# A 6-year-old child with HIV infection is admitted to the pediatric unit with fever, cough, and difficulty breathing. The child's CD4+ count is 180 cells/mm³. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542239 > language: ko > subject: Child Health ## 문제 A 6-year-old child with HIV infection is admitted to the pediatric unit with fever, cough, and difficulty breathing. The child's CD4+ count is 180 cells/mm³. Which nursing intervention should be the priority? ## 보기 1. Administer prescribed antiretroviral medications immediately 2. Place the child in protective isolation and monitor respiratory status closely **✔ 정답** 3. Obtain blood cultures and start broad-spectrum antibiotics 4. Encourage increased fluid intake and provide humidified oxygen **정답: 2** ## 해설 Children with HIV and low CD4+ counts (180 cells/mm³) are severely immunocompromised and at high risk for opportunistic infections like PCP. Protective isolation prevents exposure to pathogens, and close respiratory monitoring allows early detection of deterioration. Other interventions are important but secondary to safety. ## 심화 해설 Understanding the Priority This question tests your ability to prioritize nursing interventions for a pediatric patient with advanced HIV. The child presents with respiratory symptoms and a severely low CD4+ count of 180 cells/mm³, which indicates severe immunosuppression. In NCLEX-RN prioritization, the focus must be on immediate safety and preventing life-threatening deterioration using the ABC (Airway, Breathing, Circulation) and safety frameworks. Analyzing the Clinical Data The provided research on pediatric HIV/AIDS patients offers critical context for this scenario. The study highlights that among hospitalized children with HIV, the most common clinical presentations are fever, cough, and dyspnea, and the leading opportunistic infection is Pneumocystis jirovecii pneumonia (PCP) [1]. With a CD4+ count of 180 cells/mm³, this child is profoundly vulnerable to such infections. The study’s epidemiological data reinforces that respiratory tract infections are the predominant complication in this population, making respiratory status the central concern [1]. Why Option 2 is the Priority Placing the child in protective isolation and closely monitoring respiratory status directly addresses the two most immediate threats identified in the research: the high risk of acquiring a new, devastating infection and the potential for rapid respiratory decompensation from an existing opportunistic infection like PCP [1]. Protective isolation is a safety intervention that prevents exposure to environmental pathogens, which is crucial when the immune system is severely compromised. Simultaneously, close respiratory monitoring allows for early detection of hypoxia or worsening distress, enabling prompt intervention. This aligns with the NCLEX principle that assessment and safety interventions often come before treatments like medication administration. Why Other Options Are Not the Priority - Option 1: Administering antiretrovirals is essential for long-term immune reconstitution, but it is not the immediate priority in an acutely ill, severely immunocompromised child with respiratory distress. The study documents the clinical characteristics at admission, where managing the acute infection and preventing new ones takes precedence [1]. - Option 3: Obtaining blood cultures and starting antibiotics is an important step in managing a suspected bacterial infection. However, the priority is first to stabilize the airway and breathing and protect the patient from further harm. This diagnostic and treatment step follows the initial stabilization and safety measures. - Option 4: Providing humidified oxygen is a supportive measure for breathing, but it is a component of the broader priority of respiratory monitoring and does not address the critical safety need to prevent exposure to new pathogens through protective isolation. The study’s focus on the spectrum of opportunistic infections underscores why preventing exposure is as urgent as treating the current symptoms [1]. The convergence of severe immunosuppression and respiratory symptoms in a pediatric patient demands a dual-focused priority: protect the patient from a hostile environment and vigilantly assess for the most likely and lethal complication, which is respiratory failure from an opportunistic infection [1].References (research sources) - [1]Clinical characteristics, opportunistic infection spectrum and epidemiological analysis of pediatric AIDS patients in southwest China.Research articleLiao Y, An Q, Wang C, Wang D. (2026) · DOI: 10.3389/fcimb.2026.1824149 ## 임상 시나리오 Managing Pediatric HIV with Respiratory SymptomsPrioritizing Safety in Severe Immunosuppression A CD4+ count of 180 cells/mm³ indicates severe immunosuppression. The immediate priority is protective isolation to prevent new infections and close respiratory monitoring for decompensation from likely opportunistic infections such as Pneumocystis jirovecii pneumonia (PCP). The most common presentation in hospitalized children with HIV is fever, cough, and dyspnea. Respiratory tract infections are the predominant complication, making continuous assessment of airway and breathing the central nursing action. CautionDo not delay isolation precautions to perform other interventions like medication administration or lab draws. A child with this degree of immunosuppression is extremely vulnerable, and exposure to environmental pathogens can be rapidly fatal. ## 핵심 개념 - **Pneumocystis jirovecii pneumonia (PCP)** — A serious fungal opportunistic infection and a leading cause of respiratory distress in children with severely suppressed CD4+ counts, often presenting with fever, cough, and dyspnea. - **Protective Isolation** — A safety precaution for immunocompromised patients to minimize their exposure to potential pathogens from the environment, visitors, and healthcare staff. - **CD4+ Count** — A measure of immune function; a count of 180 cells/mm³ in a 6-year-old indicates severe immunosuppression and high susceptibility to opportunistic infections. ## 같은 주제 문제 - [A 4-year-old child with HIV infection is brought to the pediatric clinic for routine follo…](https://mymerci.kr/pages/nclex_q.php?qn_id=542235) - [A 4-year-old child with HIV infection is brought to the pediatric clinic for routine follo…](https://mymerci.kr/pages/nclex_q.php?qn_id=542236) - [A 7-year-old child with HIV infection is being cared for at home by the parents. The child…](https://mymerci.kr/pages/nclex_q.php?qn_id=542237) - [A nurse is caring for a 5-year-old child with HIV infection who has developed oral candidi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542238) - [A nurse is caring for a 4-year-old child with HIV infection who has developed oral candidi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542240) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._