Ch.21 Care of Patients with HIV Disease and Other Immune Deficiencies Evolve

The nurse presents a seminar on human immune deficiency virus (HIV) testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention (CDC) regarding HIV testing? Select all that apply. 1 "I am 78 years old, and I was treated and cured of syphilis many years ago." 2 "In 1986, I received a transfusion of platelets." 3 "Seven years ago, I was released from a penitentiary." 4 "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." 5 "At 68, I am going to get married for the fourth time."

1. "I am 78 years old, and I was treated and cured of syphilis many years ago." 3. "Seven years ago, I was released from a penitentiary." 5. "At 68, I am going to get married for the fourth time." Rationale: People who have had a sexually transmitted disease should be tested. People who are planning to get married and people who are in or have been in correctional institutions such as jails or prisons should be tested for HIV. HIV testing is recommended for clients who received a blood transfusion between 1978 and 1985. People who have used injectable drugs (not marijuana) should be tested.

A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse? 1 "With this treatment, I probably cannot spread this virus to others." 2 "This treatment does not kill the virus." 3 "This medication prevents the virus from replicating in my body." 4 "Research has shown the effectiveness of this therapy if I do not forget to take any doses."

1. "With this treatment, I probably cannot spread this virus to others." Rationale: HAART reduces viral load and improves CD4+ T-cell counts, but the client must still protect others from contact with his or her body fluids. HAART inhibits viral replication; it does not kill the virus. Remembering to take all doses of HAART is very important for preventing drug resistance.

A client with AIDS is treated with pentamidine isethionate (Pentam). What is the priority nursing care for this client? 1 Assess the respiratory function regularly. 2 Ensure a high protein, high calorie diet. 3 Provide opioid analgesics as scheduled. 4 Provide ice chips and mouth care regularly.

1. Assess the respiratory function regularly. Rationale: Pentamidine isethionate (Pentam) is used to treat Pneumocystis jiroveci pneumonia, a condition characterized by difficulty in breathing, cough, and weight loss. An effective therapy would help to decrease these sign and symptoms. Therefore, the nurse should assess the client's respiratory rate, depth, and breath sounds regularly to evaluate the efficacy of the treatment. A high-protein, high-calorie diet helps to maintain the client's nutritional status. Opioid analgesics given as scheduled helps to manage pain. Ice chips and mouth care helps to maintain oral hygiene and promotes appetite.

Which statement about Bruton's agammaglobulinemia is accurate? 1 Boys with the disease show symptoms at about 6 months of age. 2 Laboratory reports show a decrease in circulating antibodies. 3 Immune serum globulin is given at 50-90 mg/kg IV every 3 to 4 weeks. 4 It is the most common congenital immune deficiency seen in adults.

1. Boys with the disease show symptoms at about 6 months of age. Rationale: Boys with Bruton's agammaglobulinemia show symptoms at about 6 months of age because the maternal antibodies transferred through the placenta will be lost by that time. It is an X-linked trait and affects boys more than girls. Laboratory reports show an absence of circulating antibodies. Immune serum globulin is given at 100-400 mg/kg IV every 3 to 4 weeks, not at 50-90 mg. Selective immunoglobulin A (IgA) deficiency is the most common congenital immune deficiency seen in adults. Bruton's agammaglobulinemia is less common.

Which factors are possible transmission routes for human immune deficiency virus (HIV)? Select all that apply. 1 Breastfeeding 2 Anal intercourse 3 Mosquito bites 4 Toileting facilities 5 Oral sex

1. Breastfeeding 2. Anal intercourse 3. Oral sex Rationale: HIV can be transmitted via breast milk from an infected mother to the child. Anal intercourse not only allows seminal fluid to make contact with the mucous membranes of the rectum, but it also tears the mucous membranes, making infection more likely. Oral sexual contact exposes the mucous membranes to infected semen or vaginal secretions. HIV is not spread by mosquito bites or by other insects. HIV is not transmitted by casual contact, and sharing toilet facilities does not allow transmission of HIV.

A client with HIV infection has a WBC count of 3000/mm3 and a lymphocyte count of 1200/mm3. When the client receives a prescription for tenofovir (Viread), the nurse recognizes that it is important to perform what intervention? 1 Check serum phosphate levels. 2 Monitor for numbness or tingling in the toes/feet. 3 Instruct the client to take the medication 30 minutes before meals. 4 Check the kidney function and glomerular filtration rate (GFR).

1. Check serum phosphate levels. Rationale: A WBC count of 3000/mm3 and lymphocyte count of 1200/mm3 indicates the presence of HIV infection. Tenofovir (Viread) is a nucleoside analog reverse transcriptase inhibitor. Hypophosphatemia is the common side effect associated with this drug. Therefore, the nurse should check serum phosphate levels while caring for the client. The nurse should monitor for numbness or tingling in the toes/feet for a client prescribed stavudine (Zerit). The nurse instructs a client who is prescribed didanosine (Videx EC), not tenofovir (Viread), to take the medication 30 minutes before meals or 2 hours after meals. The nurse checks kidney function and glomerular filtration rate (GFR) and reports abnormal findings if the client is prescribed emtricitabine (Emtriva).

The nurse is reviewing the prescriptions of four clients with AIDS. Which client should receive instructions to take the medication on an empty stomach or before bed? 1 Client 1 Efavirenz (Sustive) 2 Client 2 Tpranavir (Aptivus) 3 Client 3 Enfuvirtide (Fuzeon) 4 Client 4 Atazanavir (Reyataz)

1. Client 1 Rationale: Efavirenz (Sustiva) is a nonnucleoside reverse transcriptase inhibitor. Food increases absorption of this drug and causes side effects. Therefore, the nurse instructs client 1 to take the medication on an empty stomach or before bed. Food increases tolerability and absorption of tipranavir (Aptivus). Therefore, the nurse instructs client 2 to take this drug after meals. Enfuvirtide (Fuzeon) is a fusion inhibitor that prevents cellular fusion between HIV and T-cells. Client 3 is instructed to reconstitute this drug with sterile water only. Food increases absorption of the drug atazanavir (Reyataz). Therefore, the nurse instructs the client 4 to take the medication after meals.

Which are general drug classes with immunosuppressive effects? Select all that apply. 1 Corticosteroids 2 Antimicrobials 3 Proton pump inhibitors 4 Cytotoxic drugs 5 Biological response modifiers

1. Corticosteroids 4. Cytotoxic drugs 5. Biological response modifiers Rationale: Corticosteroids keep T-cells in the bone marrow, reducing the number of circulating T-cells and resulting in lymphopenia and suppressed cell-mediated immunity. They also interfere with immunoglobulin G (IgG) production and reduce antibody-antigen binding. Cytotoxic drugs are used in the treatment of cancer and autoimmune disorders; they interfere with all rapidly dividing cells. Biological response modifier agents always decrease the general immune responses to some degree and increase the risk for infection. Antimicrobials and proton pump inhibitors do not have immunosuppressive effects.

Which of these disorders associated with acquired immune deficiency syndrome (AIDS) are considered opportunistic infections? Select all that apply. 1 Cryptosporidiosis 2 Candidiasis 3 Nocardiosis 4 Cryptococcosis 5 Kaposi's sarcoma

1. Cryptosporidiosis 2. Candidiasis 3. Nocardiosis 4. Cryptococcosis Rationale: Cryptosporidiosis is an opportunistic protozoal infection. Candidiasis and cryptococcosis are opportunistic fungal infections. Nocardiosis is an opportunistic bacterial infection. Kaposi's sarcoma is a malignancy. All of these are associated with AIDS.

What assessment data identifies the point when human immune deficiency virus (HIV) has progressed to acquired immune deficiency syndrome (AIDS)? Select all that apply. 1 Cytomegalovirus infection 2 Presence of hypogammaglobulinemia 3 Presence of Kaposi's sarcoma 4 CD4 count of <300/mm3 5 CD4/CD8 ratio of <2

1. Cytomegalovirus infection 3. Presence of Kaposi's sarcoma 4. CD4/CD8 ratio of <2 Rationale: The key manifestations in a client with AIDS are opportunistic infections such as cytomegalovirus and Kaposi's sarcoma. The client also has a CD4/CD8 ratio of <2. Clients with AIDS have hypergammaglobulinemia and a CD4 count <200/mm3.

Which factor is a cause of primary immune deficiency? 1 Genetic mutations 2 Viral infection 3 Contact with a toxin 4 Medical therapy

1. Genetic mutations Rationale: When the immune system fails to recognize infectious agents, severe local and systemic infections are not suppressed or controlled. Immune system failure can be the result of a primary (congenital) immune deficiency in which one or more parts of the system are not functioning properly from birth. These problems are usually genetic mutations. Immune system failure can also be secondary (acquired after birth) as the result of viral infection, contact with a toxin, or medical therapy.

Which are examples of parenteral exposure to human immune deficiency virus (HIV)? Select all that apply. 1 Injectable drug users sharing needles and syringes 2 Receiving contaminated blood products 3 Use of equipment contaminated with infected blood 4 During pregnancy or delivery when the mother is HIV-positive 5 Exposure of mucous membranes to infected vaginal secretions 6 Exposure of mucous membranes to infected semen

1. Injectable drug users sharing needles and syringes 2. Receiving contaminated blood products 3. Use of equipment contaminated with infected blood Rationale: Parenteral transmission of HIV can occur through the sharing of needles or equipment contaminated with infected blood or receiving contaminated blood products. Transmission during pregnancy or via the mother is an example of perinatal transmission. Transmission through mucous membranes via infected vaginal and seminal fluids are examples of sexual transmission.

Clients who are human immune deficiency virus (HIV) positive would also have a diagnosis of acquired immune deficiency syndrome (AIDS) if which conditions were present as well? Select all that apply. 1 Opportunistic infection and a CD4+ count of 30 2 Common cold and a CD4+ count of 400 3 Current CD4+ count of 250 that was 150 4 Elite controller genetic makeup 5 Recovering from Pneumocystis jirovecii pneumonia

1. Opportunistic infection and a CD4+ count of 30 3. Current CD4+ count of 250 that was 150 5. Recovering from Pneumocystis jirovecii pneumonia Rationale: A diagnosis of AIDS requires that the person be HIV-positive and have either a CD4+ T-cell count of fewer than 200 cells/mm3 or an opportunistic infection. Once AIDS is diagnosed, even if the client's cell count goes higher than 200 cells/mm3 or the infection is successfully treated, the AIDS diagnosis remains and the client never reverts to being just HIV-positive.

In which situations may immunosuppression be a desired therapeutic effect? Select all that apply. 1 Organ transplantation 2 Autoimmune disease treatment 3 Chemotherapy for cancer 4 Management of bacterial infection 5 Radiation for cancer

1. Organ transplantation 2 . Autoimmune disease treatment Rationale: The most common cause of secondary immune deficiency is the use of drugs and other treatment modalities for various diseases. Sometimes immunosuppression is a desired effect, as in organ transplantation to suppress organ rejection or for the treatment of autoimmune disorders to suppress inflammatory responses. Often immunosuppression is an undesirable, complicating side effect of therapy that is used for another intent, such as cancer chemotherapy and radiation, and treatment of other inflammatory processes such as bacterial infections.

In which ways can nurses safely care for clients who are at risk for infection? Select all that apply. 1 Practice good handwashing technique before and after all client contact. 2 Place clients only in rooms with other immunosuppressed clients. 3 Report signs of immunosuppression to the provider immediately. 4 Hold hematopoietic growth factor therapy in high-risk clients. 5 Restrict all outside visitors to the client's room.

1. Practice good handwashing technique before and after all client contact. 3. Report signs of immunosuppression to the provider immediately. Rationale: Good handwashing practice before and after contact with clients is essential for infection prevention. Early assessment and reporting of signs of immunosuppression allow the provider to alter drug dosages if needed. Immunosuppressed clients should be placed in a private room whenever possible. Hematopoietic growth factors stimulate bone marrow production of immune system cells in some instances, thereby reducing the risk for infection during drug therapy. Visitors to the client's room should be limited to healthy adults only; there is no need to restrict all visitors.

Which drug used to treat human immune deficiency virus (HIV) infection acts by inhibiting the HIV enzyme integrase? 1 Raltegravir (Isentress) 2 Atazanavir (Reyataz) 3 Darunavir (Prezista) 4 Fosamprenavir (Lexiva)

1. Raltegravir (Isentress) Rationale: Raltegravir is an integrase inhibitor (inhibits the HIV enzyme integrase) that prevents DNA from the HIV virus from entering the DNA from the host. Atazanavir, darunavir and fosamprenavir are protease inhibitors that prevent the viral replication and release of viral particles.

Which are the most common ways that human immune deficiency virus (HIV) is transmitted? Select all that apply. 1 Sexually 2 Parenterally 3 Perinatally 4 Environmentally 5 Vector contact

1. Sexually 2. Parenterally 3. Perinatally Rationale: HIV is transmitted most often through sexual contact, parenterally (such as through the sharing of needles or equipment contaminated with infected blood), and perinatally (from the placenta, contact with maternal blood and body fluids during birth, or breast milk from an infected mother to child). HIV cannot be transmitted through casual contact from the environment or via a vector such as a mosquito.

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? 1 The dietary worker hands the disposable meal trays to the LPN assigned to the client. 2 The social worker encourages the client to verbalize about stressors at home. 3 Housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. 4 The health care provider orders vital signs including temperature every 8 hours.

1. The dietary worker hands the disposable meal trays to the LPN assigned to the client. Rationale: The dietary worker giving the meal tray to the LPN limits the number of health care personnel entering the room, thus reducing the risk for infection. Verbalizing stressors does not reduce the risk for infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection, but does not reduce the risk for infection.

A client with AIDS is being treated for diarrhea. The nurse regularly checks the client's perineal area, and ensures that the perineal area is kept clean and dry. What is the purpose of this nursing intervention? 1 To protect skin integrity 2 To determine stool incontinence 3 To minimize the frequency of stools 4 To ensure personal hygiene in the client

1. To protect skin integrity Rationale: Diarrhea is a common side effect of AIDS and it may cause skin excoriation, increasing the risk of skin breakdown. Therefore, the nurse should ensure that the client's perineal area is kept clean and dry to protect the skin integrity. Checking the client's perineal area will not decrease the frequency of stools; the client should be administered antidiarrheal medication for this purpose. Keeping the client's perineal area clean and dry does not help diagnose stool incontinence; the nurse should record the number of stools passed by the client per day for this purpose. Keeping the perineal area clean and dry will help in personal hygiene, but this is not the primary objective of this intervention.

Which statement made to the nurse by a health care worker assigned to care for a client with human immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the nurse? 1 "I told family members they need to wash their hands when they enter and leave the room." 2 "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." 3 "Yes, I understand the reasons why I have to wear gloves when I bathe the client." 4 "The client's spouse told me she got HIV from a blood transfusion."

2. "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." Rationale: Discussing this client's illness outside of the client's room is a breach of confidentiality and requires further education by the nurse. Instruction on handwashing to family members or friends is not a breach of confidentiality. Understanding the reasons for wearing gloves recognizes Standard Precautions in direct care and is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a breach of confidentiality.

What does the nurse teach a client about condom use to prevent sexually transmitted diseases? 1 "Use only natural-membrane condoms." 2 "Unroll the condom and place it on the erect penis." 3 "Do not leave any space at the tip of the condom." 4 "Do not use oil-based lubricants for lubrication.

2. "Unroll the condom and place it on the erect penis." Rationale: The nurse should teach clients not to use oil-based lubricants such as petroleum jelly for lubrication because they can damage the condom. Water-based lubricants are safe to use. Latex or polyurethane condoms should be used rather than natural-membrane condoms because they are more durable. The condom must be unrolled onto the erect penis by holding the tip of the condom, and space should be left at the tip to collect the semen.

Which approach is the best method to prevent human immune deficiency virus (HIV) infection resulting from sexual contact? 1 Using condoms with every sexual encounter 2 Abstaining from sexual contact 3 Maintaining a mutually monogamous relationship 4 Avoiding risky sexual practices with an infected partner

2. Abstaining from sexual contact Rationale: Abstinence is the best method to prevent HIV transmitted via sexual intercourse. If a person who engages in sex is involved in a mutually monogamous relationship with a person who is infected with HIV, or a person whose HIV status is unknown, there is a risk for HIV infection. Sexual contact with any person who may be infected, even when a condom is used or when engaging in risky sexual practices, should be avoided.

Recurrent bacterial infections tend to be more common in which types of immunodeficiency disorders? Select all that apply. 1 Human immunodeficiency virus (HIV) infection 2 Bruton's agammaglobulinemia 3 Hypogammaglobulinemia 4 Selective immunoglobulin A (IgA) deficiency 5 Acquired immune deficiency syndrome (AIDS)

2. Bruton's agammaglobulinemia 3. Hypogammaglobulinemia 4. Selective immunoglobulin A (IgA) deficiency Rationale: Clients with Bruton's agammaglobulinemia usually start to have problems after maternal antibodies have been lost; the first manifestations are recurrent otitis, sinusitis, pneumonia, furunculosis, meningitis, and septicemia with organisms such as pneumococcus, streptococcus, and haemophilus. The client with hypogammaglobulinemia has recurrent bacterial infections similar to those seen with Bruton's disease; they have low levels of circulating antibodies (immunoglobulins) of all classes. Because IgA is the major antibody in secretions, bacterial infections are seen mostly in the respiratory, GI, and urogenital tracts. Clients with HIV/AIDS often develop pathogenic infections and opportunistic infections resulting from primary infection or reactivation of a latent infection, which can be protozoan, fungal, bacterial, or viral.

Which factor relates most directly to a diagnosis of primary immune deficiency? 1 History of viral infection 2 Full-term infant surfactant deficiency 3 Contact with anthrax toxin 4 Corticosteroid therapy

2. Full-term infant surfactant deficiency Rationale: Genetic mutation causes surfactant deficiency; this is a primary immune deficiency. Viral infection can cause a secondary immune deficiency. Anthrax and medical therapy are examples of a secondary immune deficiency.

A client with an autoimmune disease has been prescribed corticosteroids. What side effect is most likely to be observed by the nurse who is caring for this client? 1 Hypotension 2 Insomnia 3 Anorexia 4 Weight loss

2. Insomnia Rationale: Insomnia or sleeplessness is most likely to be observed in the client using corticosteroids because these drugs affect the central nervous system. Corticosteroids are known to cause cardiovascular changes such as hypertension. Corticosteroids tend to increase appetite and, in turn, cause weight gain.

Some people who are human immune deficiency virus (HIV)-positive do not develop symptoms and have normal CD4 counts. Which statement about long-term nonprogressors (LTNPs) is accurate? 1 LTNPs have a mutation in their CD4 receptors. 2 LTNPs constitute about 1% of HIV-infected people. 3 LTNPs have a defective receptor called alpha32. 4 LTNPs have a viral load but a virus cannot enter the cell.

2. LTNPs constitute about 1% of HIV-infected people. Rationale: LTNPs, or "elite controllers," constitute about 1% of HIV-infected people. Though they are infected with HIV for at least 10 years, they show no symptoms. LNTPs have a mutation in the CCR5/CXCR4 co-receptors, which prevents the entry of HIV into CD4 cells. The viral load in LNTPs is either undetectable or very low with normal CD4 cell counts.

The nurse is caring for a client with human immune deficiency (HIV) viral infection who has been prescribed stavudine (Zerit). What action does the nurse perform when caring for the client? 1 Administer the drug 30 minutes before meals. 2 Monitor for numbness and tingling in toes or feet. 3 Check for the client's serum phosphate levels. 4 Ensure HLA B5701 allele testing is performed.

2. Monitor for numbness and tingling in toes or feet. Rationale: The nurse should check for numbness and tingling in the toes or feet because peripheral neuropathy is a common side effect of stavudine. Clients taking didanosine (Videx EC) are given the drug 30 minutes before meals because gastric acid destroys the drug's activity. Clients taking tenofovir (Viread) are checked for serum phosphate levels because hypophosphatemia is a common side effect of the drug. HLA B5701 allele testing is performed in clients taking abacavir (Ziagen) because clients who have a specific variation of the B5701 gene allele are at high risk for hypersensitivity reactions.

Which drug is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat human immune deficiency virus (HIV) infection in clients? 1 Abacavir (Ziagen) 2 Nevirapine (Viramune) 3 Zidovudine (Retrovir) 4 Emtricitabine (Emtriva)

2. Nevirapine (Viramune) Rationale: Nevirapine is an NNRTI that inhibits the enzyme reverse transcriptase and prevents HIV replication. Abacavir, zidovudine, and emtricitabine are nucleoside analog reverse transcriptase inhibitors (NRTIs) that have a similar structure to the nucleoside bases of DNA, namely adenine, guanine, cytosine, and thymidine. NRTIs act as counterfeit bases by fooling the reverse transcriptase into using them as bases to form viral DNA, which is not inserted into the host cell's DNA.

A client who is human immune deficiency virus (HIV) positive is experiencing anorexia and diarrhea. Which nursing actions does the nurse delegate to a nursing assistant? 1 Collaborate with the client to select foods that are high in calories. 2 Provide oral care to the client before meals to enhance appetite. 3 Assess the perianal area every 8 hours for signs of skin breakdown. 4 Discuss the need to avoid foods that are spicy or irritating.

2. Provide oral care to the client before meals to enhance appetite. Rationale: Providing oral care is within the scope of practice of unlicensed personnel such as nursing assistants. Diet planning, assessment, and client teaching are higher-level actions that require more broad education and scope of practice; these actions should be done by licensed staff.

The nurse is conducting a health assessment interview with a client diagnosed with human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address? 1 "When I injected heroin, I was exposed to HIV." 2 "I don't understand how the antiretroviral drugs work." 3 "I remember to take my antiretroviral drugs almost every day." 4 "My sex drive is weaker than it used to be since I started taking my antiviral medications."

3. "I remember to take my antiretroviral drugs almost every day." Rationale: Because inconsistent use of antiretroviral medications can lead to unsuccessful therapy and the development of drug-resistant HIV strains, it is important that clients take these drugs consistently. The nurse should immediately assess the reasons why the client does not take the medications daily and then should implement a plan to improve adherence. The nurse should assess whether the client is still injecting drugs and should make certain the client understands the risks for infection with another strain of HIV or other blood-borne pathogens and the risk for spreading HIV, but this does not need to be addressed immediately. The nurse must provide further education about how the medications work and assess how the lack of knowledge or decreased libido influences compliance, but this does not need to be addressed immediately.

The nurse is instructing an unlicensed health care worker on the care of a client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions? 1 "I need to know my HIV status, so I must get tested before caring for any clients." 2 "Putting on a gown and gloves will cover up the itchy sores on my elbows." 3 "Washing my hands and putting on a gown and gloves is what I must do before starting care." 4 "I will wash my hands before going into the room, and then will put on a gown and gloves only for direct contact with the client's genitals."

3. "Washing my hands and putting on a gown and gloves is what I must do before starting care." Rationale: include whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes. Knowing HIV status is important for preventing transmission of HIV, but is not a Standard Precaution. Health care workers with weeping dermatitis should not provide direct client care regardless of the use of a gown and gloves. Unlicensed health care workers cannot make the determination of what is required for PPE or Standard Precautions.

The nurse is teaching a group of student nurses about the classification of HIV infections according to the Centers for Disease Control and Prevention (CDC). Which client data are accurately documented by the student nurse? 1 Data 1: Stage 1 Confirmed HIV infection and a CD4+ T-cell count of 400 cells/mm3 2 Data 2: Stage 2 Confirmed HIV infection and a CD4+ T-cell count of 600 cells/mm3 3 Data 3: Stage 3 Confirmed HIV infection and a CD4+ T-cell count of 100 cells/mm3 4 Data 4: Stage 4 Confirmed HIV infection and a CD4+ T-cell count of 250 cells/mm3

3. Data 3: Stage 3 Confirmed HIV infection and a CD4+ T-cell count of 100 cells/mm3 Rationale: The Centers for Disease Control and Prevention (CDC) classifies HIV infections by correlating clinical conditions with three ranges of CD4+ T-cell counts. Stage 3 describes any client with confirmed HIV infection and a CD4+ T-cell count of fewer than 200 cells/mm3. Therefore, the data for client 3 is accurate as the CD4+ T-cell count is 100 cells/mm3. Stage 1 describes any client with confirmed HIV infection and a CD4+ T-cell count of greater than 500 cells/mm3. Stage 2 describes any client with confirmed HIV infection and a CD4+ T-cell count between 200 and 499 cells/mm3. Stage 4 describes any client with confirmed HIV infection but no information regarding CD4+ T-cell counts. Therefore, data for clients 1, 2, and 4 is inaccurate.

The nurse is caring for a client who receives radiation therapy to the hip area as part of the client's cancer treatment. The client's clinical parameters are as follows: T- 98.6° F, P- 80 beats/min, R- 20 breaths/min, Hgb- 9.2g/dL, WBC- 3,000 cells/mcL, blood sugar- 140mg/dl. What is the priority nursing care for this client? 1 Provide oxygen therapy to the client at 5 L/min via non-rebreather mask. 2 Introduce more iron-rich foods into the client's diet. 3 Isolate the client in a private room and limit visitors. 4 Monitor the client's blood sugar levels every 4 hours.

3. Isolate the client in a private room and limit visitors. Rationale: Radiation therapy, especially on the ileum and femur, may lead to immunosuppression in the client because most of the production of blood cells happens in these larger bones. As a result, the client may have low immune response as evidenced by the low WBC count, which makes the client susceptible to infections. As a precaution, the client should be isolated and the visitors should be limited to prevent infections. The client's respiratory rate is normal so this client does not require oxygen therapy. The client's hemoglobin levels are low which may require the client to receive iron supplementation; however, it is not a priority nursing intervention at this time. The client's blood sugar is normal, so the nurse will not need to monitor it every 4 hours.

The nurse is caring for a client who receives radiation therapy to the hip area as part of the client's cancer treatment. The client's clinical parameters are as follows: T- 98.6° F, P- 80 beats/min, R- 20 breaths/min, Hgb- 9.2g/dL, WBC- 3,000 cells/mcL, blood sugar- 140mg/dl. What is the priority nursing care for this client? 1 Provide oxygen therapy to the client at 5 L/min via non-rebreather mask. 2 Introduce more iron-rich foods into the client's diet. 3 Isolate the client in a private room and limit visitors. 4 Monitor the client's blood sugar levels every 4 hours

3. Isolate the client in a private room and limit visitors. Rationale: Radiation therapy, especially on the ileum and femur, may lead to immunosuppression in the client because most of the production of blood cells happens in these larger bones. As a result, the client may have low immune response as evidenced by the low WBC count, which makes the client susceptible to infections. As a precaution, the client should be isolated and the visitors should be limited to prevent infections. The client's respiratory rate is normal so this client does not require oxygen therapy. The client's hemoglobin levels are low which may require the client to receive iron supplementation; however, it is not a priority nursing intervention at this time. The client's blood sugar is normal, so the nurse will not need to monitor it every 4 hours.

A client diagnosed with AIDS reports to the nurse, "I have mouth pain and difficulty swallowing. Food even tastes funny." On examining the client's mouth and back of the throat, the nurse finds cottage cheese-like, yellowish-white plaques and inflammation. Based on the assessment findings, the nurse concludes that the client has what condition? 1 Toxoplasmosis 2 Cryptococcosis 3 Cryptosporidiosis 4 Candida stomatitis

4. Candida stomatitis Rationale: Candida stomatitis is a frequent finding in a client with AIDS. The client with this condition reports mouth pain, difficulty swallowing, and food tasting "funny." The presence of cottage cheese-like, yellowish-white plaques and inflammation in the mouth and back of throat indicate the presence of candida stomatitis. A client with toxoplasmosis has difficulty with speech, gait, and vision. Cryptococcosis is debilitating meningitis in which the client has fever, blurred vision, nuchal rigidity, and mild confusion. Cryptosporidiosis is an intestinal infection in which the client reports the presence of diarrhea and unplanned weight loss of 5 pounds or more.

Which statement about transmission of the human immune deficiency (HIV) virus is accurate? 1 HIV is not present in tears. 2 The highest concentrations of HIV are in blood and vaginal fluids. 3 HIV can be spread by mosquitoes and insects. 4 HIV can be transmitted via the parenteral route.

4. HIV can be transmitted via the parenteral route. Rationale: HIV can be spread via parenteral routes such as the sharing of needles contaminated with infected blood. Another example is receiving contaminated blood products. HIV has been found in body fluids such as tears of infected clients, but there is no evidence that it transmits through tears. The highest concentrations of HIV are found in blood and semen. Though vaginal fluids also have HIV, concentrations are less than blood and semen. HIV cannot be transmitted by mosquitoes or other insects.

A client with an acquired immune deficiency is seen in the clinic for reevaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? 1. Therapeutic highly active antiretroviral therapy (HAART) level 2. Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot 3. Positive Papanicolaou (Pap) test 4. Improved CD4+ T-cell count and reduced viral load

4. Improved CD4+ T-cell count and reduced viral load Rationale: Improved CD4+ T-cell count and reduced viral load reflect the response to prescribed HAART medication. Therapeutic HAART level is the recommended medication combination given to clients with HIV to cause an increase in the CD4+ T-cell count. ELISA and Western blot, if positive, indicate that the client is HIV positive (a fact already known for this client) and do not indicate response to prescribed medication. Pap smears can be precancerous in an HIV-positive client, but the test does not indicate the immune system's response to prescribed medication.

A client with AIDS is diagnosed with candidal esophagitis. Intravenous amphotericin B (Fungizone) is prescribed. The nurse identifies that which outcome indicates that the treatment was effective? 1 Absence of cyanosis or pallor 2 Consumption of foods low in calories and proteins 3 Absence of facial grimacing and teeth-clenching 4 Normal levels of ferritin, albumin, and hemoglobin

4. Normal levels of ferritin, albumin, and hemoglobin Rationale: An AIDS client with candidal esophagitis has difficulty swallowing. The client is prescribed antifungal agents such as amphotericin B (Fungizone) intravenously to reduce this effect. Maintaining ferritin, albumin, and hemoglobin levels within the normal range indicates that the treatment is effective. Absence of cyanosis or pallor indicates enhanced oxygenation in a client with AIDS and respiratory difficulty. If a client with AIDS and candidal esophagitis consumes food low in calories and proteins, it indicates that the treatment is ineffective. Absence of facial grimacing and teeth-clenching indicates effective pain management with the use of pain medications.

A client with AIDS has developed a herpes simplex virus (HSV) abscess. What is the reason that the nurse applies modified Burow's solution (Domeboro) soaks while providing care to the client? 1 To manage the pain 2 To minimize diarrhea 3 To minimize confusion 4 To restore the skin integrity

4. To restore the skin integrity Rationale: A client has an HSV abscess. The nurse uses modified Burow's solution (Domeboro) soaks to restore skin integrity due to its astringent property. Modified Burow's solution (Domeboro) soaks do not help manage pain. Antidiarrheal agents or loperamide, not modified Burow's solution (Domeboro) soaks, are given on a regular schedule to minimize diarrhea. Psychotropic drugs, antidepressants, and anxiolytics, not modified Burow's solution (Domeboro) soaks, are prescribed to minimize confusion in the client.

Intravenous immunoglobulin (IVIG) is ordered for a client with selective immunoglobulin A (IgA) deficiency. Should the nurse question this order or administer as prescribed? 1 No; administer as prescribed since the client is immunoglobulin-deficient. 2 No; administer as prescribed because clients with IgA deficiency often have malabsorption syndrome. 3 Yes; question the order because IVIG does not contain IgA components. 4 Yes; question the order because the client is at high risk for severe allergic reactions to exogenous immunoglobulin.

4. Yes; question the order because the client is at high risk for severe allergic reactions to exogenous immunoglobulin. Rationale: Unlike other immunoglobulin deficiencies, IgA deficiency is not managed with exogenous immunoglobulin for two reasons. First, exogenous immunoglobulin contains very little IgA and would not help boost IgA levels. Second, because clients with IgA deficiency make normal amounts of all other antibodies, they are at high risk for severe allergic reactions to exogenous immunoglobulin. If malabsorption syndrome occurs with IgA deficiency, the client needs nutritional supplements.

What does the nurse teach the client who is positive for human immune deficiency virus (HIV) about ways to prevent infection? 1 "If bathing is not possible, wash the perineal area daily." 2 "Eat lot of fruits and salads to increase vitamins." 3 "Do not drink juice standing longer than 2 hours." 4 "Clean your toothbrush at least once a week."

4."Clean your toothbrush at least once a week." Rationale: The nurse should teach the client to clean toothbrushes with bleach and hot running water at least once a week to prevent infections of the mouth. If bathing is not possible, the perineal area should be cleaned twice a day to keep it clean and prevent infections. Fruits and salads should be avoided because raw fruits harbor bacteria that can cause infection. Juices standing longer than 1 hour must be avoided to prevent infection.

A nurse is teaching preventive practices to a group of drug-addicted clients at a homeless shelter to reduce their risk of HIV infection. The nurse should teach the clients to clean needles and other injectable drug paraphernalia in what order? 1. Fill the syringe with household bleach 2. Shake the bleach in the syringe for 30 seconds 3. Thoroughly wash the hands with soap and water 4. Flush the syringe with fresh, clean water

FIRST: 3. Thoroughly wash the hands with soap and water SECOND: 4. Flush the syringe with fresh, clean water THIRD: 1. Fill the syringe with household bleach FORTH: 2. Shake the bleach in the syringe for 30 seconds Rationale: Injection drug users (IDUs) should be taught to use only fresh needles or to properly clean their drug paraphernalia in order to reduce the risk of HIV transmission. Anyone who handles needles and syringes should first wash their hands with soap and water. Then the IDU should flush the syringe with fresh, clean water. Next, the syringe should be filled with household bleach and then shaken for 30-60 seconds.

A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client? 1 Fluconazole (Diflucan) 2 Trimethoprim/sulfamethoxazole (Bactrim) 3 Rifampin (Rifadin) 4 Acyclovir (Zovirax)

Fluconazole (Diflucan) Rationale: Fluconazole (Diflucan) is indicated for opportunistic candidiasis infection related to HIV. Trimethoprim/sulfamethoxazole (Bactrim) is indicated for bacterial infections such as urinary tract infection. Rifampin (Rifadin) is used for treatment of tuberculosis. Acyclovir (Zovirax) is an antiviral agent.

A client with an acquired immune deficiency is seen in the clinic for reevaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? 1 1 Therapeutic highly active antiretroviral therapy (HAART) level 2 Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot 3 Positive Papanicolaou (Pap) test 4 Improved CD4+ T-cell count and reduced viral load

Improved CD4+ T-cell count and reduced viral load Rationale: Improved CD4+ T-cell count and reduced viral load reflect the response to prescribed HAART medication. Therapeutic HAART level is the recommended medication combination given to clients with HIV to cause an increase in the CD4+ T-cell count. ELISA and Western blot, if positive, indicate that the client is HIV positive (a fact already known for this client) and do not indicate response to prescribed medication. Pap smears can be precancerous in an HIV-positive client, but the test does not indicate the immune system's response to prescribed medication.

A client with human immune deficiency virus (HIV) has been prescribed enfuvirtide (Fuzeon). What is the mode of action of enfuvirtide? 1 Generates bad nucleoside/nucleotide building blocks 2 Prevents cellular fusion between HIV and human cells 3 Inhibits the enzyme integrase present in HIV 4 Inhibits the enzyme protease present in HIV

Prevents cellular fusion between HIV and human cells Rationale: Enfuvirtide (Fuzeon) is a fusion inhibitor that prevents cellular fusion between HIV and human CD-4 cells. Nucleoside analog reverse transcriptase inhibitors (NRTIs) act by generating bad nucleoside/nucleotide building blocks for HIV. Integrase inhibitors act by inhibiting the enzyme integrase present in HIV, while protease inhibitors act by inhibiting the enzyme protease present in HIV.