A nurse is presenting a community-based program about HIV and AIDS. A client asks the nurse to describe the initial symptoms experienced with HIV infection. Which of the following manifestations should the nurse include in the explanation of initial symptoms?

Choice A rationale:
Flu-like symptoms: These are common during the early stages of HIV infection, often within 2-4 weeks after exposure to the virus. They are a result of the body's immune system responding to the virus. Symptoms can include:
Fever Fatigue

Muscle aches

Headache Sore throat

Rash

Swollen lymph nodes
Night sweats: These are also common in early HIV infection and can be caused by the body's attempts to fight off the virus or by inflammation. They can also be a side effect of some HIV medications.

Choice B rationale:
Kaposi's sarcoma (KS): This is a type of cancer that is associated with HIV infection. It is caused by a virus called Kaposi's sarcoma-associated herpesvirus (KSHV). KS often appears as purple or red lesions on the skin or in the mouth. It can also affect other organs, such as the lungs and lymph nodes. However, it's not a common initial symptom of HIV infection. It usually develops in later stages of HIV when the immune system is severely weakened.

Choice C rationale:
Fungal and bacterial infections: People with HIV are more susceptible to infections because the virus weakens their immune system. However, fungal and bacterial infections are not typically among the initial symptoms of HIV infection. They usually occur in later stages of the disease when the immune system is more compromised.

Choice D rationale:
Pneumocystis lung infection (PCP): This is a serious lung infection that is caused by a fungus called Pneumocystis jirovecii. It is a common opportunistic infection in people with HIV, but it is not typically an initial symptom. It usually develops in later stages of HIV when the CD4 count (a measure of immune system health) is very low.

Choice A rationale:
Providing a urine sample to determine therapeutic levels of phenytoin is not typically a part of routine discharge instructions. While monitoring of phenytoin levels is important, it's usually done through blood tests, and the frequency of testing is determined by the healthcare provider based on individual patient factors.

Choice C rationale:
Bleeding gums are not a common side effect of phenytoin. While some individuals might experience gum tenderness or overgrowth, significant bleeding is not expected.

Choice D rationale:
Antacids can actually interfere with the absorption of phenytoin, potentially reducing its effectiveness. Therefore, it's generally not recommended to take antacids regularly while on phenytoin therapy. If a patient needs to take an antacid for occasional heartburn or indigestion, it's best to take it at least 2 hours before or after the phenytoin dose.