Exam 4

Homologous chromosomes

Pairs of chromosomes that have genes for the same traits arranged in the same order

________ of all 4 extremities occurs if __________ cord is involved

Paralysis Cervical

Phenotype

An organism's physical appearance, or visible traits.

nucleoside reverse transcriptase inhibitors

zidovudine -Adverse effects: anemia and/or neutropenia abacavir -Adverse effect - fatal multisystem hypersensitivity reaction -Fever, rash, GI and resp symptoms -Associated with human leukocyte antigen B -Genetic test before starting triple therapy: abacavir/lamivudine/zidovudine [Trizivir]

Secondary SCI

Ongoing, progressive damage occurs after initial injury Ischemia, hypoxia, microhemorrhage, and edema

______ _________ contributes to wasting syndrome. Why?

Oral candidiasis Painful to eat/ decreased appetite, food options

Common Opportunistic infections in AIDS

Mouth ulcers (herpes simplex) Oral candidiasis (thrush) Oral hairy leukoplakia Esophageal candidiasis Vaginal yeast infection Shingles (varicella-zoster herpes) Kaposi sarcoma More serious: Pneumocystitis jiroveci pneumonia Cryptococcal meningitis Toxoplasmic encephalitis Tuberculosis Cytomegalovirus (CMV) retinitis [loss of vision] AIDS dementia complex Wasting syndrome Diarrhea caused by cryptosporidium

The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? "I need to keep my appointments for follow-up laboratory work." "I will call my health care provider if I am too sick to take these drugs." "I won't take any new drugs or herbal products without checking with my health care provider first." "Once my tests show that the virus has decreased, I cannot give HIV to another person."

"Once my tests show that the virus has decreased, I cannot give HIV to another person." Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first. p. 235-Lewis

Immune problems start when CD4+ T-cell counts drop to < ________ cells/μL. Normal range is ______ to _______ cells/μL.

500 800 1200

Punnett Squares

A chart that shows all the possible combinations of alleles that can result from a genetic cross

Locus

A specific place along the length of a chromosome where a given gene is located.

HIV: Asymptomatic infection stage- how long can it last, symptoms

AIDS diagnosis made about 10 years after initial HIV infection Symptoms absent or vague Many do not seek treatment, high risk behaviors may continue

Primary SCI

Actual physical disruption of axons

HIV labs

CD4+T cell test- Reflects infection stage and degree of HIV progression Viral load-Assess disease progression; effect of ART. If not responding to treatment-resistance tests (like a sensitivity in C&S) -Genotype assay: Detects mutations- reverse transcriptase and protease -Phenotype assay: Measures HIV growth in various concentrations of ART

Examples of chromosome disorders

CML, down syndrome

non-nucleoside reverse transcriptase inhibitor

Differ from NRTIs structure & mechanism of action Bind to active center of reverse transcriptase and cause direct inhibition efavirenz -Adverse effect: CNS symptoms

Which antiretroviral medication is suitable for administration through the subcutaneous route? Tipranavir [Aptivus] Enfuvirtide [Fuzeon] Maraviroc [Selzentry] Raltegravir [Isentress]

Enfuvirtide [Fuzeon] Enfuvirtide [Fuzeon] is the only available antiretroviral medication available that can be administered by the subcutaneous route. Tipranavir [Aptivus], maraviroc [Selzentry], and raltegravir [Isentress] are available only in oral form and cannot be administered subcutaneously. p. 1146

Initial care SCI

Ensure patent airway Stabilize cervical spine Administer O2 [NC, non-rebreather mask] Establish IV access Assess for other injuries Control external bleeding

___________ incorporates HIV DNA into CD4+T cell genome

Integrase

Apneustic

irregular and gasping resp.

Respiratory SCI If injury occurs above level C4, there is a _____ _____ of respiratory muscle function so ______ _______ is indicated.

total loss mechanical ventilation

Agonal

very slow and irregular resp.

Why is DVT difficult to detect in SCI?

won't feel pain, this is why PE is leading cause of death, not detected as quickly

Cytochrome P450

The general name for a large class of enzymes that play a significant role in drug metabolism

Kaposi sarcoma

opportunistic infection in AIDS

HIV fusion inhibitor

enfuvirtide -First and only HIV fusion inhibitor -Blocks entry of HIV into CD4 T cells -Twice-daily SC dosing and expensive -Adverse effects: Injection-site reactions, pneumonia, and hypersensitivity reactions

Which virus causes dengue fever? Ebola virus Hantavirus Flavivirus West Nile virus

Flavivirus Flavivirus causes dengue fever. Ebola virus causes Ebola hemorrhagic fever. Hantavirus causes hemorrhagic fever associated with severe pulmonary syndrome. West Nile virus causes West Nile fever. p. 229

What classification(s) of ARTs inhibit enzymes of HIV replication?

Reverse transcriptase inhibitors Integrase strand transfer inhibitors -raltegravir : Indicated for combined use with other antiretroviral agents to treat HIV-1, Adverse side effects: Insomnia, headache, and rare hypersensitivity reactions Protease inhibitors

SCI GI system Above ______ there will be hypomobility: ________ ileus, gastric _______. Tx includes ______________ tube and metoclopramide (reglan) _______-________ bleeding is difficult to diagnose. Indications of bleeding include: continued _______ despite treatment and decreased ________ and _________.

T5 paralytic distention nasogastric Intra-abdominal hypotension hemoglobin hematocrit

Bell's Palsy

motor branch dysfunction facial nerve (CN VII) on one side of the face →acute peripheral facial paresis CMs-drooping of the mouth with drooling, tinnitus, fever, and an inability to close the eye Tx-moist heat, analgesia, electrical nerve stimulation, prescribed exercises

Examples of single gene disorders

cystic fibrosis, sickle cell disease, polycystic kidney disease

Leading cause of death in patients w/ SCI is _______ ________.

pulmonary embolism

HIV is a _____virus that targets ______ cells & binds to _________ __________ on _______ cells.

retro, CD4+T, surface receptors, CD4+T

Non-compliance with medication leads to _____ _______. _____ _______ helps to prevent drug resistance.

Drug resistance Resistance tests (genotype & phenotype assay)

Which bacteria cause urinary tract infections? Helicobacter pylori Streptococcus faecalis Klebsiella-Enterobacter Haemophilus influenzae

Klebsiella-Enterobacter Eugene off target So close! Klebsiella-Enterobacter causes urinary tract infections. Helicobacter pylori causes peptic ulcer disease and gastritis. Streptococcus faecalis causes genitourinary infection and infection of surgical wounds. Haemophilus influenza causes nasopharyngitis, meningitis, and pneumonia. p. 227-Lewis

HIV uses ________ ___________ to form HIV DNA

reverse transcriptase

Which discharge instruction should the nurse provide to a patient with trigeminal neuralgia? "Eat a diet that is high in protein." "Eat low-calorie foods that are easy to chew." "Avoid hygiene activities during periods of analgesia." "Use a hard-bristled toothbrush to clean dental plaque."

"Eat a diet that is high in protein." Because chewing may precipitate the pain of trigeminal neuralgia, the patient may not eat properly. Therefore, the nurse teaches the patient to eat food that is high in protein. The nurse should teach the patient to eat food that is easy to chew and also high in calorie content. Hygiene activities should be performed when analgesia is at its peak so that the patient does not have pain. Tooth brushing can precipitate pain. Hence, the patient should be advised to use a small, soft-bristle toothbrush for oral hygiene. pp. 1464-1466

The nurse provides education to a patient about decreasing the risk for antibiotic-resistant infections. What is appropriate to include in the teaching? "Finish your antibiotic course." "Wash your hands frequently." "Take antibiotics to prevent illness." "Request an antibiotic for flu or colds." "Follow directions when taking antibiotics."

"Finish your antibiotic course." "Wash your hands frequently." "Follow directions when taking antibiotics." That's right! The complete course for any antibiotic should be followed. Even if the patient starts feeling better, he or she should not stop taking the antibiotic because if the course is incomplete, the hardiest bacteria will survive and multiply. Washing hands frequently is the single most important thing to do to prevent infections. The patient should follow directions when taking antibiotics; failure to follow directions can lead to the development of antibiotic-resistant bacteria. Taking antibiotics to prevent illness increases the risk for developing antibiotic-resistant infection. Antibiotics are effective against bacterial infections, not viruses that cause flu or colds. p. 230-Lewis

When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? "I will need to isolate any tissues I use so as not to infect my family." "I will notify all of my sexual partners so they can get tested for HIV." "Unprotected sexual contact is the most common mode of transmission." "I do not need to worry about spreading this virus to others by sweating at the gym."

"I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching. p. 232-lewis

protease inhibitor

-Among the most effective antiretroviral drugs -Used in combination with NRTIs lopinavir/ritonavir -Adverse effects: Hyperglycemia/diabetes, Fat redistribution, Hyperlipidemia, Reduced bone density, Reduced bone mineral density

Management urinary SCI: -areflexic (flaccid) -hyperreflexic (spastic)

-areflexic (flaccid) spinal shock, urine retention, self intermittent catheterization q3-4 hours, Fluid intake 2-2.5L/day, Monitor CMs urinary tract infection, stones, Bethanechol to decrease urine retention -hyperreflexic (spastic) postspinal shock, reflex emptying, sitting position, crede maneuver, baclofen to reduce spasms

The nurse is caring for a patient with human immunodeficiency virus (HIV) infection who is on didanosine [Videx] therapy. Which medication administration times would promote optimal absorption of the medication? 1 hour after meals 2 hours after meals 30 minutes after meals 20 minutes before meals 30 minutes before meals

2 hours after meals 30 minutes before meal Didanosine [Videx] (1) (1) (2) should be taken 120 minutes after meals or 30 minutes before meals because this medication has a low absorption rate when food is present in the stomach. This intervention also helps ensure the maximum therapeutic effect of the medication. Administering the medication 30 or 60 minutes after meals may not result in effective absorption of the medication because of the presence of food in the stomach. Twenty minutes before meals may cause the medication to be impacted by food. p. 1130, Table 94-3-Lehne

How often is pin site care done, what is it done with?

2x/ day saline or peroxide may use Neosporin after

What is the recommended dosage of stavudine [Zerit] for a patient who weighs 75 kg? 40 mg of the medication twice daily 20 mg of the medication twice daily 30 mg of the medication twice daily 70 mg of the medication twice daily

40 mg of the medication twice daily The recommended dosage of stavudine [Zerit] for a patient whose body weight is greater than or equal to 60 kg is 40 mg of the medication twice daily. This dosage gives the maximum therapeutic effect in the patient. A dose of 20 mg and 30 mg of the medication may be too low and is more likely to be ineffective. A dosage of 70 mg may be excessive and increase the risk of adverse effects and medication toxicity. p. 1131

CD4+ T cells are an important component of the immune system. What is the minimum count of CD4+ T cells to maintain a healthy immune function? Record your answer using a whole number.

500 Adults without immune dysfunction normally have 800 to 1200 CD4 + T cells per microliter (μL) of blood. The normal life span of a CD4 + T cell is about 100 days, but human immunodeficiency virus (HIV)-infected CD4 + T cells die after an average of only 2 days. Generally, the immune system remains healthy with more than 500 CD4 + T cells/μL. Immune problems start to occur when the count drops below 500 CD4 + T cells/μL. Severe problems develop when the count is below 200 CD4 + T cells/μL. p. 233-Lewis

As part of an awareness program for high school students on acquired immunodeficiency syndrome (AIDS), a public nurse is giving information about routes of transmission. What information should the nurse provide to students regarding the routes of transmission? Select all that apply. A person can be infected by having intercourse with one stable partner. A person can be infected by donating a pint of whole blood. A person can be infected even if a condom is used each time there is sexual intercourse. A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies. A person can get infected while hugging or shaking hands with a person infected with HIV.

A person can be infected by having intercourse with one stable partner. A person can be infected even if a condom is used each time there is sexual intercourse. A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies. The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. Equipment used in donation is disposable, and the donor does not come into contact with anyone else's blood. Hence, transmission cannot occur by donating blood. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. p. 231-Lewis

The nurse is caring for a patient with trigeminal neuralgia. What conservative therapies are appropriate to be included on the patient's plan for treatment? Acupuncture Vitamin therapy Glycerol rhizotomy Tricyclic antidepressant Microvascular decompression

Acupuncture Vitamin therapy The collaborative care for trigeminal neuralgia includes drug therapy, conservative therapy, and surgical therapy. Acupuncture and vitamin therapy are conservative therapy modalities used to treat trigeminal neuralgia. Glycerol rhizotomy is a peripheral surgical therapy for trigeminal neuralgia. Tricyclic antidepressants are part of drug therapy for trigeminal neuralgia. Microvascular decompression is an intracranial surgery used to treat trigeminal neuralgia. pp. 1464-1465

A woman infected with human immunodeficiency virus (HIV) delivers a baby with congenital anomalies. The patient was put on Atripla (tenofovir DF+emtricitabine+efavirenz) during pregnancy to control her infection. The nurse recognizes that what is the probable cause for the fetal malformations? Adverse effects of efavirenz Adverse effects of tenofovir DF Adverse effects of emtricitabine Immune deficiency due to HIV

Adverse effects of efavirenz The use of efavirenz in large doses in pregnant women may cause fetal anomalies. Tenofovir and emtricitabine are usually not associated with fetal malformations. Tenofovir and emtricitabine are used for preexposure prophylaxis. Immune deficiency due to HIV rarely causes fetal malformation. p. 238-Lewis

The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? All patients regardless of diagnosis Pediatric and gerontologic clients Patients who are immunocompromised Patients with a history of infectious diseases

All patients regardless of diagnosis Standard precautions are designed for care of all patients in hospitals and health care facilities. p. 231-Lewis

Allele

Alternative versions of a gene that produce distinguishable phenotypic effects. Dominant or recessive

The laboratory report of a patient reveals the presence of Enterococcus faecium. The nurse anticipates that which medication will be prescribed? Ampicillin Imipenem Vancomycin Streptomycin

Ampicillin Enterococcus faecium causes urinary tract infections. Ampicillin is a beta-lactam antibiotic that kills the bacteria by blocking cell wall production and action of the cross-linking enzyme transpeptidase. Imipenem is a β-lactam antibiotic that is used to treat Klebsiella pneumonia infections. Enterococcus faecium is resistant to vancomycin (a glycopeptide) and streptomycin (an aminoglycoside). p. 229-Lewis

Genotype

An organism's genetic makeup, or allele combinations.

The nurse is caring for a patient in the late stages of acquired immunodeficiency syndrome (AIDS). Which symptoms will the nurse see the patient exhibit in this stage of the disease? Ataxia Tremors Mental slowness Mental retardation Decreased cognition Inability to concentrate

Ataxia Tremors Mental slowness Decreased cognition Inability to concentrate Central nervous system complications usually occur late in this disease. The symptoms include decreased cognition, inability to concentrate, mental slowness, and motor complaints (e.g., ataxia, tremors). Mental retardation is not a symptom of the later stages of this disease. p. 1128-Lehne

A patient has been admitted with T2-level spinal cord injury and has abnormal cardiovascular signs and symptoms. Which drugs should the nurse administer to stabilize the condition of this patient? Vasodilator drugs Atropine Vasopressor drugs Digoxin Metoclopramide

Atropine Vasopressor drugs Due to the spinal cord injury at the T2 level, the patient may have abnormal cardiac signs and symptoms like bradycardia, peripheral vasodilation, and hypotension. Atropine should be administered to increase the heart rate and prevent hypoxemia. Hypotension should be treated by administering IV fluids or vasopressor drugs. Vasodilators would accentuate the peripheral pooling of blood, thereby worsening the condition. Digoxin is used to treat arrhythmias like ventricular tachycardia, and they act by reducing the heart rate. The patient has bradycardia, so digoxin administration would worsen the condition. Metoclopramide is not given for cardiac condition; it is used to treat delayed gastric emptying. p. 1475

The nurse is teaching precautions to a patient with human immunodeficiency virus (HIV) infection and who is on chronic protease inhibitor therapy. Which instruction given by the nurse may prevent complications in the patient? "Avoid smoking." "Avoid aerobic exercise." "Avoid eating fiber-rich foods." "Avoid taking the medication with foods."

Avoid smoking Protease inhibitors (1) (2) may cause metabolic abnormalities, gastrointestinal side effects, and insulin resistance as well as increase the risk for various cardiovascular complications in a patient; therefore, a nurse's instruction to avoid smoking may lessen the risk of side effects and adverse effects in a patient who is taking a protease inhibitor. As aerobic exercise helps reduce the accumulation of fat and also increases the rate of metabolism, the nurse should instruct the patient to perform physical exercise to prevent cardiovascular complications. Since diets that are rich in fiber lower the low-density lipoproteins and reduce the risk for cardiovascular diseases, the nurse should not advise the patient to avoid the intake of fiber-rich foods. The bioavailability of protease inhibitor medications will be increased when taken along with food, so taking these medications with food should be encouraged. pp. 1138-1139-Lehne

The patient has been prescribed efavirenz [Sustiva]. The nurse should instruct the patient to use which administration approach to minimize central nervous system (CNS) adverse effects? Bedtime dosing is most effective. A steroid medication should be used concurrently. The drug should be mixed only with an acidic beverage. The drug should be taken in divided doses throughout the day.

Bedtime dosing is most effective Efavirenz (1) (2) frequently causes CNS symptoms of dizziness, impaired consciousness, drowsiness, vivid dreams, and nightmares. Bedtime dosing can minimize CNS effects, which typically resolve in 2 to 4 weeks. Mixing with an acidic beverage, using a steroid medication concurrently, and taking efavirenz in divided doses throughout the day are not effective means of minimizing CNS effects. p. 1135-Lehne

Which microorganism causes Lyme disease? Hantavirus West Nile virus Borrelia burgdorferi Campylobacter jejuni

Borrelia burgdorferi Borrelia burgdorferi is a bacterium that causes Lyme disease. Hantavirus is a virus that causes hemorrhagic fever associated with severe pulmonary syndrome. West Nile virus is a virus that causes West Nile fever. Campylobacter jejuni is a bacterium that causes diarrhea. p. 228-Lewis

Which clinical manifestation would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury? Bradycardia Hypertension Neurogenic spasticity Bounding pedal pulses

Bradycardia Neurogenic shock is caused by the loss of vasomotor tone caused by injury, and is characterized by bradycardia and hypotension. Loss of sympathetic innervations causes peripheral vasodilation, venous pooling, and a decreased cardiac output. Hypertension, neurogenic spasticity, and bounding pedal pulses are not seen in neurogenic shock. p. 1470

The nurse is providing care to a patient with a spinal cord injury as the result of a motor vehicle accident. The nurse notes that the patient feels no pain in the leg on the side opposite the injury. Which spinal cord syndrome does the nurse suspect based on the assessment data? Central cord syndrome Anterior cord syndrome Cauda equina syndrome Brown-Séquard syndrome

Brown-Séquard syndrome Brown-Séquard syndrome results from damage to one half of the spinal cord. A contralateral (opposite side of the injury) loss of pain and temperature sensation below the level of the injury is a manifestation of the syndrome. Central cord syndrome is caused by damage to the central spinal cord. Motor weakness and sensory loss are the common manifestations of this syndrome. Anterior cord syndrome is caused by damage to the anterior spinal artery and often results in motor paralysis and loss of temperature and pain sensation below the level of the injury. Cauda Equina syndrome results from damage to the lowest portion of the spinal cord. Flaccid paralysis of the lower limbs and areflexic bladder and bowel are the common manifestations. p. 1472

The nurse is providing care to a patient with a penetrating spinal cord injury. The patient has ipsilateral loss of motor function and position and vibratory sense vasomotor paralysis. Which syndrome does the nurse document in this client? Central cord syndrome Anterior cord syndrome Posterior cord syndrome Brown-Séquard syndrome

Brown-Séquard syndrome Brown-Séquard syndrome results from damage to one half of the spinal cord. This syndrome is typically caused by a penetrating spinal cord injury and results in a loss of motor function on the same side as the injury. Central cord syndrome is caused by damage to the central spinal cord, resulting in motor weakness and sensory loss in both the upper and lower extremities. Anterior cord syndrome is caused by damage to the anterior spinal artery that results in compromised blood flow to the anterior spinal cord. Motor paralysis and loss of pain and temperature sensation are manifestations. Posterior cord syndrome results from damage or compression to the posterior spinal artery. It is a rare condition that manifests as loss of proprioception. p. 1472

The nurse should recognize which laboratory result is used as a major factor in deciding when antiretroviral therapy (ART) is indicated for a patient infected with human immunodeficiency virus (HIV)? Western blot assay Plasma HIV RNA assay CD4 T-lymphocyte count OralQuick Rapid HIV-1 Antibody Test

CD4 T-lymphocyte count The CD4 T-cell count is the principal indicator of how much immunocompetence remains when a patient is infected with HIV. It is used as a guide in the initiation, discontinuation, and resumption of medications for opportunistic infections. A plasma HIV RNA assay is a measure of viral load that indicates HIV replication and magnitude and accordingly is used to predict clinical outcomes. The Western blot assay and OralQuick Rapid HIV-1 Antibody Test, respectively, are used for initial screening and follow-up confirmation of HIV infection. p. 1124-Lehne

While reviewing the laboratory reports of a patient with human immunodeficiency virus (HIV) infection, the nurse suspects that the patient is susceptible to cytomegalovirus infections. Which findings in the patient's laboratory reports support the nurse's assumption? CD4 cell count of 450 cells/mL CD4 cell count of 350 cells/mL CD4 cell count of 250 cells/mL CD4 cell count of 150 cells/mL

CD4 cell count of 150 cells/mL CD4 cell counts below 200 cells/mL indicate immunosuppression (which can lead to infections) and are indications that a patient might be vulnerable to cytomegalovirus infections. CD4 cell counts above 200 cells/mL do not indicate susceptibility to opportunistic infection; therefore, if a patient has CD4 cell counts of 450, 350, or 250 cells/mL, the patient would not be prone to opportunistic infections. p. 1155-Lehne

HIV: Symptomatic infection stage- CD4+T cell count, viral load _______, symptoms

CD4+T cells decline closer to 200 viral load increases Symptoms: Persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches, severe fatigue

SCI cardiovascular support

Cardiac monitoring necessary IV fluids or vasopressor drugs to↑BP Anticholinergic drug/pacemaker Sequential compression devices Range-of-motion exercises Prophylactic heparin/LMWH

The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? Personal protective equipment Combination antiretroviral therapy Counseling to report blood exposures A negative evaluation by the manager

Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first. p. 240

A patient was admitted to the hospital with a ruptured abscess on the right thigh. Culture and sensitivity of the drainage showed methicillin-resistant Staphylococcus aureus (MRSA). What is true about MRSA? Community-acquired MRSA is more virulent than hospital-acquired MRSA. Hospital-acquired MRSA is more virulent than community-acquired MRSA. MRSA is a form of Staphlococcus aureus that does not respond to methicillin therapy. MRSA is a form of Staphylococcus aureus that does not respond to penicillin-based therapy. There is no cure for infections due to MRSA.

Community-acquired MRSA is more virulent than hospital-acquired MRSA. MRSA is a form of Staphlococcus aureus that does not respond to methicillin therapy. MRSA is a form of Staphylococcus aureus that does not respond to penicillin-based therapy. Community-acquired MRSA (CA-MRSA) is more virulent (able to cause disease or infection) compared with health care-associated MRSA (HA-MRSA). CA-MRSA has been known to cause rapidly forming skin infections and systemic diseases, including pneumonia and sepsis. Rates of CA-MRSA infections appear to be on the rise. MRSA is a form of Staphylococcus aureus that does not respond to methicillin- or penicillin-based therapies. The drug of choice for treating CA-MRSA is now believed to be vancomycin (Vancocin); HA-MRSA is susceptible to vancomycin. Newer drugs, such as linezolid (Zyvox) and daptomycin (Cubicin), are effective against both CA-MRSA and HA-MRSA. Linezolid is now felt to be the best drug for treating MRSA pneumonia. p. 229-Lewis

The patient has been started on stavudine (d4T) [Zerit]. After taking the drug for 3 days, the patient reports experiencing muscle pain and weakness. What is the nurse's highest priority action? Contact the healthcare provider regarding the patient's symptoms. Reassure the patient that the symptom is short-lived and will resolve. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to self-medicate with a nonsteroidal anti-inflammatory drug (NSAID).

Contact the healthcare provider regarding the patient's symptoms. The patient should not take any more doses of the medication (1) (1) (2) until the healthcare provider can evaluate the symptoms. The nurse's scope of practice does not allow for adjusting the patient's medication regimen. This is an adverse effect that must be addressed immediately and may not resolve completely. p. 1133

A patient with a history of prostate cancer is admitted to the hospital with severe back pain interfering with activity. A computerized tomography (CT) scan shows a metastatic tumor in the spine. Intravenous dexamethasone is prescribed. What is the desired effect of the medication? Improve muscular strength in the lower extremities. Lower the systolic blood pressure. Decrease tumor-related edema. Control elevated serum glucose levels.

Decrease tumor-related edema. Dexamethasone, a potent corticosteroid, is given intravenously to decrease inflammation and edema. The pain in the spine area decreases when compression of the spinal cord and ischemia to the area is improved. The medication will not affect muscle strength. Corticosteroid therapy tends to increase blood pressure because of sodium retention and elevate serum glucose levels caused by altered carbohydrate metabolism. p. 1485

The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as? Delaying disease progression Preventing disease transmission Helping to cure the HIV infection Enabling an increase in self-care activities

Delaying disease progression 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. p. 242

A public health nurse recently visited a rural area surrounded by a dense forest. This area has a high incidence and prevalence of zoonotic diseases. What possible infections could be spread to humans by animals in this area? Dengue fever Pertussis West Nile encephalitis Severe acute respiratory syndrome (SARS) Chickenpox

Dengue fever West Nile encephalitis Severe acute respiratory syndrome (SARS) Dengue is caused by dengue fever virus. Humans are the primary host of the virus, but it also circulates in nonhuman primates. West Nile encephalitis is caused by West Nile virus; infected mosquitoes pass the virus on to birds, animals, and people. SARS is a viral respiratory disease of zoonotic origin caused by the SARS coronavirus. Pertussis is a very contagious disease only found in humans and is spread from person to person. Chickenpox is a viral infection caused by contacts between humans. p. 229-Lewis

The patient with a spinal cord injury (SCI) is admitted to the intensive care unit. What does the nurse know about this injury? Differences in drug metabolism are related to the level and completeness of the injury. Methylprednisolone (MP) needs to be given intravenously within the first few hours of injury. Low-molecular-weight heparin is not used because of the increased risk of bleeding and hemorrhage. Vasopressor agents are contraindicated, because they can reduce the blood flow to vital organs.

Differences in drug metabolism are related to the level and completeness of the injury. Drug metabolism and pharmacologic properties are altered in SCI and are based upon the level of injury and how completely the spinal cord was injured. The differences in drug metabolism correlate with the level and completeness of injury. In patients with SCI, MP is no longer approved by the Food and Drug Administration (FDA). Unless contraindicated, low-molecular heparin is given to prevent venous thrombolytic embolism (VTE). Vasopressor agents are prescribed in the acute phase of the injury to keep the mean arterial pressure above 90 mm Hg and to improve perfusion to the spinal cord. p. 1475

The nurse observes that a patient who has human immunodeficiency virus (HIV) infection is disinterested in the teaching sessions. While communicating with the nurse, the patient says, "I've been getting horrible nightmares and feeling dizzy lately." Which medication does the nurse expect to be the cause of these symptoms in the patient? Efavirenz [Sustiva] Etravirine [Intelence] Nevirapine [Viramune] Delavirdine [Rescriptor]

Efavirenz [Sustiva] Efavirenz [Sustiva] (1) (2) may cross the blood-brain barrier and have adverse effects on the central nervous system. These effects may include lack of concentration, nightmares, and dizziness; therefore, a nurse should expect this medication to be the cause of the patient's symptoms. The administration of etravirine [Intelence] may cause side effects such as peripheral neuropathy and Stevens-Johnson syndrome. The administration of nevirapine [Viramune] causes side effects that include severe rashes and hepatotoxicity. The possible side effects of delavirdine [Rescriptor] include skin rashes and headache. p. 1135

A patient with spinal cord injury is paralyzed below the waist. The patient is completely dependent for all care, is withdrawn, and sleeps excessively. The patient states to the nurse, "I can't believe this is happening to me." Which nursing actions are appropriate for this patient? Show sympathy towards the patient. Explain the injury using written teaching material. Encourage the patient to participate in care. Encourage the patient to set daily goals. Teach the patient what to expect during the rehabilitation period.

Encourage the patient to participate in care. Encourage the patient to set daily goals. Teach the patient what to expect during the rehabilitation period. Appropriate nursing actions include encouraging the patient to participate in care, allowing the patient to make daily goals, and teaching the patient what to expect during the rehabilitation process. Although the nurse should empathize with the patient, sympathy is not a therapeutic action. The use of written material may not be the best way to teach this patient at this time. p. 1483

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? Explain the importance of completing the planned medication therapy. Instruct the patient to obtain a refill to continue the medication for another week. Instruct the patient to save the remaining medication in case the symptoms reoccur. Suggest that the patient give the leftover medications to the pharmacy.

Explain the importance of completing the planned medication therapy. 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. p. 230

A patient with a T1-level spinal cord injury is soon to be discharged from the hospital. The nurse has to plan the home care for neurogenic bowel management. What should the nurse include in the care plan? Teach the Valsalva maneuver. Explain the use of stool softeners. Teach the patient to perform digital stimulation of the rectum. Teach the patient how to use suppositories for evacuation. Advise the patient to eat a high-fiber diet. Advise the patient to limit fluids in the diet.

Explain the use of stool softeners. Teach the patient to perform digital stimulation of the rectum. Teach the patient how to use suppositories for evacuation. Advise the patient to eat a high-fiber diet. Careful management of bowel evacuation is necessary in the patient with spinal cord injury (SCI) because voluntary control of this function may be lost. This condition is called neurogenic bowel. A stool softener such as docusate sodium can be used to regulate stool consistency. A digital stimulation (performed 20 to 30 minutes after suppository insertion) by the nurse or patient may be necessary. In addition, suppositories (bisacodyl or glycerin) or small-volume enemas can be used. The usual measures for preventing constipation include a high-fiber diet and adequate fluid intake. However, these measures by themselves may not be adequate to stimulate evacuation. The Valsalva maneuver requires intact abdominal muscles, so it is used in those patients with injuries below T12. A high intake of fluid is advised for easier bowel evacuation. pp. 1481-1482

The nurse is caring for a patient with human immunodeficiency virus (HIV) infection. Upon reviewing the laboratory reports, the nurse finds that the CD4 cell count of the patient is 250 cells/mL. The nurse finds that the patient has ulcers in the mouth and genitals. Which medication should the nurse expect to be prescribed for the patient? Famciclovir [Famvir] Clindamycin [Cleocin] Fluconazole [Diflucan] Ethambutol [Myambutol]

Famciclovir [Famvir] When the CD4 cell count of a patient who has HIV infection falls below 200 cells/mL, it indicates that the patient is prone to different types of opportunistic infections. These infections include those caused by the herpes simplex virus and herpes zoster viruses. The presence of ulcers or vesicles in the mouth and/or genitals indicates that the patient has the herpes simplex virus infection; therefore, a nurse should expect that an antiviral medication, such as famciclovir [Famvir], would be prescribed to the patient to alleviate the symptoms of the infection. Clindamycin [Cleocin], fluconazole [Diflucan], and ethambutol [Myambutol] do not have antiviral properties nor do they alleviate the symptoms of the herpes simplex virus infection. Clindamycin [Cleocin] is an antifungal agent that is used to treat Pneumocystis jiroveci pneumonia. Fluconazole [Diflucan] is an antifungal agent that is prescribed to treat Candida esophagitis. Ethambutol [Myambutol] is an antibacterial agent that is prescribed to alleviate the symptoms of tuberculosis. p. 1157-Lehne

HIV: Acute infection stage -symptoms, when does it occur

Flu-like symptoms -fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle & joint pain, diarrhea, or diffuse rash Occurs ~2 - 4 weeks after infection Highly infectious

A nurse is preparing a nursing care plan for a patient with trigeminal neuralgia. What information should the nurse elicit during the patient's health history to aid in planning? Bladder habits Food habits Bowel habits Frequency of attacks and triggers Self-medication to decrease pain

Food habits Frequency of attacks and triggers Self-medication to decrease pain Patients with trigeminal neuralgia are primarily treated on an outpatient basis. Patients with trigeminal neuralgia may have difficulty in chewing; therefore, it is important to ask about food habits when planning care. Relevant history for the assessment of the attacks includes the triggering factors, characteristics, frequency, and pain management techniques; these help the nurse to plan for patient care. Trigeminal neuralgia does not affect bladder and bowel function; therefore, related history is not needed. pp. 1465-1466

What classification(s) of ARTs block HIV entry into CD4+T cells?

Fusion inhibitors CCR5 antagonist

The nurse is preparing educational materials about Guillain-Barre syndrome (GBS) and Bell's palsy. How is GBS different than Bell's palsy? GBS affects cranial nerves. GBS is a mononeuropathy. GBS is a potentially fatal disorder. GBS results in demyelination of the nerve.

GBS is a potentially fatal disorder. Guillain-Barre syndrome (GBS) is a rapidly progressing and potentially fatal disorder. Bell's palsy is a benign disorder in which full recovery may occur in three to six months. Both disorders affect cranial nerves. Guillain-Barre syndrome (GBS) also affects the peripheral nervous system and is a polyneuropathy. Bell's palsy is a mononeuropathy. Both disorders may result in demyelination of the involved nerve. pp. 1466-1467

The nurse understands that personal protective equipment helps to prevent the spread of infection and protects the health care professional from contracting infection. What would the nurse wear to prevent the spread of infection when disconnecting IV fluid tubing from the IV access port? A cap An isolation gown Shoe covers Gloves

Gloves 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. p. 230-Lewis

The nurse recalls that which surgical therapy for trigeminal neuralgia is a peripheral procedure? Glycerol rhizotomy Gamma knife radiosurgery Microvascular decompression Percutaneous radiofrequency rhizotomy

Glycerol rhizotomy Glycerol rhizotomy is a peripheral procedure used for trigeminal neuralgia where glycerol is injected into one or more branches of the trigeminal nerve. The injection of glycerol causes a chemical ablation resulting in loss of pain sensations. Gamma knife radiosurgery is an intracranial technique that uses high doses of radiation focused on the trigeminal nerve root using stereotactic localization. Microvascular decompression is an intracranial procedure in which the artery pressing on the nerve root is lifted up. Percutaneous radio frequency rhizotomy is an intracranial procedure that involves the destruction of sensory fibers by low-voltage current. p. 1465

A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? Shaking hands Sharing a toilet seat Eating from the same utensils Having unprotected sex

Having unprotected sex AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes. p. 231-232-Lewis

Which manifestations in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia? Headache and rising blood pressure Irregular respirations and shortness of breath Decreased level of consciousness or hallucinations Abdominal distention and absence of bowel sounds

Headache and rising blood pressure Manifestations of autonomic dysreflexia are hypertension (up to 300 mm Hg systolic), a throbbing headache, bradycardia, and diaphoresis. Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic manifestations. p. 1479

A patient has been diagnosed with trigeminal neuralgia. For which etiologic factors should the nurse assess the patient? Herpes virus infection Infection of the teeth and jaw Brainstem infarct Sarcoidosis Lyme disease

Herpes virus infection Infection of the teeth and jaw Brainstem infarct The etiologic factors of trigeminal neuralgia include herpesvirus infection, infection of the teeth and jaw, and brainstem infarct. Sarcoidosis and Lyme disease do not cause trigeminal neuralgia; they are etiologic factors for Bell's palsy. p. 1464

A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: Hyperthermia Social isolation Impaired memory Sexual dysfunction

Hyperthermia Temperature increase is the highest priority for the nurse because Pneumocystis jiroveci pneumonia (PCP) is an indication of AIDS (acquired immunodeficiency syndrome). Early detection and treatment of PCP is directly related to a positive outcome. Temperature increase in an immunosuppressed patient is always a concern. Social isolation is a secondary risk of all persons who test positive for human immunodeficiency virus (HIV). Impaired memory and sexual dysfunction may develop as complications in patients with HIV disease, but these issues are not always present. p. 236-Lewis

The nurse is caring for a patient with human immunodeficiency virus (HIV) infection. What are the goals of treatment during all phases of HIV disease? Improved quality of life Improved quantity of life Reduction of sexual HIV transmission Maximal and durable suppression of viral load Restoration or preservation of immune function Reduction of HIV-related morbidity and mortality

Improved quality of life Reduction of sexual HIV transmission Maximal and durable suppression of viral load Restoration or preservation of immune function Reduction of HIV-related morbidity and mortality During all phases of HIV disease, treatment has six basic goals: maximal and durable suppression of viral load; restoration or preservation of immune function; improved quality of life; reduction of HIV-related morbidity and mortality; reduction of sexual HIV transmission; and prevention of HIV transmission to the child. Improved quantity of life is not a goal for HIV treatment at phases where quality of life is significantly diminished due to acquired immunodeficiency syndrome (AIDS) and there is no hope of improvement. p. 1149-Lehne

The nurse is assessing a patient with acquired immunodeficiency syndrome (AIDS) who is on atazanavir [Reyataz] therapy. After reviewing the laboratory reports, the nurse suspects that the patient is experiencing an adverse effect. Which findings in the patient's laboratory reports support the nurse's assumption? Increased glucose levels Decreased bilirubin levels Increased thyroxine levels Increased lipoprotein levels

Increased glucose level Hyperglycemia and diabetes mellitus are common adverse effects of atazanavir [Reyataz] (1) (2). An increase in glucose levels indicates that the patient has hyperglycemia and is at risk for diabetes mellitus; therefore, the nurse should suspect that an increase in the glucose levels likely suggests that the patient is experiencing an adverse effect of the medication. Increased lipoprotein levels indicate that patient has hyperlipidemia. Hyperlipidemia is not the adverse effect of atazanavir because it does not alter the lipid levels. As atazanavir [Reyataz] increases bilirubin levels and causes jaundice, any decrease in bilirubin levels would not indicate that the patient has had an adverse effect from the medication. Atazanavir [Reyataz] does not cause hyperthyroidism. p. 1140, Table 94-5-Lehne

Which antiretroviral medication is associated with thrombocytopenia in patients with human immunodeficiency virus (HIV) infection? Indinavir [Crixivan] Rilpivirine [Edurant] Etravirine [Intelence] Nevirapine [Viramune]

Indinavir [Crixivan] Indinavir [Crixivan], a protease inhibitor, decreases the formation of thrombocytes and results in thrombocytopenia; therefore, a patient who has an HIV infection and is taking Indinavir may be at risk of thrombocytopenia. Rilpivirine [Edurant] is a non-nucleoside reverse transcriptase inhibitor (NNRTIs) that has central nervous system-depressant action and may cause depression and insomnia. Efavirenz [Sustiva] (1) (2) is a NNRTI that may impair gastrointestinal functioning and cause nausea. Nevirapine [Viramune] is a NNRTI that may impair hepatic functioning and cause symptomatic hepatitis. p. 1140, Table 94-5-Lehne

A patient currently taking emtricitabine, asks the nurse how this medication helps with the patient's human immunodeficiency virus (HIV) infection. The nurse would explain that it: Prevents the binding of the HIV to cells, which prevents HIV entry into the cell. Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. Inhibits the action of the reverse transciptase enzyme, so that DNA is no longer converted to RNA. Binds with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell.

Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. Emtricitabine is classified as a nucleoside reverse transcriptase inhibitor (NRTI), and works by inserting DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. Medications that prevent binding of the HIV to cells are classified as entry inhibitors. Drugs that inhibit the action of the reverse transciptase enzyme so that DNA is no longer converted to RNA, are classified as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Medications that bind with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell, are classified as integrase inhibitors. p. 237-Lewis

A patient is experiencing occasional episodes of nausea and vomiting and has been taking ritonavir (RTV) [Norvir] for a week. What teaching will the nurse provide to the patient? Instruct the patient to maintain a symptom diary. Instruct the patient to stop taking the medication. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to report episodes that increase in intensity or frequency.

Instruct the patient to maintain a symptom diary. Reassure the patient that this is an expected side effect of the medication. Instruct the patient to report episodes that increase in intensity or frequency. Nausea and vomiting are expected side effects of the medication (1) (2) and are not indicative of any significant problem with the medication. Often, these dissipate within 2 weeks of medication initiation. However, the patient should certainly report episodes of nausea or vomiting that increase in intensity and/or frequency. Use of a symptom diary can assist with the reporting process. pp. 1141, 1144,-Lehne

Poikilothermism

Interruption of SNS ↓Ability to sweat or shiver More common w/high cervical injury

A patient has been admitted with a C5-level spinal cord injury and has marked hypotension. What pharmacologic therapies would the nurse expect to be prescribed for this patient? Nitrates Diuretics Intravenous fluids Anticoagulants Beta blockers

Intravenous fluids Anticoagulants The spinal cord injury at the C5 level causes loss of sympathetic nervous system tone in peripheral vessels. This results in chronic low blood pressure with potential postural hypotension. Lack of muscle tone to aid venous return can result in sluggish blood flow, thus predisposing the patient to deep vein thrombosis. To treat hypotension, a vasopressor agent such as dopamine or norepinephrine should be administered. Fluid replacement also helps in maintaining optimal blood pressure. Nitrates are potent vasodilators and would worsen the hypotension if administered. Diuretics increase fluid loss from the body and may worsen hypotension. Beta blockers decrease the heart rate and cardiac output, which lower blood pressure and make the heart beat more slowly and with less force; this is inappropriate to treat hypotension. pp. 1477-1478

The nurse is aware that mother-to-child transmission of human immunodeficiency virus (HIV) occurs primarily during labor and delivery. Which interventions can reduce the risk of transmission? Planned induction of labor Two forms of birth control, including barrier and hormonal Intravenous zidovudine [Retrovir] to the mother during labor and delivery Oral or intravenous zidovudine to the infant for 6 weeks following delivery Antiretroviral therapy (ART) during gestation to minimize maternal viral load

Intravenous zidovudine [Retrovir] to the mother during labor and delivery Oral or intravenous zidovudine to the infant for 6 weeks following delivery Antiretroviral therapy (ART) during gestation to minimize maternal viral load So close! Mother-to-child transmission of HIV occurs primarily during labor and delivery. The risk of transmission can be greatly reduced by (1) using ART during gestation to minimize maternal viral load, (2) giving intravenous (IV) zidovudine to the mother during labor and delivery, and (3) giving oral or IV zidovudine to the infant for 6 weeks following delivery. Birth control may prevent pregnancy, but not transmission of HIV to the infant. Planned induction does not prevent virus transmission. pp. 1153-1155-Lehne

The patient with human immunodeficiency virus (HIV) is scheduled to begin raltegravir [Isentress]. The nurse educates the patient regarding which mechanism of action of this drug? It inhibits the enzyme integrase. It destroys reverse transcriptase. It increases protease enzyme activity. It blocks the entry of HIV into CD4 T cells.

It inhibits the enzyme integrase. Raltegravir is the first and only member of a new class of antiretroviral medications, the HIV integrase inhibitors. Integrase is one of three viral enzymes needed for HIV-derived DNA insertion into DNA of CD4 T cells. Raltegravir effectively blocks HIV replication. It does not increase protease enzyme activity or destroy reverse transcriptase. Blocking HIV entry into CD4 T cells is an action of other antiretroviral medications, not raltegravir. p. 1145-Lehne

The nurse is caring for a patient with hemophilia who also takes protease inhibitors for human immunodeficiency virus (HIV) infection. Which orders should the nurse monitor to detect for adverse effects of protease inhibitors? Chest x-ray Lipid profile Bleeding time Bone density test Blood glucose monitoring Computed tomography (CT) scan of the head

Lipid profile Bleeding time Bone density test Blood glucose monitoring Adverse effects of protease inhibitors include hyperglycemia, diabetes, reduced bone mineral density, increased bleeding in hemophiliacs, and elevation of triglyceride and transaminase levels. Therefore, to monitor for adverse effects, the patient should have blood glucose monitoring, a bone density test, bleeding time, and a lipid profile. A CT scan of the head and a chest x-ray are not indicated. p. 1138-Lehne

The nurse should assess a patient with acquired immunodeficiency syndrome (AIDS) for which most common symptoms? Tremors and bradykinesia Hematuria and abdominal pain Persistent vomiting and headache Low-grade fever and persistent diarrhea

Low-grade fever and persistent diarrhea The symptoms of acquired immunodeficiency syndrome (AIDS) are variable, but low-grade fever and persistent diarrhea are common. The symptoms listed in the other answer options are not specifically associated with AIDS. p. 235-lewis

____________ results is ______ or _______ cord is damaged

Paraplegia thoracic lumbar

A patient has had two episodes of trigeminal neuralgia and has lately been exhibiting strange mannerisms. The nurse identifies them to be coping strategies to avoid another episode. What observed mannerisms would have led the nurse to conclude this? Patient avoids sleeping. Patient has stopped eating. Patient avoids blinking the eye. Patient covers the face with a cloth. Patient avoids interacting with people.

Patient has stopped eating. Patient covers the face with a cloth. Patient avoids interacting with people. A triggering mechanism can initiate painful episodes in trigeminal neuralgia. The triggers may include a light touch at a specific point along the distribution of the nerve branches. It can be precipitated by chewing, tooth brushing, feeling a hot or cold blast of air on the face, washing the face, yawning, or even talking. Therefore, the patient may avoid these activities to prevent painful episodes. As a result, the patient may not chew food and may eat improperly, may cover the face with a cloth, and may withdraw from interaction with other individuals. The patient may sleep excessively as a means of coping with the pain. Movement of eyes does not trigger a painful episode. p. 1464

A patient with Guillain-Barré syndrome is admitted to the medical-surgical floor. What does the nurse understand regarding this disorder? Pain is generally worse during the day. It affects males twice as often as females. Patients also may have syndrome of inappropriate antidiuretic hormone (SIADH). Heart failure (HF) is the most serious complication of this condition.

Patients also may have syndrome of inappropriate antidiuretic hormone (SIADH). Syndrome of SIADH also can occur in patients with Guillain-Barré syndrome. The pain, which is manifested by paresthesias, generally is worse at night and the most serious complication is respiratory failure. Guillain-Barré syndrome affects males 1.5 times more frequently than females. pp. 1542-1543

The nurse is assessing a patient with acquired immunodeficiency syndrome (AIDS). Which medication does the nurse find in the patient's prescription as prophylactic treatment for Pneumocystis infection? Mefloquine [Lariam] Chloroquine [Aralen] Pentamidine [NebuPent] Amphotericin B [Amphocin]

Pentamidine (NebuPent) Patients who have AIDS are highly prone to infections due to impaired immunity. Pentamidine [NebuPent] is an antiprotozoal drug that is used for prophylactic treatment to prevent Pneumocystis infection in AIDS patients. The preferred medication for prophylaxis is trimethoprim plus sulfamethoxazole (TMP/SMZ) given as one double-strength tablet each day. For patients who cannot tolerate TMP/SMZ, aerosolized pentamidine [NebuPent] may be used instead. Mefloquine [Lariam] and chloroquine [Aralen] are the antimalarial drugs prescribed for the prophylaxis of malaria. Amophotericin B [Amphocin] is an antifungal medication that can be prescribed for the treatment of fungal infections. p. 1157-Lehne

The nurse provides preoperative information to a patient with trigeminal neuralgia. The nurse explains that the surgery involves destruction of the sensory fibers of the trigeminal nerve using low-voltage current. What surgery is planned for the patient? Glycerol rhizotomy Gamma knife radiosurgery Microvascular decompression Percutaneous radiofrequency rhizotomy

Percutaneous radiofrequency rhizotomy Percutaneous radiofrequency rhizotomy is an intracranial procedure that involves the destruction of sensory fibers by low-voltage current. Glycerol rhizotomy is a peripheral procedure in which glycerol is injected into one or more branches of the trigeminal nerve to cause chemical ablation. Gamma knife radiosurgery is an intracranial technique that uses high doses of radiation focused on the trigeminal nerve root using stereotactic localization. Microvascular decompression is an intracranial procedure in which the artery pressing on the nerve root is lifted up and repositioned. p. 1465

The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS). The nurse finds that the primary healthcare provider is prescribing abacavir [Ziagen] to the patient. Which intervention should the nurse expect to be beneficial for the patient before initiating the therapy? Performing a tropism test Performing an HLA-B5701 test Performing a viral load [VL] test Performing a thyroid function test (TFT)

Performing an HLA-B5701 test An HLA-B5701 test helps determine whether a patient has a gene mutation associated with hypersensitivity reaction to abacavir [Ziagen] (1) (1) (2). A patient who has a positive HLA-B5701 test result should not receive abacavir due to the high risk of allergic reaction. A tropism test is used to determine the presence of the CCR5 co-receptor and should be performed before prescribing maraviroc [Selzentry]. A thyroid function test (TFT) is used to determine whether a patient has any thyroid disorders. Since abacavir does not impair thyroid functioning, a TFT would not be recommended for a patient. A viral load [VL] test is used to determine the severity of the infection and should be performed before prescribing the medication to a patient. p. 1134-Lehne

A human immunodeficiency virus (HIV) patient on antiretroviral therapy comes into the clinic complaining that he or she is starting to feel like he or she did before starting the therapy. What should the nurse plan for? Phenotype assay Western Blot test Standard antibody test White blood cell count lab test

Phenotype assay 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. p. 235

A patient who has acquired immunodeficiency syndrome (AIDS) exhibits convulsions while receiving antiretroviral therapy that includes maraviroc [Selzentry]. Which anticonvulsive drugs are contraindicated in this patient because it is likely to decrease the effectiveness of the therapy? Diazepam [Valium] Phenytoin [Dilantin] Topiramate [Topamax] Phenobarbital [Luminal]

Phenytoin [Dilantin] Phenobarbital [Luminal] Maraviroc levels will be lowered by strong CYP3A4 inducers including rifampin, etravirine, efavirenz, carbamazepine, phenobarbital, phenytoin, and St. John' s wort; this means that the metabolism of maraviroc [Selzentry] occurs more quickly, leading to a lower concentrations circulating in the blood for a shorter period. Diazepam [Valium] and topiramate [Topamax] may or may not be used, depending on the patient needs. p. 1147-Lehne

The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who states, "My doctor told me I have the most common opportunistic infection among people with AIDS." What infection is the patient referring to? Tuberculosis Cytomegalovirus Pneumocystis pneumonia Disseminated histoplasmosis

Pneumocystis pneumonia Pneumocystis pneumonia is the most common opportunistic infection among people with AIDS. Other AIDS-defining illnesses include cytomegalovirus, disseminated histoplasmosis, and tuberculosis. p. 1160-Lehne

A primary health care provider prescribes a blood test for a patient who reports fever, chills, cough, and blood-tinged sputum. The blood reports indicate the presence of Yersinia pestis in the patient's blood sample . Which diagnosis does the nurse anticipate? Diarrhea Pertussis Diphtheria Pneumonic plague

Pneumonic plague Fever, chills, cough, and bloody sputum indicate that the patient has pneumonic plague. Yersinia pestis is the bacterium that causes plague. Giardia is a parasite that causes diarrhea. Bordetella pertussis is a bacterium that causes pertussis, a respiratory disease characterized by loud whooping inspiration . Corynebacterium diphtheriae causes diphtheria, which is characterized by localized skin or mucous membrane infection. p. 229-Lewis

Which condition should be evaluated in a patient who is newly diagnosed with human immunodeficiency virus (HIV) infection prior to receiving retroviral therapy? . Viral load Pregnancy status Thyroid functioning Genotypic-resistance testing Potential medication-to-medication interactions

Pregnancy status Genotypic-resistance testing Potential medication-to-medication interactions Certain parameters should be checked before initiating antiretroviral (ART) therapy for a patient to ensure safety. The nurse should evaluate the pregnancy status of the patient because some antiretroviral medications are contraindicated during pregnancy. Genotypic-resistance testing helps identify mutations in the genes that may reduce the therapeutic effectiveness of certain medications. Potential medication-to-medication interactions should be assessed in order to prevent the adverse effects caused by medication interactions; therefore, a nurse should obtain a list of all prescribed and over-the-counter medications. A nurse checks the viral load while diagnosing the disease or condition but not while initiating therapy. Antiretroviral medications do not alter thyroid functioning; therefore, a nurse should not anticipate thyroid functioning tests will be needed for the patient. pp. 1147-1148-Lehne

A homosexual who was diagnosed with acquired immunodeficiency syndrome (AIDS) has come to a nurse to find out which tests would determine the prognosis of the syndrome. What should the nurse provide? Prognosis can be assessed by viral load. Prognosis can be assessed by red blood cell count. Prognosis can be assessed by CD4 + T-cell count. Prognosis can be assessed by testing for hepatitis B virus (HBV) or hepatitis C virus (HCV). Prognosis can be assessed by immunoglobulin M (IgM) antibody levels.

Prognosis can be assessed by viral load. Prognosis can be assessed by CD4 + T-cell count. The progression of 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. p. 233-Lewis

____________ separates HIV DNA to leave cell and infect another CD4+T cell

Protease

A patient with spinal cord injury has poor nutritional intake. What measures should the nurse take to improve the patient's nutrition? Provide a pleasant eating environment. Provide adequate time to eat. Feed the patient only hospital-cooked food Keep a calorie count of the food taken. Encourage intake of dietary fiber. Provide a low-protein and low-calorie diet.

Provide a pleasant eating environment. Provide adequate time to eat. Keep a calorie count of the food taken. Encourage intake of dietary fiber. General measures such as providing a pleasant eating environment, allowing adequate time to eat (including any self-feeding the patient can achieve), encouraging the family to bring in special foods to avoid the patient becoming bored with institutional food, and planning social rewards for eating may be useful to improve nutrition of the patient. Keep a calorie count, and record the patient's daily weight to evaluate progress. If feasible, the patient should participate in recording caloric intake. Dietary supplements may be necessary to meet nutritional needs. Increased dietary fiber should be included to promote bowel function. Because there is severe catabolism taking place, a high-protein, high-calorie diet is necessary for energy and tissue repair. p. 1478

The oral intake of a patient with trigeminal neuralgia is sharply reduced, and the patient's nutritional status is compromised. What is the priority nursing intervention? Serving lukewarm food Ensuring that the food is easy to chew Providing food through a nasogastric tube Encouraging intake of foods high in protein

Providing food through a nasogastric tube' If the nutritional status of the patient is compromised due to a sharp reduction of oral intake, the priority intervention should be to provide enteral feedings through a nasogastric tube. Once a reasonable amount of nutrition is restored and the patient is able to feed orally, food should be served lukewarm and at frequent intervals. After the patient can eat normally, food should be easy to chew and high in protein content. Until then, nasogastric feedings are indicated to facilitate a return to homeostasis. p. 1466

A nurse is instructed to take vitals and administer an intramuscular injection to a patient who has acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take in this case? Put on gloves. Use a mask. Put on a gown. Wash the hands thoroughly. Put on boots.

Put on gloves Wash hands thoroughly Even though this procedure does not involve more than minimal contact with blood, additional protection is required. The nurse should put on gloves after washing the hands thoroughly. A mask, gown, and boots must be used when splashes, sprays, spatters, or droplets of blood or other potentially infectious materials pose a hazard to the eyes, nose, or mouth and are not required in this case. p. 230

HIV diagnostics

Rapid point-of-care (POC) test-swab, quick, takes about 20 min, person can wait for results & take Western Blot if positive Enzyme-linked immunosorbent assay (ELISA)-blood test, not rapid results Western Blot test- only true diagnostic test

The nurse reviews a patient's medical record and notes tic douloureux. The nurse expects what assessment finding? Severe, bilateral pain along the distribution of the trigeminal nerve Recurrent episodes of stabbing pain along the distribution of the trigeminal nerve Cycles of pain along the trigeminal nerve and refractoriness that continues for hours Specific point along the trigeminal nerve that can initiate pain when it is lightly touched

Recurrent episodes of stabbing pain along the distribution of the trigeminal nerve Trigeminal neuralgia is also referred to as tic douloureux. It is characterized by recurrent episodes of stabbing pain along the distribution of the trigeminal nerve. It is not a severe, bilateral pain but a severe, unilateral pain along the distribution of the nerve. Cycles of pain along the trigeminal nerve and refractoriness that continue for hours are referred to as clustering. The specific point along the trigeminal nerve that can initiate pain when it is lightly touched is called a trigger zone. p. 1464

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? Repeat the EIA test. Confirm with a Western blot test. Confirm with an immunofluorescence assay. Confirm with a rapid screening test for antigens. Inform the patient that the patient is HIV-antibody positive.

Repeat the EIA test. Confirm with a Western blot test. Confirm with an immunofluorescence assay. 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. p. 236-Lewis

Why is monotherapy not used in ART? What is the minimum amount of drugs?

Resistance (usually d/t nonadherance of regimen, but sometimes d/t infection with a drug-resistant HIV variant) Min amt: 3

When reviewing the diagnostic reports of a patient with human immunodeficiency virus (HIV) infection, the nurse observes that the patient has the herpes zoster infection. Which concomitant conditions might the nurse find in this patient? Pyrexia Retinitis Hepatitis Dyspnea Encephalitis

Retinitis Encephalitis A patient who has HIV infection and herpes zoster infection may have retinitis and encephalitis. The herpes zoster virus affects the retina and brain tissue leading to medical conditions such as retinitis and encephalitis in the patient. Pyrexia refers to an increase in temperature and is not associated with the herpes zoster infection. Herpes zoster does not affect the respiratory system; therefore, it does not cause dyspnea. The herpes zoster virus does not alter the structure or functioning of the liver; therefore, hepatitis, or inflammation of the liver, does not occur in the patients affected with the herpes zoster infection. p. 1157-Lehne

Autonomic Dysreflexia

SNS responds to stimulation of sensory receptors - parasympathetic nervous system unable to counteract these responses Hypertension and bradycardia Common causes: distended bladder or rectum CMs: Sudden hypertension, Throbbing headache, Diaphoresis above level of injury, Facial flushing, sweating, piloerection, Bradycardia , Blurred vision or spots in visual field, Nasal congestion, Anxiety, Nausea Nursing: -immediate: place HOB in upright position to ↓BP (allows blood to pool in LEs), Check BP, Determine cause and remove, Notify HCP if full bladder: catheterize using lidocaine jelly, irrigation -if stool impaction: remove stool using anesthetic ointment -Administer IV antihypertensive: Hydralazine, Nifedipine

A patient was given 500 mL of O-negative blood after proper cross-matching. Later, it was found that the blood donor was human immunodeficiency virus-(HIV) positive. After two weeks, the patient complained of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and diffuse rash. What could be the possible reason for these symptoms? Flu Seroconversion Mononucleosis Acute HIV infection Guillain-Barré syndrome

Seroconversion Acute HIV infection In this case, the patient would have acquired HIV infection from the donor. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompanies seroconversion (when HIV-specific antibodies develop). These symptoms, called acute HIV infection, generally occur within two to four weeks after the initial infection and last for one to three weeks, although some symptoms may persist for several months. Many people, including health care providers, mistake acute HIV symptoms for a bad case of the flu. Some people also develop neurologic complications, such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome. This patient has not yet developed neurologic symptoms. p. 234-lewis

A patient has been diagnosed with human immunodeficiency virus (HIV) infection. The patient states, "I thought that only gay men could get that." The nurse would teach the patient that possible causes of this disease include what? Sexual contact with an infected person Sharing IV needles with an infected person Kissing and touching a person infected with HIV Receiving a blood infusion from an infected person Eating and drinking after a person infected with HIV

Sexual contact with an infected person Sharing IV needles with an infected person Receiving a blood infusion from an infected person HIV is transmitted sexually and is present in all body fluids of infected individuals. HIV can be transmitted by sexual contact, blood transfusion, sharing IV needles, and accidental needle sticks. HIV infection used to be limited largely to homosexual males, injection-drug users, and hemophiliacs, but it is now found routinely in the population at large. HIV infection is not transmitted through eating and drinking after a person infected with HIV. HIV infection is not contracted through kissing and touching a person infected with HIV. pp. 1126-1127-Lehne

The nurse is caring for a patient with poikilothermia. What condition in the patient's medical record likely caused this clinical manifestation? Polyneuropathy Spinal cord injury Spinal cord tumor Cranial nerve disorder

Spinal cord injury Poikilothermia is the inability to maintain body temperature. It is one of the manifestations of spinal cord injury. Polyneuropathies may result in weakness of the lower extremities, paresthesia (numbness and tingling), paralysis with muscle incoordination and weakness, stiffness in the jaw and neck, sharp pains in the leg, and ataxia. Spinal cord tumor may result in back pain, coldness, numbness, and tingling in the extremities. Cranial nerve disorders usually result in burning, knifelike or lightning-like shock in the lips, intense pain, twitching, tinnitus, paralysis of the motor branches of the facial nerve, and drooping of the mouth accompanied by drooling. p. 1473

The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following? Central cord syndrome Spinal shock syndrome Anterior cord syndrome Brown-Séquard syndrome

Spinal shock syndrome About 50 percent of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as spinal shock. Central cord syndrome is manifested by motor and sensory loss that is greater in the upper extremities than in the lower extremities. Anterior cord syndrome results in motor and sensory loss but not reflexes. Brown-Séquard syndrome is characterized by ipsilateral loss of motor function and contralateral loss of sensory function. p. 1470

A patient whose condition is resistant to several antiretroviral therapies is prescribed maraviroc [Selzentry]. What medication in the patient's history would decrease the therapeutic effect of the drug? Ginger St. John's wort Oral contraceptives Acetaminophen [Tylenol]

St. John's wort Maraviroc [Selzentry] is a new class of antiviral that is used to treat patients who have developed resistance to antiretroviral therapies. Maraviroc [Selzentry] has a reduced effect when used in combination with St. John's wort, which is an herbal medication that is used for depression. St. John's wort quickly processes maraviroc [Selzentry], reducing its absorption time and thereby reducing its effect. The drug is unrelated to ginger, oral contraceptives, or acetaminophen [Tylenol] and does not interact with them. p. 1147-Lehne

A patient who came to the hospital two days ago is diagnosed with Guillain Barré syndrome. Plasmapheresis is planned to treat the condition. What criteria are used to determine if this treatment is effective? Stabilization of blood pressure and pulse rate. Lung vital capacity and arterial blood gases are stable. Symptoms of paralysis stop progressing and abate. Blood urea nitrogen (BUN) and creatinine levels are within normal levels. Urinary output is at least 30 mL per hour.

Stabilization of blood pressure and pulse rate. Lung vital capacity and arterial blood gases are stable. Symptoms of paralysis stop progressing and abate. Guillain Barré syndrome is a polyneuropathic condition resulting from an immune response following some type of infection. Symptoms include paresthesia with ascending bilateral paralysis as demyelination of the nerves occurs. The paralysis starts in the extremities and can advance to the thoracic area, resulting in respiratory failure. Disturbance in the autonomic nervous system causes episodes of hypotension, hypertension, and bradycardia. Treatment is successful with the halt of paralysis and stabilization of cardiovascular function and respiratory status. BUN and creatinine levels and urinary output are measures of renal function. p. 1468

While assessing a patient with fever, the nurse finds that the patient has symptoms of lymphadenopathy and pharyngitis. The patient's medical history shows that the patient underwent a blood transfusion 12 weeks ago. What does the nurse infer from this finding? The patient may have wasting syndrome. The patient may have a transient, flu-like illness. The patient may have Stevens-Johnson syndrome. The patient may have a primary human immunodeficiency virus (HIV) infection.

The patient may have a primary human immunodeficiency virus (HIV) infection. A patient who has recently been infected with HIV would have symptoms such as fever, fatigue, headache, lymphadenopathy, and pharyngitis. The patient experiences these symptoms 2 to 12 weeks after exposure to HIV. Because of the patient's history of a blood transfusion 12 weeks prior coupled with the patient's current symptoms of fever, lymphadenopathy, and pharyngitis, the nurse should infer that the patient has primary HIV infection. Transient flu-like illness is manifested by fever, fatigue, pharyngitis, and headache; therefore, the nurse should confirm the presence of HIV infection. Wasting syndrome results in both loss of weight and appetite and occurs when the CD4 cell count is less than 100 cells/mL. Stevens-Johnson syndrome is a major side effect of antiretroviral therapy, which presents with fever and disruption of integument. p. 1127-Lehne

A patient has been admitted to the hospital with spinal cord injury at the upper thoracic level. The health care provider informs the caregiver that the patient is in a state of neurogenic shock. How should the nurse explain the term neurogenic shock to the caregivers? There is loss of nervous control of the blood vessels. Blood pressure and heart rate have increased. Blood vessels in the extremities have constricted. There is pooling of blood in the veins of the extremities. The amount of blood pumped out of the heart reduces.

There is loss of nervous control of the blood vessels. There is pooling of blood in the veins of the extremities. The amount of blood pumped out of the heart reduces. Neurogenic shock is due to the loss of vasomotor tone caused by spinal cord injury. Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and decreased cardiac output. It is chiefly characterized by hypotension and bradycardia, not increased blood pressure and heart rate. The blood vessels in the extremities dilate due to neurogenic shock. p. 1470

Which antiretroviral therapy is most likely to induce dyslipidemia in a patient who has acquired immunodeficiency syndrome (AIDS)? Tipranavir [Aptivus] Enfuvirtide [Fuzeon] Maraviroc [Selzentry] Delavirdine [Rescriptor]

Tipranavir [Aptivus] Tipranavir [Aptivus] is a protease inhibitor (1) (2) and impairs liver function. It is most likely that this drug induces dyslipidemia in patients who have AIDS. In addition to dyslipidemia, protease inhibitor therapy can cause lipodystrophy, resulting in a hump at the base of the neck, redistribution of body fat, and a skeleton-like appearance. Enfuvirtide [Fuzeon], maraviroc [Selzentry], and delavirdine [Rescriptor] do not cause any of the adverse effects caused by Tipranavir [Aptivus]. pp. 1139, 1141-Lehne

While assessing a patient, the health care provider observes that the patient has trismus and suspects the patient has a tetanus infection. How would the nurse describe trismus and its relation to tetanus infection? Trismus is stiffness of the jaw and is one of the first manifestations of tetanus. Trismus refers to spasms of the laryngeal and respiratory muscles and is one of the last stages of tetanus. Trismus causes extreme arching of the back and retraction of the head and is unrelated to tetanus. Trismus is the rigidity of neck muscles, back, abdomen, and extremities and is one of the first manifestations of tetanus.

Trismus is stiffness of the jaw and is one of the first manifestations of tetanus. Trismus or lockjaw is stiffness of the jaw due to spasms of the surrounding muscles. It is one of the initial and characteristic features of tetanus. Other manifestations of tetanus include spasms of laryngeal and respiratory muscles, which could cause anoxia, and extreme arching of the back and retraction of the head, also called opisthotonos, which are due to spasms of the trunk (back mainly) musculature. As the disease progresses, there is extreme rigidity of neck muscles, back, abdomen, and extremities. p. 1468

The nurse is caring for a patient infected with human immunodeficiency virus (HIV). The primary healthcare provider plans to prescribe maraviroc [Selzentry] to the patient. Which test would the primary healthcare provider most likely prescribe to the patient before initiating the therapy? Tropism test HLA-B5701 test Viral load [VL] test Renal function test

Tropism test HIV infection enters the immune cells either through the CCR5 co-receptor, the CXCR4 co-receptor, or by a mix of both co-receptors, and it impairs the immune functions. Maraviroc [Selzentry] is a CCR5 co-receptor antagonist that blocks the CCR5 co-receptor and prevents the entry of the virus into the immune cells. Tropism tests help determine the presence of the CCR5 co-receptor and if the virus has entered the immune cells through the CCR5 co-receptor. The HLA-B5701 test helps to determine the gene mutations that may cause hypersensitivity reactions to abacavir [Ziagen]. This test is not specific to maraviroc [Selzentry]. The renal function test helps determine the functioning of the kidneys. As maraviroc does not affect the renal function, a renal function test is not needed. The viral load [VL] test helps identify the severity of HIV infection. It is done while diagnosing the HIV infection, not before initiating the therapy. pp. 1147-1148-Lehne

A patient with spinal cord injury has to be catheterized. Which nursing interventions will help to prevent urinary tract infection (UTI)? Ensure regular and complete drainage of the bladder. Start intermittent catheterization once the patient is stabilized. Empty the urine bag whenever it is 25 percent filled. Maintain the urine drainage bag above the level of the bladder. Cleanse the patient's genitalia using antiseptic before placing the catheter.

UTIs are a common problem in patients with spinal cord injuries. The best method for preventing UTIs is regular and complete bladder drainage. After the patient is stabilized, the best means of managing long-term urinary function should be assessed. Usually the patient is started on an intermittent catheterization program. The other common yet important intervention that a nurse could utilize is to use aseptic methods while inserting the catheter, like cleaning the genitalia using antiseptic. The urine bag should be drained every eight hours or when filled about two thirds. When catheterized for a long period, the urine bag should be kept below the level of the bladder; this will prevent backflow of urine and guard against infections. p. 1481

What instructions should the nurse give to the patient and caregivers to prevent skin breakdown in the patient with spinal cord injury who can sit in the wheelchair? If in a wheelchair, lift oneself up and shift weight every two to four hours. If in bed, change positions using a regular turning schedule of six hours. Use special mattresses to reduce pressure. Use wheelchair cushions to reduce pressure. Use pillows to protect bony prominences when in bed.

Use special mattresses to reduce pressure. Use wheelchair cushions to reduce pressure. Use pillows to protect bony prominences when in bed. For preventing skin breakdown in the patient with spinal cord injury, the nurse should teach the patient and caregivers to use special mattresses and wheelchair cushions to reduce pressure. Pillows should be used to protect bony prominences when in bed. If in a wheelchair, the patient should be told to lift him- or herself up and shift weight every 15 to 30 minutes to promote circulation. If in bed, position should be changed every two hours. p. 1482

A university nurse is teaching her students how to decrease the risk of contracting the human immunodeficiency virus (HIV). What will she include in her teaching? Using condoms Sexual abstinence Circumcision of males Limiting sexual partners Circumcision of females Limiting sexual contact to unprotected oral sex

Using condoms Sexual abstinence Circumcision of males Limiting sexual partners The risk of acquiring HIV sexually can be reduced by male circumcision, limiting sexual partners, using condoms, and sexual abstinence. Female circumcision does not decrease the risk of contracting HIV. Unprotected sex and oral sex places the person at high risk of contracting HIV. p. 1127-Lehne

The nurse is caring for a patient with a skin infection. The patient's laboratory report reveals the presence of Staphylococcus aureus. The nurse recognizes that which medication will be beneficial? Imipenem Methicillin Vancomycin Ceftriaxone

Vancomycin Staphylococcus aureus is a gram-positive coccus bacterium that can cause skin infections. Vancomycin is a glycopeptide antibiotic that acts by inhibiting cell wall synthesis; the medication is effective against Staphylococcus aureus. Imipenem is a beta lactam antibiotic used against Klebsiella pneumoniae. Staphylococcus aureus is resistant to methicillin (a beta lactam antibiotic). Ceftriaxone is a third-generation cephalosporin that is ineffective against Staphylococcus aureus. p. 229

Enterococcus faecalis is resistant to which medications? Ampicillin Methicillin Penicillin G Vancomycin Streptomycin

Vancomycin Streptomycin The bacteria Enterococcus faecalis is resistant to the drugs vancomycin and streptomycin. Ampicillin is effective against Enterococcus faecalis. Staphylococcus aureus and Staphylococcus epidermidis are sensitive to methicillin. Penicillin G is effective for Enterococcus faecalis and resistant to Streptococcus pneumoniae. p. 229-Lewis

Urinary: SCI In the _____ phase or spinal shock there is ______ retention, the ______ is atonic and becomes _________, this patient requires catheterization In the _______ phase or post spinal shock the ______ may become hyperirritable, there is a loss of ________ from the brain, and ______ emptying.

acute urine bladder overdistended postacute bladder inhibition reflex

Guillain-Barre Syndrome

acute rapidly progressing, potential fatal polyneuritis CMs-affects peripheral nervous system→myelin loss, edema, inflammation causing neurotransmission loss Cause-Etiology unknown- may be an immunologic reaction; often preceded by viral infection, trauma, surgery, viral immunizations, or HIV infection Most serious complication resp. failure- ascending paralysis progresses to thoracic nerves Tx-supportive, ventilatory during acute phase

Emergency management SCI

cervical spine x-ray, CT or MRI Prepare for stabilization with tongs and traction Ongoing monitoring of VS, LOC, O2 sat, ECG, urine output Keep warm

Spinal shock is characterized by _____ reflexes, _____ of sensation and ________ paralysis below injury level. This condition is _______ and may last ____ to _____.

decreased loss flaccid temporary days months

Cardiac: SCI If the injury is above level T6 there is a _______ influence of the _______ nervous system. This leads to ________ which causes hypoxemia, peripheral ________ which leads to hypotension, and relative ________ d/t dilated veins.

decreased sympathetic bradycardia vasodilation hypovolemia

Respiratory SCI If injury occurs below level C4, patient will demonstrate ___________ breathing which leads to __________ insufficiency (hypoventilation.)

diaphragmatic respiratory

Neurogenic shock is characterized by ________ and _________. There is a loss of ____ innervation which leads to peripheral _________, ________ pooling, and decreased _______ _______. Occurs in a ____ or higher injury

hypotension bradycardia SNS vasodilation venous cardiac output T6

SCI: metabolic needs There are _________ nutritional needs for this patient including a _____ protein diet which prevents ______ breakdown and _______ & decreases rate of muscular _________. This patient may need _________ or ________ nutrition.

increased high skin infection atrophy enteral parental

Respiratory: SCI In cervical & thoracic injuries there is a risk for ________ and ________ _________ __________. Paralysis occurs in the ________ and ________ muscles which leads to ineffective _________, this puts the person @ risk for atelectasis or pneumonia.

infection neurogenic pulmonary edema abdominal intercostal cough

CCR5 antagonist

maraviroc -Indicated for combined use with other antiretroviral drugs to treat patients age 16 years or older who are infected with CCR5-tropic HIV-1 strains work outside CD4 cells to block HIV entry Adverse effects: hepatotoxicity, cardiovascular effects

A nurse is monitoring a patient with spinal cord injury. The nurse reviews the arterial blood gas (ABG) reports and notifies the health care provider that the patient may need mechanical ventilation. Which blood gas abnormality would have led the nurse to this opinion? pH = 7.27 PaO 2 = 80 mm Hg PaHCO 3 = 26 mm Hg PaCO 2 = 55 mm Hg

pH = 7.27 PaCO 2 = 55 mm Hg A pH of 7.27 is indicative of acidosis and a PaCO 2 of more than 45 is indicative of respiratory acidosis. This is due to failure of the ventilatory pump to adequately wash out oxygen. Therefore, ventilator support is a must in this case. A PaO 2 of 80 can be managed well without ventilator support and a PaHCO 3 level of 26 is within normal limits. p. 1477

SCI: GI system These patients are at increased risk for ______ ______ d/t severe trauma and physiologic stress. Monitor _____, ______ ______, and hematocrit. Give ________ medications. In ________ bowel, the injury occurs level ____ or below. Initially the bowel is ______ w/______ sphincter tone. When reflexes return sphincter tone is ______ w/ reflex emptying. Tx includes daily rectal _______ (suppository or small volume enema), digital ______, or manual ______. The patient should remain in a _______ position when able

stress ulcers stool gastric contents prophylactic neurogenic bowel areflexic decreased enhanced stimulant stimulation evacuation upright