Signs of opportunistic infection such as fever, persistent cough, or oral thrush must be reported.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client taking combination antiretroviral therapy reports taking St. John's wort for mood. What is the nurse's priority concern?
Answer: A. St. John's wort induces hepatic enzymes and significantly decreases serum levels of many antiretrovirals (such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors), reducing their effectiveness and promoting drug resistance. The priority is the loss of antiretroviral efficacy, not photosensitivity, appetite, or insomnia.
Question 2 of 5
A client newly diagnosed with HIV is started on antiretroviral therapy. Which instruction is most important for the nurse to emphasize to promote effectiveness and prevent resistance?
Answer: A. Strict adherence to the antiretroviral regimen at the prescribed times is essential to suppress viral replication and prevent the emergence of drug-resistant HIV. Missing doses promotes resistance. The drugs are continued lifelong, not stopped when the viral load is undetectable, and most are taken regardless of symptoms.
Question 3 of 5
A client with HIV is on antiretroviral therapy (ART). The nurse emphasizes that:
Answer: B. Strict, consistent adherence to ART is essential to suppress the virus and prevent resistance; missing doses risks treatment failure. The regimen is lifelong and adherence is the priority teaching.
Question 4 of 5
A client with HIV is prescribed a protease inhibitor as part of antiretroviral therapy. The nurse should monitor the client for which common metabolic adverse effect of this drug class?
Answer: A. Protease inhibitors are associated with metabolic effects including hyperglycemia, hyperlipidemia, and fat redistribution (lipodystrophy). The nurse monitors glucose and lipid levels. Hypoglycemia, hypolipidemia, and weight loss as a class effect are not characteristic of protease inhibitors.
Question 5 of 5
A client is to receive negative-pressure wound therapy (wound vac). Which statement best describes how this therapy promotes healing?
Answer: A. Negative-pressure wound therapy applies controlled subatmospheric (negative) pressure to the wound, which removes excess exudate, reduces edema, increases local blood flow, and promotes the formation of granulation tissue. It is not used to cauterize tissue or deliver systemic antibiotics.
Keep the streak going with more questions like these, each with a full rationale.
What is antiretroviral therapy?
It does not cure HIV, and strict lifelong adherence is essential to prevent drug resistance. The key principle is that consistent adherence to the full regimen maintains an undetectable viral load.
Key points to remember
- ART uses a combination of at least three drugs from different classes to suppress HIV and prevent resistance.
- Strict, lifelong adherence is critical because missed doses promote drug-resistant virus.
- Treatment goals are an undetectable viral load and a rising CD4 count, not cure.
- An undetectable viral load means the virus is effectively not transmitted sexually (undetectable equals untransmittable).
- Many antiretrovirals interact with other drugs through CYP450, including statins and some seizure medications.
- Immune reconstitution inflammatory syndrome can occur as the immune system recovers.
Nursing priorities
- Reinforce strict adherence and help the patient build a consistent dosing routine.
- Monitor CD4 count and viral load to evaluate treatment effectiveness.
- Assess for and manage side effects that threaten adherence such as nausea and fatigue.
- Review all medications and supplements for interactions before adding new drugs.
- Educate on continued safer sex and infection prevention even when undetectable.
Labs & values
Patient teaching
- Take every dose exactly on schedule because missing doses lets the virus become resistant.
- These drugs control HIV but do not cure it, and you must take them for life.
- Keeping an undetectable viral load means you will not transmit HIV through sex, but continue safer sex practices.
- Tell every provider you take HIV medication before starting any new drug or supplement.
Red flags: report now
- Signs of opportunistic infection such as fever, persistent cough, or oral thrush must be reported.
- Symptoms of lactic acidosis such as deep rapid breathing, nausea, and fatigue should be reported.
- Never skip or stop doses without provider guidance because resistance develops quickly.
References
Clinical references for this topic
