# A nurse is caring for a client with HIV/AIDS who has a CD4+ count of 150 cells/mm³ and is experiencing frequent opportunistic infections. Which nursing intervention should be the highest priority?

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> subject: Infectious Diseases

## 문제

A nurse is caring for a client with HIV/AIDS who has a CD4+ count of 150 cells/mm³ and is experiencing frequent opportunistic infections. Which nursing intervention should be the highest priority?

## 보기

1. Implement strict isolation precautions and monitor for signs of infection **✔ 정답**
2. Encourage increased fluid intake to prevent dehydration
3. Provide emotional support and counseling resources
4. Administer prescribed antiretroviral medications as scheduled

**정답: 1**

## 해설

With a CD4+ count of 150 cells/mm³, the client is severely immunocompromised and at high risk for life-threatening opportunistic infections. Strict isolation precautions and infection monitoring are the highest priority to prevent fatal complications, while other options are important but less urgent.

## 심화 해설

Understanding the Priority: Infection Risk in Severe Immunocompromise

The client’s CD4+ count of 150 cells/mm³ places them in a severely immunocompromised state, classified clinically as AIDS. At this level, the adaptive immune system is profoundly suppressed, leaving the client highly vulnerable to opportunistic infections. The question stem explicitly states the client is already experiencing frequent opportunistic infections, which confirms this vulnerability is an active, ongoing threat. In the NCLEX-RN prioritization framework, this situation directly engages the first level of Maslow's hierarchy (physiological safety) and the ABCs, where preventing systemic infection and sepsis is the most immediate life-saving measure.

Why Strict Isolation and Monitoring is the Priority

Infection prevention is the cornerstone of care for a client with a CD4+ count below 200 cells/mm³. The highest priority intervention is to protect the client from new pathogens while vigilantly monitoring for signs of an active infection that could rapidly progress to sepsis. This involves implementing neutropenic precautions, which include strict hand hygiene, restricting exposure to ill individuals, and ensuring a clean environment. Monitoring focuses on subtle, early signs of infection, such as a low-grade fever, which in an immunocompromised client is a critical finding that demands immediate intervention. The clinical reasoning is that an infection in this population can quickly become life-threatening due to the body's inability to mount an effective immune response.

Analysis of Other Options

The remaining options represent important but secondary aspects of care. While administering prescribed antiretroviral medications (Option 4) is essential for long-term immune reconstitution and viral suppression, it does not address the immediate, active threat of a new or worsening infection. The immunological recovery from ART is a process that takes months to years, and as noted in the literature, many patients do not achieve optimal immune recovery even with viral suppression [1]. Therefore, for a client currently suffering from frequent infections, pharmacologic therapy is a lower priority than immediate protective measures.

Providing emotional support (Option 3) addresses psychosocial integrity, which is a higher-level need on Maslow's hierarchy. This becomes a priority only after physiological safety is established. Similarly, while encouraging fluid intake (Option 2) is a supportive measure that can be relevant during an infection, it is a dependent and preventative intervention that is not the nurse’s first action when facing a client with a critically low CD4+ count and a history of active infections. The immediate nursing action must be to assess and protect, not to implement a generic comfort measure.References (research sources)

- [1]Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients.Research articleFan L, Li P, Yu A, Liu D, Wang Z, Wu Y, Zhang D, Zou M, Ma P. (2023) · DOI: 10.3389/fmed.2023.1259871

## 임상 시나리오

Protective Isolation for Severe ImmunosuppressionCD4+ count below 200 cells/mm³
For a client with a CD4+ count of 150 cells/mm³, the priority is infection prevention and early detection of sepsis. Implement neutropenic precautions immediately.

Strict hand hygiene and restriction of sick visitors are essential. Monitor vital signs every 4 hours, paying close attention to even a low-grade fever (e.g., 38°C/100.4°F), as this is a critical finding in an immunocompromised client.

CautionDo not delay reporting subtle changes such as mild confusion, tachypnea, or a slight temperature elevation. In severe immunosuppression, the inflammatory response is blunted, and classic signs of infection may be absent until the client is critically ill.

## 핵심 개념

- **Opportunistic Infection** — An infection caused by pathogens that take advantage of a weakened immune system, typically occurring when CD4+ count drops below 200 cells/mm³.
- **CD4+ T-cell Count** — A laboratory marker indicating the strength of the immune system; a count below 200 cells/mm³ defines AIDS and signifies severe immunosuppression.
- **Neutropenic Precautions** — Infection control measures for immunocompromised patients, including strict hand hygiene, avoiding fresh flowers/raw foods, and restricting contact with sick individuals.

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