# Situation: A 17-year-old boy comes alone to the social hygiene clinic of the Rural Health Unit (RHU). He has injected drugs with shared needles over the past year and asks to be tested for human immunodeficiency virus (HIV) and hepatitis C. He asks that his parents not be told about his visit. His HIV rapid screening test is reactive. What should the nurse tell him?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629918  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 17-year-old boy comes alone to the social hygiene clinic of the Rural Health Unit (RHU). He has injected drugs with shared needles over the past year and asks to be tested for human immunodeficiency virus (HIV) and hepatitis C. He asks that his parents not be told about his visit.

His HIV rapid screening test is reactive. What should the nurse tell him?

## 보기

1. This result means he has the virus and should start treatment today
2. This result is likely false, so he should simply retest in 3 months
3. This result must be confirmed before a diagnosis can be made **✔ 정답**
4. This result will be confirmed by repeating the same rapid test

**정답: 3**

## 해설

A reactive screening test is not a diagnosis; it must be confirmed according to the national HIV testing algorithm, which uses different assays. The nurse explains this, arranges confirmatory testing, gives support, and prepares linkage to a treatment hub. A reactive result is neither ignored nor treated as final.

## 심화 해설

A reactive screen is not a diagnosis
This 17-year-old has injected drugs with shared needles and his HIV rapid screening test is reactive. Screening tests are chosen for high sensitivity so that few infections are missed, but this means some reactive results are false positives. A reactive screening result must be confirmed according to the national HIV testing algorithm before HIV can be diagnosed. The nurse explains this clearly, arranges confirmatory testing, gives emotional support, and prepares linkage to a treatment hub so that care can begin quickly once the diagnosis is confirmed.

How confirmation works
The national HIV testing algorithm uses a sequence of different assays, chosen so that the combination is highly specific. A reactive screen is followed by further tests that work in different ways; repeating the same rapid test would simply repeat the same possible false reaction and does not confirm anything. Only when the algorithm is completed is the result reported as positive. This protects clients from a wrong diagnosis while ensuring that true infections are confirmed and treated.

| Response | Assessment |
| --- | --- |
| The result means he has the virus; start treatment today | Wrong: treats a screen as a diagnosis |
| The result is likely false; retest in 3 months | Wrong: dismisses a reactive result and delays confirmation |
| The result must be confirmed before a diagnosis | Correct |
| The same rapid test will be repeated to confirm | Wrong: confirmation uses different assays |

Why the other responses are wrong
Telling him he has HIV and should start treatment today treats a screening result as final; treatment follows confirmation. Calling the result likely false and suggesting a retest in 3 months dismisses a reactive result in a young man with a clear exposure risk, and delays a diagnosis that may be real. A retest after a waiting period is used for a nonreactive result after a recent exposure, not to resolve a reactive one.

Watch out! Confidentiality and consent are central here. Under the Philippine HIV and AIDS Policy Act (RA 11166), a minor aged 15 to below 18 may consent to HIV testing, and his request that his parents not be told is respected within the law. The clinic should also offer hepatitis C testing, harm reduction counseling, and support.

Exam takeaway
Key point! Screening is sensitive; confirmation is specific. A reactive HIV screen is followed by confirmatory testing using the national algorithm, with support and linkage to care. Never announce a diagnosis or dismiss the result on the basis of a single screening test.

## 임상 시나리오

Reactive HIV Screening ResultWhat to tell the client
A reactive rapid test is a screening result, not a diagnosis. It must be confirmed by the national HIV testing algorithm, which uses different assays.

Explain this clearly, arrange confirmatory testing, give emotional support, and prepare linkage to a treatment hub so care starts quickly after confirmation.

Respect confidentiality. Under RA 11166, a minor aged 15 to below 18 may consent to HIV testing.

CautionDo not tell him he has HIV, do not call the result false, and do not confirm by repeating the same rapid test.

## 핵심 개념

- **HIV rapid screening test** — A quick, highly sensitive test whose reactive result must be confirmed before HIV is diagnosed.
- **National HIV testing algorithm** — The official sequence of different assays used to confirm an HIV diagnosis.
- **Linkage to care** — Connecting a newly diagnosed client to a treatment hub for counseling, monitoring, and antiretroviral therapy.
- **RA 11166** — The Philippine HIV and AIDS Policy Act, which governs HIV testing, consent, and confidentiality.

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