Walkthrough: Pharmacological and Parenteral Therapies Q12 – NCLEX-RN®

00:00 The nurse evaluates a client who is diagnosed with human immunodeficiency virus. Now, in order to assess the effectiveness of antiretroviral treatment or ART, which outcome does the nurse expect if the client is taking ART as prescribed? Okay, let's break it down. So, I'm evaluating a client, right, I know they're diagnosed with HIV and I want to assess the antiretroviral treatment, the ART.

00:30 I want to see if it's doing what it's intended to do. Very common type of question.

00:35 Part of our rule as nurses is to collaborate with the whole healthcare team, make sure that the plan of care is safe and it's effective. So that's what it's asking us.

00:45 What would you look for? What outcome would there be to show that this patient is consistently taking their ART and it's effective? Right. So there's the topic, use your scratch paper; number 1, number 2, number 3, number 4, written on your scratch paper. Use that as a worksheet to identify your best answer. Remember, after each one you eliminate or keep in, make yourself say why and sometimes it's going to be "Ahh, I'm not sure." That's okay. But try to make yourself think through why you're eliminating or keeping that answer. So pause the video, I'll see you in a couple of minutes. Let's take a look at the answer options. Now, make sure you've chosen yours before you listen to the walk through. So we looked at the stem of the question. It was asking us to see if we can evaluate treatment. So, a client who has HIV, means they just have that virus present. They have been exposed to it and now they have contracted the virus. AIDS is acquired immunodeficiency disease. That means that they've now had a really low CD4 T-cell count. Their immune system is very compromised and some opportunistic infection has taken over. Now, what an opportunistic infection is? That means someone with a healthy immune system would have been able to fight that off, but since their immune system is so compromised in AIDS that's what happens. They have an opportunistic infection take over because their CD4 T-cell count is really low. So if I have someone with HIV, it does not mean they have AIDS. That's a different stage or progression. What I'm looking for is if they have HIV, they've had the virus present in their bloodstream, they've been positive for the virus, I'm expecting that I'm going to do ART treatment that I can control the progression.

02:43 Right? I want to keep that virus low and I want to keep their immune system really revving up. So, now, it's time for true confessions. I don't like the correct answer in this one. I wouldn't word it that way. I would choose other options. But let me tell you, that's normal. You're going to experience that when you take a test so just vent what you need to, but get over yourself because it happens. I'll show you what you do. This is where eliminating is really going to serve you well. So, we know that if a client was taking ART and they were HIV positive, if they have a high viral load count that means they have a high viral load of HIV in their bloodstream.

03:33 That would not be a sign of effective ART. So, we can throw that one out. ART has to be taken really consistently, I mean like at the same time. It's pretty complex sometimes to take it. So, if a client is not consistent and when they take their medication for any number of reasons, we're not judging, we're just saying it is what it is. If they don't take their ART regularly, they can end up with drug resistance. So, the drug is less effective. So that with drug resistance, we're talking about the ART, that's the drug that's resistant to, you want to make sure that not a good thing. So, number 4 we're going to get rid of you. So we've got rid of number 1 and we've got rid of number 4. Now I'm left with a low CD4 T-cell count or a healthy immune system. Well, they're asking me to identify effective treatment for ART for someone who has HIV. So, a low CD4 T-cell count, now I don't want anyone to have a low CD4 T-cell count because that means their immune system is just puny, can't fight off anything. So the answer I'm left with, number 2. So what would I expect? A healthy immune system. Seems kind of vague. Doesn't it? I would want a much different answer, but I did the work. I eliminated 1, 3, and 4 and 2 is not a great answer but it's the best answer on this question. So mentally prepare yourself that's going to happen. But if you've done the work of eliminating the answers and saying why, you can be confident that that is likely the correct answer and in this case it is. Number 2, if ART is doing what it needs to do, the client is going to have a healthy immune system and be able to fight off infection and will definitely not be soccer punched by an opportunistic infection. So, take that all frustration and use it as motivation to do your very best on exams so you only have to take them one time. Alright, join us for another question, don't give up, take a break if you need to but come on back and we'll do another question together.