A nurse is caring for a client diagnosed with HIV-I. The client's CD4+ cell count is 399/mm (0.399 × 109/L). What action by the nurse is best?
Counsel the client on safer sex practices/abstinence.
Encourage the client to abstain from alcohol.
Facilitate genetic testing for CD4+ CCR5/CXCR4 Co-receptors.
Help the client plan high-protein/iron meals.
Correct Answer : A,D
Choice A rationale
HIV-I is transmitted primarily through intimate contact or shared needles, so counseling on safer sexual practices and abstinence is vital to prevent transmission to others and potential re-exposure, which could accelerate disease progression. The client's CD4+ count (399/mm) is near the threshold for AIDS diagnosis (<200/mm), emphasizing the need to minimize all risks.
Choice B rationale
Alcohol abuse can further suppress the immune system, potentially accelerating the progression of HIV-I by impairing T-lymphocyte function and increasing susceptibility to opportunistic infections. While important for general health, this action is not the single best priority related to the specific diagnosis and CD4+ count compared to preventing transmission or improving nutritional status.
Choice C rationale
Genetic testing for coreceptor tropism (CCR5/CXCR4) is performed to determine if the virus can use these co-receptors to enter CD4+ cells. This is primarily done before initiating or changing CCR5 antagonist therapy (like maraviroc) to ensure drug effectiveness, not as a standard care action at this CD4+ level.
Choice D rationale
High-protein and iron-rich meals support the synthesis of immune cells, including lymphocytes, and red blood cells, which are often affected by HIV-related wasting or anemia (fatigue). Optimal nutrition is essential to maintain immune function, combat chronic inflammation, and help slow disease progression. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Osteoarthritis is a non-inflammatory degenerative joint disease characterized by cartilage breakdown. While it causes pain and functional impairment, it does not directly suppress the immune system or increase susceptibility to opportunistic infections. The risk for opportunistic infections is directly related to impaired cellular immunity.
Choice B rationale
Rheumatoid arthritis (RA) is a chronic autoimmune disease causing systemic inflammation. While the disease itself can affect the immune system, the highest risk for opportunistic infection typically arises from the immunosuppressive medications used to treat the flare-up (e.g., corticosteroids, biologics), rather than the disease state alone.
Choice C rationale
A client with HIV (Human Immunodeficiency Virus) experiences a progressive decline in the number and function of CD4+ T-lymphocytes. These cells are central to cell-mediated immunity, and their depletion allows opportunistic pathogens (e.g., Pneumocystis jirovecii, Mycobacterium avium) that are normally controlled by a healthy immune system to cause severe, life-threatening infections.
Choice D rationale
A client with a risk of severe anaphylaxis has a hyperactive immune response (Type I hypersensitivity) to an antigen. This is an inappropriate, exaggerated immune reaction that is not characterized by generalized immunosuppression; therefore, it does not increase the risk for opportunistic infections.
Correct Answer is B
Explanation
Choice A rationale
While contacting the police is important for legal and safety reasons following a sexual assault, the most immediate priority in a potential HIV exposure is medical intervention. The administration of Post-Exposure Prophylaxis (PEP) must begin as soon as possible, ideally within hours of the assault, making the timing of the exposure the most critical clinical data point.
Choice B rationale
The most important clinical question is establishing the exact time and date of the assault. This is crucial because HIV Post-Exposure Prophylaxis (PEP) must be initiated within 72 hours of the exposure event to be effective in preventing seroconversion. Determining the timing immediately guides the decision for initiating life-saving prophylactic treatment.
Choice C rationale
Identifying the assailant is critical for forensic, legal, and criminal investigation purposes following a sexual assault. However, it is not the most important factor in the immediate medical management for potential HIV exposure, which is dictated by the time elapsed since the exposure and the prompt initiation of PEP.
Choice D rationale
Knowing the location of the assault is important for forensic evidence collection and police investigation. This information does not, however, directly influence the immediate clinical decision-making regarding the administration of Post-Exposure Prophylaxis (PEP) for HIV, which is solely dependent on the time frame since the potential exposure occurred.
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