A patient with HIV-1 has experienced a sudden decline in health status accompanied by a significant increase in viral load. What is the first action the nurse should take?
Assess the patient’s adherence to the drug regimen.
Inquire about the patient’s recent travel to foreign countries.
Determine if the patient has any new sexual partners.
Request information about changes in the patient’s living conditions or pets.
The Correct Answer is A
Choice A rationale:
Assessing the patient's adherence to the drug regimen is the most crucial first step in this situation. Here's a comprehensive explanation:
1. Significance of Adherence in HIV Treatment:
Viral Suppression and Disease Progression: Adherence to antiretroviral therapy (ART) is paramount in HIV management. It directly impacts viral suppression, preventing disease progression, and reducing the risk of opportunistic infections and complications. Non-adherence can lead to viral rebound, increased viral load, and potential disease advancement.
Primary Cause of Treatment Failure: Suboptimal adherence is the leading cause of treatment failure in HIV patients. It can result in:
Reduced effectiveness of ART Development of drug resistance Increased healthcare costs Increased risk of transmission
2. Rationale for Prioritizing Adherence Assessment:
Direct Link to Viral Load and Health Status: A sudden decline in health status and a significant increase in viral load strongly suggest potential non-adherence. Assessing adherence early on can:
Identify the root cause of the clinical deterioration
Inform timely interventions to address adherence barriers Prevent further complications
3. Assessing Adherence Thoroughly:
Non-Judgmental Approach: Creating a supportive and non-judgmental environment is essential for honest and accurate assessment.
Open-Ended Questions: Utilize open-ended questions to explore potential challenges and barriers to adherence, such as: Difficulties with medication schedules
Side effects Financial constraints Forgetfulness
Mental health concerns Substance abuse
Lack of social support
Objective Measures: Complement patient reports with objective measures like:
Pill counts
Pharmacy refill records
Medication Event Monitoring Systems (MEMS)
4. Addressing Adherence Barriers:
Tailored Interventions: Based on the assessment findings, develop individualized strategies to enhance adherence, such as: Simplifying medication regimens
Addressing side effects
Providing medication reminders
Offering counseling and support services
Connecting patients with resources
5. Reassessing and Monitoring:
Continuous Evaluation: Regularly reassess adherence and viral load to ensure treatment effectiveness and make adjustments as needed.
Conclusion:
While other options (B, C, D) may provide valuable information, prioritizing adherence assessment is critical to promptly identify and address potential adherence issues, optimize treatment outcomes, and prevent further health decline in HIV patients experiencing viral rebound.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Planning activities to prevent fatigue is a valid self-care strategy for SLE patients. Fatigue is a common symptom of SLE, and it can be exacerbated by overexertion. By planning activities and pacing themselves, patients can help to manage their fatigue and conserve energy.
Fatigue management strategies include:
Prioritizing tasks and delegating when possible.
Breaking down large tasks into smaller, more manageable ones. Taking frequent rest breaks throughout the day.
Maintaining a regular sleep schedule. Engaging in moderate exercise, as tolerated.
Avoiding caffeine and alcohol, which can interfere with sleep.
Addressing any underlying health conditions that may be contributing to fatigue, such as anemia or depression.
Choice B rationale:
Prioritizing rest is another essential self-care strategy for SLE patients. Rest allows the body to conserve energy and repair itself. Patients with SLE may need more rest than healthy individuals, especially during flares.
Resting strategies include:
Getting enough sleep at night. Napping during the day, as needed.
Taking breaks from activities throughout the day.
Practicing relaxation techniques, such as deep breathing or meditation.
Choice C rationale:
Sunbathing is not recommended for SLE patients, as it can trigger flares. Ultraviolet (UV) radiation from the sun can damage skin cells and exacerbate inflammation in SLE patients. This can lead to a flare-up of symptoms, such as skin rash, joint pain, and fatigue.
Sun protection strategies include:
Avoiding direct sunlight, especially during the middle of the day when UV rays are strongest. Wearing protective clothing, such as long-sleeved shirts, pants, and wide-brimmed hats.
Using sunscreen with an SPF of 30 or higher on a daily basis.
Applying sunscreen liberally and reapplying it every two hours, or more often if sweating or swimming.
Choice D rationale:
Avoiding direct sunlight is a correct self-care strategy for SLE patients.
Correct Answer is D
Explanation
Choice A rationale:
It is not accurate to state that the patient is at risk for seizures due to fungal infections. While fungal infections can occur in individuals with HIV-1, they are not a primary cause of seizures in this population.
Linking fungal infections directly to seizure risk without clear evidence could cause unnecessary anxiety in the patient. It's important to provide accurate and relevant information to patients.
Choice B rationale:
Responding with "I have no idea why you would be taking this drug" is unprofessional and unhelpful.
Nurses are expected to have a basic understanding of the medications their patients are taking and to be able to provide education and support.
It's essential to demonstrate knowledge and confidence when interacting with patients.
Choice C rationale:
While gabapentin can have mood-elevating effects in some individuals, it is not primarily used as an antidepressant. Mentioning this potential side effect without clarifying the primary purpose of the medication could mislead the patient. It's crucial to prioritize the main indication for the medication to avoid confusion.
Choice D rationale:
This is the most appropriate response because it accurately explains the primary reason for prescribing gabapentin to this patient.
Gabapentin is commonly used to treat neuropathic pain, which is pain caused by nerve damage.
HIV-1 can often lead to neuropathic pain, making gabapentin a valuable treatment option in this population.
Providing clear and accurate information about medication purpose builds trust and understanding between the nurse and the patient.
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