Ch. 14
A nurse is caring for older adults in a long-term care facility. For which early manifestation should the nurse monitor to detect infection in older adults? 1 High fever 2 Pain in the legs 3 Cognitive changes 4 Altered laboratory values
Correct3 In older adults, infections usually have atypical manifestations such as cognitive and behavioral changes. Unlike young adults, older adults have lower core temperatures and decreased immune responses; therefore, they may not have fever as a hallmark sign of infection. Pain, fever, and altered laboratory changes may occur in due course of the disease.
The patient with cellulitis has a prescription to receive cefotetan 1.5 g intravenous piggyback (IVPB) q12h. The reconstituted vial contains 3000 mg per 20 mL. The nurse should draw up milliliters to add to the IVPB solution? Record your answer using a whole number.
10 mL 1.5 gram equals 1500 mg. Using ratio and proportion, multiply 3000 by x and multiply 1500 × 20 to yield 3000x = 30000. Divide 30,000 by 3000 to yield 10 mL.
A patient with pneumococcal pneumonia is prescribed ceftriaxone for 10 days. During a follow-up visit, the patient reports to the nurse, "I stopped the medication after taking it for five days because I felt better." What is the best nursing response? 1 Explain the importance of completing the planned medication therapy. 2 Suggest that the patient give the leftover medications to the pharmacy. 3 Instruct the patient to obtain a refill to continue the medication for another week. 4 Instruct the patient to save the remaining medication in case the symptoms reoccur.
Correct 1 Antibiotics should always be taken until the completion of planned therapy even if the symptoms subside. Skipping the medications or not completing the therapy may result in developing resistance to the organism. Antibiotics should not be used for more than the planned therapy. Organisms may develop resistance to antibiotics if used for a longer duration. Antibiotics will lose their effectiveness when stored for a longer time, and they can even be fatal. The nurse will not instruct the patient to save the remaining medication for future use. The patient should not give it back to the pharmacy, because this medication may not be appropriate for others and may contain inadequate doses that do not provide full treatment.
Which patient factor has contributed to the development of antibiotic-resistant superinfections? 1 Skipping doses of antibiotics 2 Finishing the full course of antibiotics 3 Compliance regarding dosing intervals 4 Adherence to prescribed course of treatment
Correct 1 Patient factors that have led to the development of antibiotic-resistant organisms include skipping doses of medications and not finishing the full course of antibiotics. Adherence to a prescribed course of treatment and compliance regarding dosing intervals (taking medication on time as prescribed) lead to the intended eradication of infectious organisms.
A patient with human immunodeficiency virus (HIV) taking antiretroviral therapy reports they are starting to feel like they did before starting the therapy. What test should the nurse prepare the patient for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test
Correct 1 The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection.
A patient with human immunodeficiency virus (HIV) is educated about health promotion activities. What should the nurse inform the patient the importance of these activities is? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities
Correct 1 These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.
A patient diagnosed with acquired immunodeficiency syndrome (AIDS) comes to the clinic to find out which tests would determine the prognosis of the syndrome. What information will the nurse provide? Select all that apply. 1 Prognosis can be assessed by viral load. 2 Prognosis can be assessed by CD4 +T-cell count. 3 Prognosis can be assessed by red blood cell count. 4 Prognosis can be assessed by testing for hepatitis B virus (HBV). 5 Prognosis can be assessed by immunoglobulin M (IgM) antibody levels.
Correct 1, 2'The progression HIV infection is monitored by two important laboratory assessments: CD4+T-cell counts and viral load. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4 +T-cell count is done to monitor the progression of HIV infection and response to treatment. The normal range for CD4 +T cells is 800 to 1200 cells/μL. The red blood cell count indicates presence or absence of anemia. The tests for HBV and HCV indicate the infection with respective hepatitis virus. IgM antibody levels are nonspecific and do not indicate the progress of AIDS.
A patient who participates in high-risk activities has undergone an enzyme immunoassay (EIA) test for human immunodeficiency virus (HIV) infection. The nurse reviews the patient's lab results and notes a positive EIA result. What is likely to be included in the patient's plan of care? Select all that apply. 1 Repeat the EIA test. Correct 2 Confirm with a Western blot test. Correct 3 Confirm with an immunofluorescence assay. 4 Confirm with a rapid screening test for antigens. 5 Inform the patient that the patient is HIV-antibody positive.
Correct 1, 2, 3 If the patient tests positive with the enzyme immunoassay (EIA) test, which is highly sensitive, the test has to be repeated. If the repeat test is positive, the patient should be subjected to a confirmatory Western blot or immunofluorescence assay. Rapid screening tests are helpful for detecting antibodies, not antigens. The patient should be informed that he is positive for HIV antibody only if the confirmatory Western blot or immunofluorescence assay is positive.
The nurse knows that more patients are developing antibiotic-resistant infections requiring inpatient care. What actions may have contributed to the development of antibiotic-resistant infections? Select all that apply. 1 Prescribing antibiotics for viral infections 2 Performing cultures prior to initiating antibiotic therapy 3 Prescribing inadequate drug regimens to treat infections 4 Prescribing antibiotics based on need rather than patient insistence 5 Prescribing broad-spectrum antibiotics when only first-line antibiotics are needed
Correct 1, 3, 5 Health care providers (HCPs) have contributed to the development of antibiotic-resistant infections by prescribing broad-spectrum antibiotics when first-line medications should be used. HCPs that prescribe inadequate drug regimens depending on the bacteria involved also lead to development of antibiotic-resistance. Antibiotics should be used to treat infections caused by bacteria only since they are ineffective for viral infections. Performing cultures prior to initiating antibiotic therapy helps HCPs identify the bacteria and prescribe the appropriate first-line medication. Prescribing antibiotics based on need is an effective strategy for treating patients while also preventing the rise of antibiotic-resistant infections.
A nurse educator is teaching a group of nurses how to prevent health care-associated infections (HAI) in hospitals. Which bacteria are common culprits for the spread of health care-associated infections? Select all that apply. 1 Escherichia coli 2 Salmonella typhi 3 Clostridium botulinum 4 Staphylococcus aureus 5 Enterobacter aerogenes
Correct 1, 4, 5 Escherichia coli, Staphylococcus aureus, and Enterobacter aerogenes are the common culprits for health care-associated infections (HAI). These infections are acquired as a result of exposure to the microorganisms in a hospital setting. Surgical and immunocompromised patients are at increased risk of acquiring HAI. Salmonella typhi, which causes typhoid fever, and Clostridium botulinum, which causes food poisoning, are less common infections in hospitals.
In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? Select all that apply. 1 Platelets 2 T lymphocytes 3 B lymphocytes 4 Red blood cells 5 Immunoglobulins
Correct 2, 3 In the early stages of HIV infection, B cells and T cells protect the body from infections. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T-cells. Platelets do not take part in providing immunity to the human body. They are required for clotting mechanism. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.
A patient is diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse monitor for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex
Correct 2, 4, 5 Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS, because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with HIV due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus, and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence.
A primary health care provider advises against prescribing an antibiotic to a patient with a severe cold, sore throat, and running nose. The patient tells the nurse, "I really want an antibiotic to make this cold go away." What is the best response by the nurse? 1 "An antibiotic is ineffective against a cold or flu." 2 "Use the rest of a previous prescribed antibiotic from home." 3 "I will ask the health care provider to prescribe a low-dose antibiotic." 4 Communicate the patient request and ask the primary health care provider to prescribe an antibiotic
Correct1 A cold, sore throat, and running nose are symptoms of cold and flu (a viral infection), and antibiotics are ineffective in treating viral infections. The nurse should inform the patient about the use of antibiotics, not tell the patient to use the rest of a previous prescribed antibiotic from home. The nurse should not give antibiotics to the patient, because frequent use of antibiotics causes resistance. The nurse should not ask the primary health care provider to prescribe antibiotics. Test-Taking Tip: A cold, sore throat, and running nose indicate a viral infection. Antibiotics are ineffective against viruses. Use this tip in answering this question.
During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidioides immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans
Correct1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus and the presence of thrush indicate Candida albicans. Infection by Coccidioides immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans.
A patient has been prescribed antiretroviral therapy (ART), and the nurse is monitoring the assessment of growth of HIV in the concentrations of prescribed antiretroviral drugs. The nurse anticipates that what test will be advised for the patient? 1 Genotype assay 2 Phenotype assay 3 Enzyme immunoassay 4 Immunofluorescence assay
Correct2 A phenotype assay involves the assessment of growth of HIV in various concentrations of antiretroviral drugs. It helps determine the correct dosage of ART for the patient. A genotype test assesses the drug-resistant mutations in protease and reverse transcriptase genes. The enzyme immunoassay and immunofluorescence assay are used to detect serum antibodies that bind to HIV antigens.
The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). The patient asks what would determine the actual development of acquired immunodeficiency syndrome (AIDS). The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? 1 Presence of HIV antibodies 2 CD4 +T cell count below 200/µL 3 Presence of oral hairy leukoplakia 4 White blood cell (WBC) count below 5000/µL
Correct2 Diagnostic criteria for AIDS include a CD4 +T cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or oral hairy leukoplakia or WBC count below 5000/µL may be found in patients with HIV disease, but do not define the advancement of HIV infection to AIDS.
The nurse is caring for a patient who is human immunodeficiency virus (HIV)-positive. The nurse is educating the patient about CD4 T cells. Which statement will be a part of the nurse's teaching? 1 "HIV produces CD4 cells to cause your infections." 2 "HIV will destroy your CD4 cells and overwhelm your body." 3 "Your immune system is healthy as long as you have CD4 cells." 4 "Immune problems occur when your CD4 level is greater than 500 CD4 T cells/uL."
Correct2 HIV cripples the immune system by destroying CD4 cells and overwhelming the body. The human body produces CD4 cells to fight the HIV virus. An immune system is considered healthy as long as CD4 levels remain above 500 CD4 T cells/uL, not for as long as the human body has CD4 cells. Immune problems occur when CD4 levels are less than 500 CD4 T cells/uL.
The nurse is caring for a group of assigned patients on the acute care unit. Which nursing action is a priority for preventing healthcare-associated infections (HAIs)? 1 Avoid direct contact with patients. 2 Wash hands before and after patient care. 3 Wear sterile gloves when working with patients. 4 Treat all patients as if they are infected with mycobacterium tuberculosis.
Correct2 Standard precautions should be instituted for all patients in the healthcare setting. These precautions include washing hands before and after patient care with soap and water or an alcohol-based rub. Wearing sterile gloves when working with patients is not always appropriate. Direct contact with patients is an aspect needed to deliver quality patient care. Precautions for care of patients with mycobacterium tuberculosis infection requires airborne precautions. Airborne precautions are instituted for patients with highly communicable respiratory diseases spread through the air over short distances.
A patient is being placed on efavirenz with a once-a-day dose. Which instructions should the nurse give to help the patient cope with the side effects? 1 Use electronic reminders, timers, and beepers. 2 Take the dose at bedtime before going to sleep. 3 Have tests regularly to assess viral load in the body. 4 Inform the health care provider about other drugs being taken.
Correct2 The antiretroviral drug efavirenz is associated with side effects like dizziness and confusion. Therefore the nurse should teach the patient to take the drug dose at bedtime to cope better with the side effects. Electronic reminders, timers, and beepers are used to increase adherence to drug regimens. Informing the health care providers about concurrent medicines is important to decrease adverse drug interactions, but may not help in coping with side effects of the drug. Regular testing should be done to assess the viral load on the body and, in turn, indicate the efficacy of the drug therapy.
A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the patient reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."
Correct2 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4 + T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection, nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle.
A patient has been diagnosed with human immunodeficiency virus (HIV). The patient does not want to take more than one antiretroviral drug. What explanation can the nurse give to the patient regarding the importance of combination antiretroviral therapy? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs
Correct2 The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.
The nurse is providing education to parents to prepare their children for school. Which infection is preventable with vaccines? 1 Avian flu 2 Poliomyelitis 3 West Nile virus 4 Human immunodeficiency virus (HIV)
Correct2 The polio vaccine prevents the outbreak of the infection. There are currently no vaccines available to prevent the avian flu, HIV, or West Nile virus.
The nurse is preparing to disconnect IV fluid tubing from the access port so the patient can ambulate to the bathroom. What will the nurse wear to prevent the spread of pathogens? 1 A cap 2 Gloves 3 Shoe covers 4 An isolation gown
Correct2 When disconnecting IV fluid tubing, the nurse may come in contact with blood. Therefore personal protective equipment such as gloves should be used. This also helps the nurse avoid an infection by not touching contaminated items or surfaces. Caps, gowns, and boots are not required when removing IV tubing
Which is a microorganism capable of causing disease? 1 Lipase 2 Antigen 3 Pathogen 4 Microorganism
Correct3 A pathogen is a microorganism, such as a bacteria or virus, capable of causing disease. A pathogen can invade the body, multiply, produce disease, and cause harm to the host. An organism that can only be seen with a microscope is termed a microorganism. An antigen is a toxin or foreign substance that enters the body and initiates the immune response. Lipase is a pancreatic enzyme.
The nurse assesses a patient with recently diagnosed acquired immunodeficiency syndrome (AIDS). When obtaining a health history from the patient, what statement does the nurse determine most correlates with this diagnosis? 1 "I am feeling fatigue in the evening." 2 "I am sleeping six to eight hours per night." 3 "I have had a steady weight loss over the past several months." 4 "I have been having feelings of helplessness and hopelessness."
Correct3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss.
A patient with human immunodeficiency virus (HIV) comes into the clinic with a temperature of 102oF. Which statement would be of most concern to the nurse? 1 "I vomited once this morning." 2 "I woke up this morning with a mild headache." 3 "I have a rash that appeared on my stomach this morning." 4 "I started coughing up some clear mucous when I woke up this morning."
Correct3 Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.
Zoonosis is the spread of disease from animals to humans. Which is a clinical example of a zoonosis infection? 1 Acute meningitis 2 Tuberculosis bacterium (TB) 3 Severe acute respiratory syndrome (SARS) 4 Methicillin-resistant staphylococcus aureus (MRSA)
Correct3 SARS is an example of a zoonosis infection. In 2003, China experienced an outbreak of SARS linked to the civet cat, a small carnivorous mammal found throughout Asia and Africa. TB is an infection that spreads through the air from person to person. Acute meningitis is a bacterial infection spread from person to person via respiratory and throat secretions. MRSA is an antibiotic-resistant infection spread from person to person via droplets or contact with contaminated objects.
An HIV patient is on long-term antiretroviral therapy (ART). Of what side effects of the antiretroviral therapy should the nurse instruct the patient to be aware? 1 Nausea 2 Vomiting 3 Diarrhea 4 Lipodystrophy
Correct4 HIV-infected patients on antiretroviral therapy may develop a metabolic disorder called lipodystrophy, which is the deposition of fat in the abdomen, upper back, and breasts. There may simultaneously be a loss of fat in the arms, legs, and face. Nausea, vomiting, and diarrhea are short-term side effects of ART and tend to subside with regular use.
