nontender skin lesions with firm, nodular, purplish
appearance. It is usually found when the CD4 count falls below 200 cells/μL.
2. A 45-year-old female patient was diagnosed with HIV by her primary care
provider 2 weeks ago. She is waiting to see the infectious disease specialist
and presents to the emergency department with a 2-day history of
headache, fever, and confusion. At diagnosis, her CD4 count was 68 cells/μL.
In the emergency department, computed tomography scan of the head
shows multiple ring enhancing lesions. Which is the most likely etiology of
these findings?
1. Bartonella henselae.
2. Cytomegalovirus encephalopathy.
3. HIV encephalopathy.
4. Toxoplasma gondii. - correct answer ✅✅4. Toxoplasma gondii.
Rationale: Toxoplasma encephalitis can present in days to weeks. Patients
may present with fever, headache, altered mental status, focal neurological
,Adult-Gerontology Acute Care Nurse
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
changes, and seizures. Imaging can show ring enhancing lesions in
approximately 90% of cases with edema and mass effect. The CD4 count is
often less than 100 cells/μL.
3. A 54-year-old male patient with a known history of HIV presents to the
emergency department. He has been well controlled on highly active
antiretroviral therapy and follows regularly with his infectious disease
specialist. Over the past 2 weeks, he has noticed development of cough that
has gradually worsened. He now has fever, night sweats, and weight loss. His
chest imaging reveals a cavitary lesion in the right upper lobe with
associated hilar adenopathy. His CD4 count is 356 cells/μL. What is the likely
etiology of his presentation?
1. Pneumocystis jiroveci pneumonia.
2. Mycobacterium tuberculosis infection.
3. Kaposi sarcoma.
4. Bacterial pneumonia. - correct answer ✅✅2. Mycobacterium
tuberculosis infection.
Rationale: HIV patients' risk of tuberculosis (TB) doubles within the first year
after HIV seroconversion. Classic presenting symptoms of pulmonary TB with
HIV patients are similar to non-HIV patients. These can include fever, cough,
weight loss, malaise, and night sweats. Typical radiographic findings include
cavitary lesions found in the upper lung fields.
4. A 32-year-old male patient with a new diagnosis of HIV has begun highly
active antiretroviral therapy in the past 1 week. He calls with complaint of
increased nausea over the past week since starting therapy. He reports a
long history of gastroesophageal disease (GERD) and remains on chronic
proton-pump inhibitor therapy. He underwent upper endoscopy
approximately 2 months prior to evaluate his GERD and found no concerns.
He denies any other symptoms and otherwise is feeling well. What is most
likely the cause of his new-onset symptoms?
, Adult-Gerontology Acute Care Nurse
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
1. Candida esophagitis.
2. Cytomegalovirus esophagitis.
3. Herpes simplex virus esophagitis.
4. Drug side effect. - correct answer ✅✅4. Drug side effect.
Rationale: Antiretroviral therapy side effects are extremely common and can
contribute to poor compliance with therapy. Protease inhibitors can cause
significant nausea and diarrhea and are the likely culprit. Other significant
potential side effects of highly active antiretroviral therapy can include
pancreatitis, hepatitis, hepatic necrosis, and self-limited neuropsychiatric
problems.
5. You are providing education to a newly diagnosed HIV patient in your
clinic. The patient is a pet lover and has numerous cats. Which bacteria are
you concerned with and educate the patient about in changing the litter box?
1. Toxoplasma gondii.
2. Bartonella henselae.
3. Salmonella species.
4. Francisella tularensis. - correct answer ✅✅1. Toxoplasma gondii
Rationale: To reduce risk of infection, it is important to educate HIV-infected
patients about their surrounding risks. They should learn to avoid activities
that might increase risk of exposure to opportunistic infections. Cleaning out
a cat litter box increases risk for toxoplasmosis.
6. The diagnostic criteria for AIDS is an HIV patient with which of the
following?
1. CD4+ T-cell count less than 500 cells/μL.
2. CD4+ T-cell percentage of total lymphocytes greater than 14%.
3. CD4+ T-cell count less than 200 cells/μL.
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
1. A 28-year-old male patient presents to his infectious disease specialist
with complaint of headaches, malaise, fever, and night sweats for the past
week. He is homosexual and has one monogamous partner. He believes his
partner is monogamous as well. He has been diagnosed with HIV in the past
6 months and his last CD4 count was 400 cells/μL 3 months prior. His current
treatment includes dolutegravir, abacavir, and lamivudine. On exam, he is
found to have nontender skin lesions with firm, nodular, purplish
appearance. His labs reveal a CD4 count of 85 cells/μL. Which of the
following is the diagnosis of his skin lesion?
1. Kaposi sarcoma.
2. Erythema multiform.
3. Seborrheic dermatitis.
4. Drug reaction. - correct answer ✅✅1. Kaposi sarcoma.
Rationale: Kaposi sarcoma is related to human herpesvirus 8. The rash is
characterized by nontender skin lesions with firm, nodular, purplish
appearance. It is usually found when the CD4 count falls below 200 cells/μL.
2. A 45-year-old female patient was diagnosed with HIV by her primary care
provider 2 weeks ago. She is waiting to see the infectious disease specialist
and presents to the emergency department with a 2-day history of
headache, fever, and confusion. At diagnosis, her CD4 count was 68 cells/μL.
In the emergency department, computed tomography scan of the head
shows multiple ring enhancing lesions. Which is the most likely etiology of
these findings?
1. Bartonella henselae.
2. Cytomegalovirus encephalopathy.
3. HIV encephalopathy.
4. Toxoplasma gondii. - correct answer ✅✅4. Toxoplasma gondii.
Rationale: Toxoplasma encephalitis can present in days to weeks. Patients
may present with fever, headache, altered mental status, focal neurological
,Adult-Gerontology Acute Care Nurse
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
changes, and seizures. Imaging can show ring enhancing lesions in
approximately 90% of cases with edema and mass effect. The CD4 count is
often less than 100 cells/μL.
3. A 54-year-old male patient with a known history of HIV presents to the
emergency department. He has been well controlled on highly active
antiretroviral therapy and follows regularly with his infectious disease
specialist. Over the past 2 weeks, he has noticed development of cough that
has gradually worsened. He now has fever, night sweats, and weight loss. His
chest imaging reveals a cavitary lesion in the right upper lobe with
associated hilar adenopathy. His CD4 count is 356 cells/μL. What is the likely
etiology of his presentation?
1. Pneumocystis jiroveci pneumonia.
2. Mycobacterium tuberculosis infection.
3. Kaposi sarcoma.
4. Bacterial pneumonia. - correct answer ✅✅2. Mycobacterium
tuberculosis infection.
Rationale: HIV patients' risk of tuberculosis (TB) doubles within the first year
after HIV seroconversion. Classic presenting symptoms of pulmonary TB with
HIV patients are similar to non-HIV patients. These can include fever, cough,
weight loss, malaise, and night sweats. Typical radiographic findings include
cavitary lesions found in the upper lung fields.
4. A 32-year-old male patient with a new diagnosis of HIV has begun highly
active antiretroviral therapy in the past 1 week. He calls with complaint of
increased nausea over the past week since starting therapy. He reports a
long history of gastroesophageal disease (GERD) and remains on chronic
proton-pump inhibitor therapy. He underwent upper endoscopy
approximately 2 months prior to evaluate his GERD and found no concerns.
He denies any other symptoms and otherwise is feeling well. What is most
likely the cause of his new-onset symptoms?
, Adult-Gerontology Acute Care Nurse
Practitioner Certification
Hematology/Immunology/Oncology
Question and Answers 2024-2025
1. Candida esophagitis.
2. Cytomegalovirus esophagitis.
3. Herpes simplex virus esophagitis.
4. Drug side effect. - correct answer ✅✅4. Drug side effect.
Rationale: Antiretroviral therapy side effects are extremely common and can
contribute to poor compliance with therapy. Protease inhibitors can cause
significant nausea and diarrhea and are the likely culprit. Other significant
potential side effects of highly active antiretroviral therapy can include
pancreatitis, hepatitis, hepatic necrosis, and self-limited neuropsychiatric
problems.
5. You are providing education to a newly diagnosed HIV patient in your
clinic. The patient is a pet lover and has numerous cats. Which bacteria are
you concerned with and educate the patient about in changing the litter box?
1. Toxoplasma gondii.
2. Bartonella henselae.
3. Salmonella species.
4. Francisella tularensis. - correct answer ✅✅1. Toxoplasma gondii
Rationale: To reduce risk of infection, it is important to educate HIV-infected
patients about their surrounding risks. They should learn to avoid activities
that might increase risk of exposure to opportunistic infections. Cleaning out
a cat litter box increases risk for toxoplasmosis.
6. The diagnostic criteria for AIDS is an HIV patient with which of the
following?
1. CD4+ T-cell count less than 500 cells/μL.
2. CD4+ T-cell percentage of total lymphocytes greater than 14%.
3. CD4+ T-cell count less than 200 cells/μL.
