HIV and normal aging can each negatively affect executive functioning, attention, memory, and, ultimately, metacognitive abilities, which are important for internally monitoring neuropsychological performance. Some individuals who are aging with HIV may experience severe changes in their metacognitive abilities. They may be unaware of their neuropsychological functioning and may not be accurately monitoring their cognitive abilities. Nurses who rely on patients' self-reports of cognitive status should exercise caution regarding the accuracy of these reports and consider confirming and validating such responses when impairments are suspected. A flowchart for monitoring patients with suspected metacognitive impairments is provided.