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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000438868.67777.8d
Feature Articles

CE Test 2.5 Hours: HIV Peripheral Neuropathy and Foot Care Management: A Review of Assessment and Relevant Guidelines

Contrada, Emily

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Continued Education
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TEST INSTRUCTIONS

* To take the test online, go to our secure Web site at http://www.nursingcenter.com/ce/ajn .

* To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

* Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to:Lippincott Williams and Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is December 31, 2015.

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* Send in together two or more tests from any nursing journal published by Lippincott, Williams and Wilkins (LWW), and deduct $0.95 from the price of each test.

* We also offer CE accounts for hospitals and other health care facilities online at www.nursingcenter.com. Call 1-800-787-8985 for details.

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PROVIDER ACCREDITATION

LWW, publisher of AJN, will award the number of contact hours indicated for each continuing nursing education activity. LWW is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center (ANCC).

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LWW is also an approved provider of continuing nursing education by the District of Columbia and Florida #50-1223. Your certificate is valid in all states.

The ANCC's accreditation status of the LWW Department of Continuing Education refers to its continuing nursing educational activities only and does not imply Commission on Accreditation approval or endorsement of any commercial product.

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CE TEST QUESTIONS

GENERAL PURPOSE:

To provide information about distal sensory peripheral (DSP) neuropathy in HIV and evidence-based guidelines for foot care in HIV patients.

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LEARNING OBJECTIVES:

After reading this article and taking this test, you will be able to

* identify the prevalence and symptoms of DSP neuropathy in HIV.

* recognize evidence-based guidelines for foot care in patients who have HIV.

1. The prevalence of distal sensory peripheral (DSP) neuropathy in HIV patients ranges from

a. 24% to 30%.

b. 31% to 37%.

c. 38% to 44%.

d. 45% to 51%.

2. Early symptoms of DSP neuropathy in HIV patients typically begin in the

a. toes.

b. dorsum.

c. ankle.

d. lower leg.

3. Common manifestations of DSP neuropathy include

a. hyperreflexia.

b. hypothermia.

c. excessive vibration.

d. intrinsic muscle weakness.

4. A fungal or bacterial infection of the skin at the edge of a nail that often affects people who are immunocompromised is called

a. tinea pedis.

b. paronychia.

c. erythrasma.

d. onychomycosis.

5. In a study by Gupta and colleagues of people who have HIV, what percentage had onychomycosis?

a. 7%

b. 14%

c. 23%

d. 32%

6. With antiretroviral toxicity, symptoms of DSP neuropathy tend to appear suddenly at the start of antiretroviral therapy and usually peak within the first

a. month.

b. 2 months.

c. 3 months.

d. 4 months.

7. Of the following nucleoside reverse transcriptase inhibitors (NRTIs), which has the greatest association with neuropathy?

a. tenofovir

b. didanosine

c. abacavir

d. zidovudine

8. Of the following NRTIs, which is the component most commonly found in the fixed-dose generic drugs?

a. lamivudine

b. emtricitabine

c. zalcitabine

d. stavudine

9. Normal changes noted in the peripheral nervous system as people age include all of these except decreased

a. density of myelinated fibers.

b. amplitude of nerve action potentials.

c. nerve conduction.

d. number of small sensory fibers.

10. Individuals using highly active antiretroviral therapy often develop specific metabolic complications that increase their risk of

a. diabetes mellitus.

b. thrombophlebitis.

c. thyroid disease.

d. coronary artery disease.

11. Long-term, heavy alcohol use can lead to deficiencies in vitamins and minerals that are essential for healthy nerve function, particularly

a. calcium and magnesium.

b. the B vitamins.

c. vitamin D.

d. vitamin C.

12. All patients with HIV should receive a comprehensive foot exam every

a. 3 months.

b. 6 months.

c. year.

d. 2 years.

13. Smieja and colleagues reported a sensitivity of 90% to 93% with exams that included the first toe plus which metatarsal head in addition to either two other toes or two other metatarsal heads?

a. first

b. second

c. third

d. fourth

14. For DSP neuropathy in HIV, testing for a reduced or absent Achilles tendon reflex has a specificity of

a. 73%.

b. 84%.

c. 89%.

d. 98%.

15. Which of the following drugs is used in treating the primary symptoms of HIV-associated DSP neuropathy?

a. acetaminophen

b. amitriptyline

c. pregabalin

d. lidocaine

16. Recommendations for routine foot care include

a. washing the feet with antibacterial soap.

b. using cool water when washing the feet.

c. applying a thin coat of vitamin E oil to the feet.

d. filing corns and calluses with an emery board.

17. When buying or wearing new shoes, patients should

a. make sure they are made of permeable materials.

b. shop for shoes at the beginning of their day.

c. wear them only for 2 hours a day.

d. buy open-toed sandals for the beach.

18. Which statement about performing a pressure sensory exam with a nylon monofilament is correct?

a. Let the patient watch so she or he knows what to expect.

b. Apply the monofilament perpendicular to the skin's surface.

c. Use very little force so as not to allow the filament to bend or buckle.

d. Apply the filament along the ulcer site, callus, scar, or necrotic tissue.

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