1.

While teaching about HIV/AIDS to a group of high school seniors, the school health
nurse will begin by explaining the basic facts that will likely include which of the
following information?
A) Like all viruses, HIV is a genetic material made from DNA with long molecules
that carry genetic information.
B) HIV is different from other viruses since it is a retrovirus that selectively attacks
the body's immune cells.
C) There are two types of HIV, but the one that is endemic to the United States is
HIV type 2.
D) HIV type 1 for some reason rarely develops into full-blown AIDS.
Ans: B
Feedback:
HIV is a retrovirus that selectively attacks the CD4+ T lymphocytes, the immune cells
responsible for orchestrating and coordinating the immune response to infection. It must
change from RNA to DNA through a series of stages in order to get in a cell and begin
replication. HIV type 2 is endemic in West Africa but is rarely seen in other parts of the
world. People with HIV-2 tend not to develop AIDS.

2. As part of her prenatal education, a 29-year-old woman who is pregnant with her first
child is receiving teaching from her primary care provider. Which of the following
statements by the woman reflects an accurate understanding of HIV transmission?
A) “I know my baby is safe from HIV while in the womb, but the delivery will place
him or her at real risk.”
B) “It's discouraging to know that my breast milk can pass on HIV to my baby.”
C) “I know it's possible, but it's comforting that the chances of my child contracting
my HIV are actually very low.”
D) “I'm relieved to learn that a caesarean delivery will protect my baby from being
born HIV positive.”
Ans: B
Feedback:
Transmission from mother to infant is the most common way that children become
infected with HIV. HIV may be transmitted from infected women to their offspring in
utero, during labor and delivery, or through breast-feeding. Ninety percent of infected
children acquired the virus from their mother. The risk of transmission of HIV from
mother to infant is approximately 25%, with estimates ranging from 15% to 45%,
depending on what country they live in.

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3. A potential donor is angry at the personal nature of the questions about HIV risk factors
that he is required to answer at a blood collection center and states that simple blood
testing should suffice. How can the nurse at the center best respond?
A) “There are some very uncommon subtypes of the HIV virus that are not detectable
by current testing methods.”
B) “There's a chance that persons who are asymptomatic, but HIV positive can have
their antibodies missed by serum testing.”
C) “There's a period shortly after someone is infected with HIV when blood tests
might still be negative.”
D) “Even though blood tests are completely accurate, the high stakes of blood
donation and transfusion mean that double measures are appropriate.”
Ans: C
Feedback:
The time after infection and before seroconversion is known as the window period,
during which HIV antibody screening may be negative. Potential donors are thus
screened to identify potential risk factors. Undetectable subtypes of HIV do not exist,
and individuals who are asymptomatic are still able to be accurately tested.

4. A 40-year-old male who has been HIV positive for 6 years is experiencing a new
increase in his viral load along with a corresponding decrease in his CD4+ count. Which
of the following aspects of his immune system is likely to remain most intact?
A) Presentation of major histocompatibility molecules on body cells
B) Orchestration of natural killer cells as part of cell-mediated immunity
C) Activation of B lymphocytes
D) Phagocytic function of monocytes and macrophages
Ans: A
Feedback:
The expression of MHC on various cells of the body is not noted to be directly
influenced by HIV. However, infected CD4+ cells are compromised in their ability to
guide the action of NK cells, to direct phagocytic function of macrophages, and to
present antigens that activate B cells.

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5. A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is
experiencing a rapid proliferation in viral load. Which of the following statements best
captures an aspect of the process of HIV replication that underlies this proliferation?
A) Free HIV RNA is able to attach to the cell coat of CD4+ cells.
B) The cytoplasm of CD4+ cells provides a protected environment for the replication
of RNA by HIV.
C) Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells
rather than new lymphocytes.
D) HIV is able to change its RNA into DNA to allow for replication by CD4+ cells.
Ans: D
Feedback:
In order for the HIV to reproduce, it must change its RNA into DNA. It does this by
using the reverse transcriptase enzyme. Reverse transcriptase makes a copy of the viral
RNA and then in reverse makes another mirror-image copy. The result is
double-stranded DNA that carries instructions for viral replication. HIV RNA does not
directly attach to CD4+ cells, and RNA is not replicated by HIV itself in the CD4+
cytoplasm. Reverse transcriptase is not produced by CD4+ cells, and CD4+ cells do not
directly produce new lymphocytes.

6. Utilizing the World Health Organization (WHO) framework of clinical categories for
persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a
visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of
20 lb, and feeling like he is running a temperature. These manifestations have been
occurring for the past 5 weeks. The nurse would identify this patient to be in which
clinical stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
Ans: C
Feedback:
Clinical stage 3 includes unexplained chronic diarrhea for greater than 1 month,
persistent oral candidiasis, oral hairy leukoplakia, TB, neutropenia, anemia, and
thrombocytopenia.

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7. Which of the following patients would be considered to be in the latent period of HIV
infection?
A) A 16-year-old prostitute who has open sores on her labia that drain purulent
secretions
B) A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his
axilla and cervical neck region for the past 4 months
C) A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood
that started 2 weeks ago
D) A 24-year-old college student who has developed a chronic cough that will not go
away, even after taking two courses of antibiotics.
Ans: B
Feedback:
In the latent period, which can last up to 10 years, the CD4+ count falls gradually to
approximately 200 cells/µL. Some people experience swollen lymph nodes that are
chronically swollen for more than 3 months in at least two locations, not including the
groin. The lymph nodes may be sore or visible externally.

8. A person who has been diagnosed with HIV infection 12 years ago and still has a CD4+
cell count of 800 cells/µL and a low viral load is considered clinical to be a
A) rapid progressor.
B) typical progressor.
C) slow progressor.
D) long-term nonprogressor.
Ans: D
Feedback:
There is a subset of slow progressors: the long-term nonprogressors, who account for
1% of all HIV infections. These people have been infected for at least 8 years, are
antiretroviral naive, have high CD4+ cell counts, and usually have very low viral loads.
They are being investigated to determine how they maintain viral suppression of HIV.

9. A 39-year-old female with HIV infection has been characterized as a typical progressor
by her care team and is experiencing an increase in her manifestations and health
complaints as her CD4+ count declines. Which of the following health problems would
her care team most likely attribute to a cause other than her HIV?
A) Her recent diagnosis of bacterial pneumonia
B) Her esophagitis that has been linked to herpes simplex infection
C) Her decreased bone density and recent fractures
D) Her increasing confusion and disorientation
Ans: C
Feedback:
While pneumonia, esophagitis, and cognitive deficits are all well-documented
manifestations of HIV, changes in bone density are less likely to be a direct result of the
virus.

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10. A patient comes into a clinic complaining of cough, fever, and shortness of breath. The
patient informs the health care provider that he is HIV positive. Upon physical exam,
the family nurse practitioner (FNP) may note which of the following clinical
manifestations of suspected Pneumocystis jiroveci pneumonia (PCP)? Select all that
apply.
A) Interstitial infiltrates on chest x-ray
B) Respiratory rate of 32 with normal breath sounds
C) Stridor when taking a deep breath
D) Use of abdominal muscles to breathe while sitting on the exam table
E) Night sweats that require clothing changes frequently throughout the night
Ans: A, B
Feedback:
PCP is a common presenting manifestation of AIDS or people with compromised
immune systems. The symptoms include cough, fever, shortness of breath, and weight
loss. Physical exam demonstrates only fever and tachypnea (elevated respiratory rate)
and normal breath sounds. Chest x-ray shows interstitial infiltrates. Night sweats are
usually associated with tuberculosis infection.

11. Members of an AIDS support group who have more advanced cases are sharing some of
their recent health problems with a member who has just been diagnosed. Which of the
member's statements is most accurate?
A) “One of the scariest things out there now is the huge increase in drug-resistant
tuberculosis.”
B) “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend
the life expectancy of a lot of persons living with AIDS.”
C) “Those of us with HIV are so much more prone to loss of vision and hearing.”
D) “As people with HIV live longer, most of us are eventually succumbing to the
cancers that are associated with HIV.”
Ans: D
Feedback:
There is an increased risk of AIDS-associated cancers as persons with age live longer.
Drug resistance in tuberculosis is on the decline in recent years, and PCP has not been
eradicated. Sensory loss is not a noted HIV-related manifestation.

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12. A 48-year-old man who has been HIV positive for 6 years has just learned that he has
been diagnosed with Kaposi sarcoma (KS). Which of the following facts most
accurately conveys an aspect of his diagnosis?
A) An opportunistic Epstein-Barr virus underlies the man's KS.
B) He is likely to have lesions on his skin, mouth, or GI tract.
C) Intense pain was probably his first manifestation of KS.
D) Heterosexual contact most likely underlies his HIV and subsequent KS.
Ans: B
Feedback:
The lesions of KS can be found on the skin and in the oral cavity, gastrointestinal tract,
and the lungs. More than 50% of people with skin lesions also have gastrointestinal
lesions. It is linked with a herpes virus and can often be painless, especially in early
stages. Men who have sex with men are at a higher risk of developing KS.

13. Which of the following signs and diagnostic findings are recognized components of the
metabolic and morphologic changes that occur with HIV infection accompanied with
lipodystrophy? Select all that apply.
A) Hyperlipidemia
B) Insulin resistance
C) Deficiencies of anterior pituitary hormones
D) Increased abdominal girth
E) Breast enlargement
Ans: A, B, D, E
Feedback:
Hyperlipidemia and insulin resistance are aspects of lipodystrophy, a phenomenon that
also frequently includes breast enlargement and increased abdominal girth. Pituitary
hormone deficiencies are not a noted component of HIV-related metabolic changes.

14. When counseling a male patient with suspected HIV, the nurse informs him that if the
enzyme-linked immunosorbent assay (ELISA) comes back positive, then
A) no further testing is required since this confirms HIV infection.
B) a second test known as the Western blot assay will be ordered to confirm positive
HIV status.
C) he will be sent to an infectious disease physician for a tissue biopsy to confirm
infection.
D) if the second test, the Western blot, returns negative, he has not developed a case
of full-blown AIDS.
Ans: B
Feedback:
If ELISA is positive, his blood sample is then sent for Western blot assay. If the
Western blot is positive, diagnosis of HIV is confirmed. If the Western blot is negative,
then the person is not infected with HIV.

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15. A school nurse is teaching high school students about HIV and AIDS in the context of
the school's sexual health curriculum. Which of the students' following statements
would the nurse most likely want to correct or clarify?
A) “They have to take a blood sample from you in order to test you for AIDS.”
B) “Drugs for AIDS reduce the virus in your body, but they don't get rid of it.”
C) “Lots more heterosexual people get HIV these days than they used to.”
D) “Condoms provide really good protection from AIDS.”
Ans: A
Feedback:
Oral tests now exist for preliminary diagnosis of HIV. Medications for AIDS do not
cure the disease, and incidence is increasing among heterosexuals. Condoms provide
effective protection from the virus.

16. Which of the following individuals would most likely be placed on highly active
antiretroviral therapy (HAART) if he or she were not yet receiving the treatment? Select
all that apply.
A) A 35-year-old female sex trade worker who is HIV negative but who has a
documented history of sharing needles for heroin use
B) A 46-year-old male with long-standing HIV and a CD4+ count of 125 cells/mL
C) A 16-year-old female who was diagnosed with HIV 2 days prior and is
asymptomatic with normal CD4+ levels
D) A 38-year-old woman who has a CD4+ count of 250 cells/mL and is keen to begin
HAART
E) Prophylactically to a health care worker who incurred a laceration from a scalpel
used in surgery but has no abnormal lab results
Ans: B, D
Feedback:
All symptomatic patients should be treated with antiretroviral therapy. If the individual
is asymptomatic, therapy is recommended for CD4+ cell counts less than or equal to
160/mL. For those who have a CD4+ cell count greater than 350 cells/mL, antiretroviral
therapy is generally not recommended. For those whose CD4+ cell count is 160 to 350
cells/mL, then antiretroviral therapy should be considered, and a decision individualized
to the patient should be made. HAART is not begun prophylactically in the absence of
HIV.

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17. A 37-year-old male with HIV who has recently become symptomatic has begun highly
active antiretroviral therapy (HAART). Among the numerous medications that the man
now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+
cell. Which of the following classes of medications addresses this component of
the HIV replication cycle?
A) Entry inhibitors
B) Protease inhibitors
C) Integrase inhibitors
D) Non-nucleoside reverse transcriptase inhibitors
Ans: D
Feedback:
Reverse transcriptase inhibitors inhibit HIV replication by acting on the enzyme reverse
transcriptase. Non-nucleotide reverse transcriptase inhibitors block the copying of RNA
into DNA. Entry inhibitors, protease inhibitors, and integrase inhibitors do not address
this aspect of the HIV replication cycle.

18. All antiretroviral medications interfere with some stage of the HIV life cycle. What
stage do protease inhibitors prevent?
A) Cleavage of the polyprotein chain into the individual proteins that will be used to
make new virus
B) Addition of more nucleosides to the DNA chain
C) Killing of the CD4+ T cell to release virions into the bloodstream
D) Attachment of the virus to CD4+ cell receptors
Ans: A
Feedback:
By binding to the protease enzyme and inhibiting its function, protease inhibitors
prevent cleavage of the polyprotein chain into individual proteins. Virions are still
released into the body, but they are immature and noninfectious.

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19. A 23-year-old HIV-positive woman in the United States with routinely low viral loads
and robust CD4+ cell counts is planning to get pregnant. Which precaution would
her care giver eliminate from her care?
A) Offer her HAART that includes zidovudine
B) Counsel her not to breast-feed
C) Give her single-dose perinatal nevirapine
D) Give the infant trimethoprim–sulfamethoxazole, starting at 4 to 6 weeks of age
Ans: C
Feedback:
Single-dose nevirapine is an appropriate alternative when zidovudine is not available.
However, HAART-containing zidovudine is readily available in the United States.
Avoiding breast-feeding will reduce the client's chances of transmitting HIV to her
infant. Because the risk of transmission is not zero, prophylaxis with
trimethoprim–sulfamethoxazole will protect her infant from PCP until its serostatus is
known.

20. While volunteering in an HIV clinic in a big city, the nurse notices a new mom and her
baby (a 6-month-old male) in the waiting room. Upon assessing the infant for possible
HIV infection, the nurse will be assessing for which of the following clinical
manifestations of HIV infection? Select all that apply.
A) Weighing him to determine if he is gaining 1.5 to 2 lb/month
B) Observing to see if he can roll over from back to stomach
C) Lack of coordination to play with toys/stuffed animals
D) History of repeated episodes of bacterial pneumonia and ear infections
E) Listlessness and poor eye contact
Ans: C, D, E
Feedback:
Children differ as to their clinical presentation of HIV infection when compared to
adults. Failure to thrive (gain weight/height), CNS abnormalities (listlessness), and
developmental delays are the most prominent primary manifestation of HIV infection in
children. Answers A and B are normal growth and developmental tasks of a
6-month-old.

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