A nurse is talking with a client who has come to the clinic for HIV testing.
The nurse should explain that, after the laboratory has the enzyme-linked immunosorbent assay (ELISA) results, it will use which of the following tests to confirm the diagnosis?
CD4+ T-cell count.
Quantitative RNA assay.
Viral load test.
Western blot analysis.
The Correct Answer is D
Choice A rationale
The CD4+ T-cell count is a measure of immune function, not a confirmatory diagnostic test for HIV infection itself. These lymphocytes are the primary target of the HIV virus, and their count typically declines as the disease progresses, with a normal range generally 500 to 1,500 cells/mm. A low CD4+ count indicates immunodeficiency but is used for staging and monitoring, not confirmation.
Choice B rationale
The quantitative RNA assay, also known as the viral load test, measures the number of HIV RNA copies in the blood. While it is highly specific and sensitive for diagnosing acute infection and monitoring treatment effectiveness, it is not the standard confirmatory test after a positive ELISA, which is typically an antibody-based screening. The viral load is crucial for disease management.
Choice C rationale
The viral load test is the quantitative RNA assay described in Choice B. It measures the amount of active HIV replication and is key for predicting disease progression and assessing antiretroviral therapy success. However, the ELISA screens for HIV antibodies, and the confirmation test seeks to specifically confirm the presence of these or other viral proteins.
Choice D rationale
Western blot analysis is the traditional, more specific test used to confirm positive or indeterminate results from an initial ELISA or rapid antibody screening test. It detects antibodies to specific, individual HIV proteins, ensuring the initial positive result was not a false positive due to cross-reacting antibodies. This high specificity confirms the presence of HIV infection
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
Unprotected sexual activity, particularly anal or vaginal intercourse, poses a high risk of HIV transmission because the virus is present in semen and vaginal fluid. Lack of a barrier method, such as a condom, allows the exchange of these fluids containing infected CD4 cells and virus particles across mucosal membranes, leading to infection.
Choice B rationale
Sharing needles, syringes, or other injection equipment when using intravenous drugs is a major risk factor. This practice directly transfers blood from an infected person into the bloodstream of an uninfected person, allowing the direct inoculation of the HIV virus, which has a high concentration in the blood.
Choice C rationale
Sexual assault significantly increases the risk of HIV transmission due to the potential for the exchange of blood or body fluids and the high likelihood of mucosal trauma (tears or abrasions) during the assault. This trauma provides an easier entry point for the virus into the recipient's bloodstream, facilitating infection.
Choice D rationale
Exposure to blood or certain body fluids (semen, vaginal and rectal secretions, breast milk, or other body fluid containing visible blood) from a person with HIV is the route of transmission. This includes percutaneous exposure (needlestick), mucous membrane contact, or non-intact skin contact with the fluid containing the virus, which then enters the recipient's system.
Choice E rationale
Smoking marijuana is not a direct route for the transmission of the HIV virus. HIV is transmitted through specific body fluids, primarily blood, semen, vaginal and rectal secretions, and breast milk, during activities like unprotected sex or sharing needles. Marijuana use does not involve these fluid exchanges.
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