WEEK 1: HIV QUIZ

Question 1

The Human Immunodeficiency Virus (HIV) mainly attacks what type of cells in the human body?
A. Red Blood Cells
B. CD4 positive cells
C. Stem Cells
D. Platelets

Answer 1

The answer is B. The HIV virus attacks the human body’s immune system, specifically the CD4 positive cells…mainly the helper t cells. These cells are white blood cells that help the immune system fight infection.

Question 2

2. The Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply:
   A. Breastmilk
   B. Blood
   C. Tears
   D. Semen
   E. Vaginal Fluid
   F. Sweat

Answer 2

The answers are C and F. HIV can NOT be spread in tears or sweat (unless blood is present which rarely occurs). HIV is spread in the following fluids: breastmilk, blood, semen, and vaginal fluid.

Question 3

3. Which statement below is not true regarding the role of the helper t cell?
   A. The helper T cell releases cytokines to help activate other immune system cells.
   B. The helper T cell is part of the adaptive immune system.
   C. The helper T cell is cytotoxic and kills invaders.
   D. The helper T cell has CD4 receptors found on its surface.

Answer 3

The answer is C. All the other options are true statements about the helper T cell. Option C is NOT true. Helper T cells are not cytotoxic and kill invaders (this is another type of t cells called cytotoxic t cell). Helper T cells are “helpers” in that they HELP the immune system by releasing cytokines, which help activate other immune system cells.

Question 4

4. Identify the correct statements about the anatomy of the Human Immunodeficiency Virus (HIV). Select all that apply:
   A. HIV is a retrovirus.
   B. Inside the virus is packaged DNA.
   C. The protein projections found on the virus’ surface play a key role in attaching to the receptors on the helper t-cell.
   D. The glycoproteins (specifically GP140) are vital for engaging the receptors on the targeted cell.

Answer 4

The answers are A and C. Options B is an incorrect statement, it should say “Inside the virus is packaged RNA (not DNA)”, and Option C is incorrect because it should say “The glycoproteins (specifically GP120…NOT GP140) are vital for engaging the CD4 receptor on the targeted cell.

Question 5

5. The first step in the “Lifecycle of HIV” is the attachment step. During this step what co-receptors are also targeted so entry can be gained inside the cell?
   A. CCR5 or CXCR4
   B. CD4 or CD2
   C. CCR4 or CXCR5
   D. CD8 or CD5

Answer 5

The answer is A: CCR5 or CXCR4. Attachment occurs when the glycoproteins (GP120) projections make contact and bind with a CD4 receptor. In addition, there is also binding with certain co-receptors called CCR5 or CXCR4 to gain entry into the cell.

Question 6

6. What step in the ““Lifecycle of HIV” does the Human Immunodeficiency Virus (HIV) become united with the targeted cell and dumps its contents into that cell?
   A. Integration
   B. Fusion
   C. Budding
   D. Assembly

Answer 6

The answer is B: Fusion

Question 7

7. Which statement below best describes the role of reverse transcriptase?
   A. It’s an enzyme that helps cut up the long protein chains of HIV.
   B. It plays a key role in the maturity of the virus.
   C. Reverse transcriptase is an enzyme that turns viral RNA into viral DNA.
   D. Reverse transcriptase is an enzyme that allows the viral DNA to become part of the cell’s DNA.

Answer 7

The answer is C: Reverse transcriptase is an enzyme that turns viral RNA into viral DNA.

Question 8

8. Fill in the blank: Once inside the nucleus of the cell, the Human Immunodeficiency Virus (HIV) needs to become part of the cell’s DNA. To do this, the virus releases an enzyme called __________________.
   A. Protease
   B. Reverse transcriptase
   C. Kinase
   D. Integrase

Answer 8

The answer is D: Integrase

Question 9

10. A 30-year-old patient is in the Acute Stage of HIV. What findings below correlate with this stage of HIV? Select all that apply:
    A. CD4 level <500 cells/mm3
    B. No present of Opportunistic Infections
    C. High viral load
    D. Patient reports flu-like symptoms
    E. Patient is asymptomatic

Answer 9

The answers are B, C, and D. The Acute Stage of HIV is the first stage and tends to occur a couple of weeks to a month after becoming infected. The patient’s viral load is very HIGH during this time, but the CD4 count should be greater than 500 cells/mm3. Therefore, NO opportunistic infections are present during this time (the CD4 count is high enough to fight off these types of infections/diseases). In addition, the patient may report flu-like symptoms (aches, joint pain, headache, fever, fatigue, sore throat, swollen lymph nodes, GI upset, and rash). The patient is usually asymptomatic in the 2nd stage (Chronic Stage of HIV).

Question 10

11. A patient arrives to the clinic and requests an HIV test. The patient had unprotected sexual intercourse 2 days ago with a person who may have HIV. As the nurse you know there is a window period for detecting an infection of HIV. What statements should you provide to the patient about this window period and testing for HIV? Select all that apply:
    A. No test is available at this time to show immediate infection.
    B. The window period is the time when you become infected with HIV to when a test can deliver positive results.
    C. Window periods vary depending on the type of HIV test administered.
    D. The absolute earliest an HIV test can detect HIV is about 3 months.

Answer 10

The answers are A, B, C. These are correct statement. Option D is incorrect because the NAT (nucleic acid test) can detect HIV the earliest of all the test types. It can detect around 10 days after exposure for some patients. It assesses for the virus’ genetic material and measures the amount of virus present in the blood. It is not commonly ordered and is used only for high risk patients.

Question 11

12. The physician orders a combination HIV antigen/antibody test on a patient. The patient was potentially exposed to HIV 3 weeks ago. What HIV antigen does this test assess for?
    A. GP120
    B. p24
    C. GP41
    D. P35

Answer 11

B

Question 12

13. Which HIV test can give the earliest test results?
    A. Nucleic Acid Test (NAT)
    B. Antibody HIV Test
    C. Combination HIV antigen/antibody test
    D. CD4 count

Answer 12

A

Question 13

14. A patient, who is in the Chronic Stage of HIV, has a CD4 count ordered. What does this test measure?
    A. Red blood cells
    B. B cells
    C. Cytotoxic T cells
    D. Helper T cells

Answer 13

D

Question 14

15. What is a normal CD4 count?
    A. 200-500 cells/mm3
    B. 1500-3500 cells/mm3
    C. 500-1500 cells/mm3
    D. <200 cells/mm3

Answer 14

C

Question 15

A 48-year-old patient is HIV positive. The patient has no signs and symptoms and has a CD4 count of 400 cells/mm3. In addition, no opportunistic infections or diseases are present. These findings correlate with what stage of HIV?
A. Acute
B. Chronic
C. AIDS

Answer 15

The answer is B: Chronic. These findings correlate with the Chronic Stage (also called the Asymptomatic Stage) of HIV. Signs and symptoms may not be experienced, the viral load is lower than the Acute Stage, but the virus is still replicating and destroying the cells. The patient can still transmit the virus to others. In addition, the CD4 count should be more than 200 cells/mm3 to about 500 cells/mm3. In addition, no opportunistic infections or diseases should be present.

Question 16

17. Select the criteria below that is used to help diagnosed a patient with Acquired Immunodeficiency Syndrome (AIDS):
    A. CD4 count <200 cells/mm3
    B. Presence of opportunistic infection
    C. CD4 count >1500 cells/mm3
    D. WBC 9500
    E. Absence of opportunistic infection

Answer 16

The answers are A and B. A patient is diagnosed with AIDS if: CD4 count drops to less than 200 cells/mm3 or an opportunistic infection is present.

Question 17

18. A patient with AIDS has dark purplish brown lesions on the mucus membranes of the mouth. As the nurse you know these lesions correlate with what type of opportunistic disease?
    A. Epstein-Barr Virus
    B. Herpes Simplex Virus
    C. Cytomegalovirus
    D. Kaposi’s Sarcoma

Answer 17

D

Question 18

19. What sign and symptoms in your patient with HIV indicates the disease is worsening and the immune system is severely compromised?
    A. Open, oozing lesions around the mouth
    B. White hair like spots on the side of the tongue
    C. Cheesy white film on the tonsils and inside cheeks
    D. Vision changes

Answer 18

The answer is B. This is known as oral hairy leukoplakia. It occurs when the immune system is extremely compromised like with HIV and the Epstein-Barr virus. It is a signal the HIV is getting worse.

Question 19

20. A patient with AIDS has developed CMV (cytomegalovirus). The nurse makes it PRIORITY to educate the patient about which of the following regarding CMV?
    A. Avoiding exposure to cat feces.
    B. Drinking water from clean sources only.
    C. Scheduling an eye appointment.
    D. Isolating for 14 days to prevent transmission of CMV to others.

Answer 19

The answer is C. CMV is an opportunistic infection that can develop in patients with AIDS. This virus can cause damage to the retina (hence retinitis) and lead to blindness. The nurse should educate the patient about scheduling an eye exam to monitor for this condition.

Question 20

21. Your patient is in the last stage of HIV. The patient CD4 count is 100 cells/mm3. Which of the following FUNGAL infections if your patient at risk for? Select all that apply:
    A. Mycobacterium tuberculosis
    B. Candidiasis
    C. Coccidioidomycosis
    D. Toxoplasmosis
    E. Histoplasmosis

Answer 20

The answers are B, C, and E. Candidiasis, Coccidioidomycosis, Histoplasmosis are all FUNGAL infections. Mycobacterium tuberculosis is a bacterial infection, and Toxoplasmosis is a protozoal (parasitic type) infection.

Question 21

22. Which type of opportunistic infection occurs from inhaling a parasitic organism that can be found in cat and bird feces?
    A. Histoplasmosis
    B. Crytococcosis
    C. Mycobacterium Avium Complex
    D. Toxoplasmosis

Answer 21

The answer is D. Toxoplasmosis is a protozoal parasitic infection that is found in cat and bird feces along with undercook meat, such as pork and red meat.

Question 22

23. You’re providing education to a patient with AIDS on how to prevent opportunistic infections. Which statement below requires the nurse to re-educate the patient about this topic?
    A. “I’m traveling to Puerto Rico next week and will be sure to pack bottled water.”
    B. “I’ve switched to buying raw organic milk.”
    C. “Last month I received the Pneumovax.”
    D. “My neighbor bought a cat last week.”

Answer 22

The answer is B. Patients with AIDS should AVOID raw, undercooked, and unpasteurized foods and beverages. These items could contain organisms that could cause serious infections to a person with a compromised immune system.

Question 23

24. The nurse plays a vital role in screening patients for a possible HIV infection. What questions below could the nurse ask to help identify a patient who is at risk for HIV? Select all that apply:
    A. “How often do you use alcohol or drugs?”
    B. “Have you recently experienced an abusive relationship?”
    C. “If you are sexually active, do you or your partner use protection?”
    D. “In the past month, have you felt sad or unable to get out of bed?”
    E. “Have you ever been treated for a sexually transmitted infection?”
    F. “Do you ever experience intrusive or unwanted thoughts?

Answer 23

The answers are A, C, E. The nurse should screen patients for HIV. Questions about sexual behavior (if the patient is sexually active, how often, treatment for STI, barrier devices used, and number of partners), drug/alcohol usage, and if they’ve had a blood transfusion before 1985, can all help the nurse identify patients who may need to undergo HIV testing.

Question 24

25. TRUE OR FALSE: The Center for Disease Control and Prevention (CDC) recommends that all people between the ages of 13-64 be tested at least once for HIV during a routine health visit, regardless of risk factors.
    True
    False

Answer 24

TRUE

Question 25

26. A 25-year-old patient reports that they engage in high risk activities that could lead to an HIV infection. The patient’s test results show the patient is HIV-negative. The nurse should provide the patient with education about?
    A. PEP
    B. PrEP
    C. Opportunistic Infections
    D. Nucleic Acid Test (NAT)

Answer 25

The answer is B. The nurse should provide the patient with education about PrEP (Pre-Exposure Prophylaxis). These medications are taken BEFORE a possible encounter with HIV, which helps prevent a possible HIV infection. The patient must be HIV-negative before taking these medications.

Question 26

27. Which patient below is a candidate for PEP (Post-exposure Prophylaxis)?
    A. A 32-year-old patient who reports sharing IV drug injection devices with a person who is HIV-positive 5 days ago.
    B. A 28-year-old patient who engages in high risk activities on a regular basis that could lead to an HIV infection.
    C. A 55-year-old who is HIV-positive.
    D. A 30-year-old who was sexually assaulted two days ago.

Answer 26

The answer is D. PEP (post-exposure prophylaxis) is medication that is taken AFTER an encounter with an HIV infected person. These medications can help prevent becoming infected with HIV, if started within 72 HOURS of the exposure (option A is not a candidate). These medications are NOT for routine usage but for emergencies (sexual assault, needle stick etc.). If a patient is at high risk (as with the patient in option B), they should consider PrEP (pre-exposure prophylaxis). PEP is taken for 28 day

Question 27

28. A 25-year-old female is about to deliver a baby. The patient is HIV-positive and has been taking antiretroviral therapy during the pregnancy. What steps can be taken to help prevent transmitting the virus to the baby after birth?
    A. Substitute formula for breastfeeding.
    B. Administer antiretroviral treatment to the newborn for 2 weeks after birth.
    C. Avoid kissing and hugging the newborn.
    D. Stop taking antiretroviral therapy for 2 months postpartum.

Answer 27

The answer is A. Breastmilk can transmit the HIV virus. The patient should avoid breastfeeding but use formula instead. Option B is wrong because the newborn should receive antiretroviral treatment for 4-6 weeks after birth (NOT 2 weeks). The mother can kiss and hug her newborn (this does NOT transmit the virus), and the patient should not quit taking antiretroviral therapy during the postpartum period.

Question 28

29. Which statement below is not a true statement about Antiretroviral Treatment?
    A. “The patient starts out taking 3 medications from at least 2 drug classes.”
    B. “ART decreases the amount of virus in the blood within about 6 months.”
    C. “ART helps decrease the risk of developing an opportunistic infection.”
    D. “Antiretroviral medications are taken when signs and symptoms appear and then tapered off.”

Answer 28

The answer is D: This option is false and all the others are true regarding ART. ART must be taken EXACTLY as prescribed (everyday, at the same time, at the right dosage etc.). It is not taken when signs and symptoms appear and tapered off. If ART is not taken as prescribed or doses are missed, drug resistance can develop. In other words, the medications will stop being effective against the HIV.

Question 29

30. Which class of antiretroviral medications bind with the CD4 receptors and inhibit the HIV’s glycoprotein from being able to activate and engage the co-receptors?
    A. Post-attachment Inhibitors
    B. Fusion Inhibitors
    C. Integrase Inhibitors
    D. Non-nucleoside Reverse Transcriptase Inhibitors

Answer 29

The answer is A: Post-attachment Inhibitors. Trogarzo (ibalizumab) is a type of post-attachment inhibitor. It is given IV every 2 weeks.

Question 30

31. Fill-in-the-blank: Chemokine Receptor Antagonists block the co-receptor __________ on the cell so HIV cannot engage the receptor and enter the cell.
    A. CXCR4
    B. CD4
    C. CCR5
    D. GP120

Answer 30

C

Question 31

32. The patient is prescribed to take Enfuvirtide (Fuzeon). The nurse prepares to administer this medication via?
    A. Intravenous route
    B. Oral route
    C. Topical Route
    D. Subcutaneous Route

Answer 31

D

Question 32

33. Which antiretroviral medication treatment stops the enzyme reverse transcriptase from working by binding to it?
    A. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
    B. Integrase Inhibitors
    C. Protease Inhibitors
    D. Fusion Inhibitors

Answer 32

A

Question 33

34. A patient with Stage 2 HIV (Chronic Stage) is prescribed to take Raltegravir. The nurse knows that this medication is part of what class of ART?
    A. Protease Inhibitors
    B. Integrase Inhibitors
    C. Nucleoside Reverse Transcriptase Inhibitors
    D. Attachment Inhibitors

Answer 33

The answer is B. Raltegravir is an Integrase Inhibitors. Remember from the lecture: “tegra” in Integrase….the meds in this class have “tegra” in the middle…like RalTEGRAvir.

Question 34

35. What group of ART for the treatment of HIV stop an enzyme from cutting the long chains of virus so the immature virus can’t be assembled and mature?
    A. Protease Inhibitors
    B. Integrase Inhibitors
    C. Nucleoside Reverse Transcriptase Inhibitors
    D. Attachment Inhibitors

Answer 34

A

Question 35

36. A patient with HIV is prescribed to start antiretroviral therapy. The nurse is providing education about these medications. Which statement below by the patient indicates they need re-education on these medications?
    A. “If I take these medications as prescribed my viral load will become undetectable, and I have a low risk of transmitting the virus to others.”
    B. “Drug resistance is likely to develop if I’m non-compliant with my medications.”
    C. “I currently take a medication called St. John’s Wort to treat depression.”
    D. “This therapy does not cure me from HIV but helps me live a healthier and longer life.”

Answer 35

The answer is C. Patients who take ART should be educated about how these medications can interact with over-the-counter medications, especially herbal supplements like St. John’s Wort. This medication is used to treat depression. The patient should be re-educated about this topic.