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1. Adherence to antiretroviral medications seems to play a more important role in long-term outcome than does choice of antiretroviral medication for persons with HIV/AIDS. Each of the following is an accurate statement about these patients and compliance with medication EXCEPT:
A. A client who adheres to the medications will likely have a better outcome, and adherence also is important for preventing the development of drug resistance
B. Although health care providers seldom can predict which clients will comply with complex medication schedules, primary care providers should be aware that a client's relapse into substance abuse is likely to result in noncompliance with medical care
C. Simplified drug regimens, with medications taken once a day, should be the goal to maintain compliance
D. Having support people such as case managers and family members reinforce the importance of keeping appointments and adhering to medication regimens is important to ensure success
2. In addition to taking medications as prescribed, the foremost challenge in providing HIV/AIDS treatment is engaging clients and encouraging them to be active participants in their own care.
A. True
B. False
3. Which of the following is an accurate statement about challenges that occur with getting substance abusers with HIV into treatment?
A. Many clients delay treatment after they receive positive test results, and according to one study, most enter medical care within 6 months of receiving positive test results, but 29 percent delay for more than 1 year
B. This study also showed that people with a history of intravenous drug use (IDU) on average delayed entering medical care 12 months longer than those with no history of IDU
C. Factors that may interfere with clients' seeking treatment may include lack of financial resources, fear of disclosure, lack of health insurance, lack of social support, difficulty in admitting they may need treatment, an underlying psychiatric disorder, and past problems with the treatment system
D. Women, in general, tend to seek treatment more quickly than men, probably because they feel an obligation to get well in order to care for their children and families
4. The practice of moving clients from substance abuse treatment programs to various clinical sites for primary medical care is called a:
A. Collaborative care system
B. Distributive care system
C. Specialized care system
D. None of the above
5. Postexposure prophylaxis (PEP) is an HIV treatment administered to an individual who has been exposed to the virus to prevent it from becoming established in the body, but it must be taken within 24 hours after exposure.
A. True
B. False
6. Certain symptoms might indicate the need for an HIV test, including each of the following EXCEPT:
A. A painful rash that occurs in a line on only one side of the body caused by folliculitis, a common early sign of HIV infection
B. Flulike symptoms for someone who has engaged in risky behavior
C. Oral thrush in a nonpregnant adult, chronic diarrhea, night sweats, weight loss, or fevers
D. Recurrent vaginal yeast infections, which are a common sign of HIV infection in women
7. Which of the following is NOT a true statement about medical conditions that may affect the HIV/AIDS client?
A. Herpes, both simplex and zoster, may be the initial indication of HIV disease and often is more severe in clients who are HIV positive
B. Oral lesions can affect nutrition, and cause extreme discomfort and periodontal disease can be aggressive in persons with HIV disease
C. Most HIV-infected persons have palpable lymph nodes at some point during the course of disease and these tend to predict disease progression and cause discomfort and distress
D. Clients with HIV may be at risk for other STDs such as syphilis, chlamydia, gonorrhea, herpes simplex, and chancroid
8. For those who are HIV-infected, increasing symptoms, progressive disability, and decline in function may bring sadness, anxiety, fear, insomnia, and a feeling of being overwhelmed.
A. True
B. False
9. Medications to control HIV infection have become more available, and the most effective treatment appears to be is a combination of two or more different medications.
A. True
B. False
10. The decision to begin antiretroviral therapy in the asymptomatic client is difficult and often involves multiple visits to review treatment options, and the factors to consider include all of the following EXCEPT:
A. Client willingness and readiness to begin therapy and remain adherent
B. The degree of immunodeficiency and the risk of side effects
C. The ongoing treatment of other medical conditions, such as diabetes
D. The risk of disease progression as determined by monotherapy
11. When the first approved antiretroviral agent, AZT, was given to pregnant HIV-infected women at 14 to 34 weeks of gestation, transmission of the virus to their babies was reduced from 30 to 12 percent.
A. True
B. False
12. Protease inhibitors are medications used to prevent HIV maturation, replication, and infection of new cells. Which of the following is an example of a protease inhibitor?
A. Neviripine
B. Delavirdine
C. Efavirenz
D. Ritonavir
13. Combination therapy that suppresses HIV replication can delay the emergence of drug-resistant virus.
A. True
B. False
14. Each of the following is an accurate statement about pain management for HIV/substance abuse clients EXCEPT:
A. Like other clients, substance abusers often are undertreated for acute pain, and education for pain control including narcotics, should never be withheld merely because a client has a history of substance abuse
B. Managing pain in methadone-maintained clients is usually accomplished by increasing their daily dose of methadone
C. The treatment plan and the reason for using narcotics for pain control must be clear to both the provider and patient, and it is important not only that the patient know that his or her pain is taken seriously, but also that narcotic use will not be extended beyond a time-limited period required for analgesia
D. The provider's primary goal is to maximize comfort while minimizing side effects
15. Since clients with HIV/AIDS often have pain problems similar to clients with cancer, the World Health Organization's (WHO's) 'cancer pain analgesic ladder' is a useful starting point for managing pain in HIV-infected persons.
A. True
B. False
16. Which of the following is a true statement about these unapproved medications and alternative therapy?
A. Clinicians have the responsibility to share information with clients about alternative therapies and medications, while emphasizing that the risks and benefits of these cannot always be predicted
B. Clients should be discouraged from trying alternative treatments until all other approved treatment regimens have been exhausted
C. Clients who used unapproved medications or alternative therapies incurred substantial expenditures, but most did not report improvement with these treatments
D. None of the above
17. Clients should receive a baseline assessment that includes taking a history of STDs and any involvement in sex-for-sale or sex-for-drugs transactions, as well as inspection for genital and perianal lesions.
A. True
B. False
18. Clinicians caring for HIV-infected clients must frequently assess clients for altered mental state and other neurologic and neuropsychiatric syndromes, and differential diagnosis in such clients may include HIV-related dementia or encephalopathy and specific opportunistic infections affecting the central nervous system.
A. True
B. False
19. Which of the following is an accurate statement about issues affecting women with HIV and substance abuse?
A. Since 1993, invasive cervical cancer has been considered an AIDS-defining condition and HIV infected women are at high risk for cervical dysplasia and cervical cancer associated with human papillomavirus
B. Drug-using women, with and without HIV infection, have high rates of vaginitis, and the most common causes include candidiasis and trichomonas, followed by bacterial vaginosis
C. Women who are current or former substance abusers constitute approximately 30 percent of AIDS cases in women in the United States
D. All of the above
20. A large number of women become pregnant after they are diagnosed with HIV disease, and there is increasing evidence that HIV disease progression is accelerated during pregnancy, after an abortion, or in the postpartum period.
A. True
B. False
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