Immunity/Infection

Which signs/symptoms make the nurse suspect the most common opportunistic infection in the female client diagnosed with acquired immunodeficiency syndrome (AIDS)? 1. Fever, cough, and shortness of breath. 2. Oral thrush, esophagitis, and vaginal candidiasis. 3. Abdominal pain, diarrhea, and weight loss. 4. Painless violet lesions on the face and tip of nose.

1. Pneumocystis pneumonia (PCP) occurs in approximately 75% to 80% of clients diagnosed with AIDS. Signs/symptoms of it include fever, cough, and shortness of breath. 2. This is an opportunistic infection, but it is not the most common infection. 3. These are signs/symptoms of Mycobacterium avium complex (MAC), which affects up to 25% of client's with AIDS, but it is not the most common opportunistic infection. 4. These are signs/symptoms of Kaposi's sarcoma, which is the most common cancer associated with AIDS; it is not an infectious disease. Content - Medical: Integrated Nursing Process - Assessment: Client Needs - Physiological Integrity, Reduction of Risk Potential: Cognitive Level - Analysis: Concept - Immunity.

To evaluate the effectiveness of ART, the nurse will schedule the patient for a. viral load testing. b. enzyme immunoassay. c. rapid HIV antibody testing. d. immunofluorescence assay.

A Rationale: The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect for HIV antibodies, which remain positive even with effective ART. Cognitive Level: Application Text Reference: p. 265 Nursing Process: Planning NCLEX: Physiological Integrity

When teaching a patient with HIV infection about ART, the nurse explains that these drugs a. work in various ways to decrease viral replication in the blood. b. boost the ability of the immune system to destroy the virus. c. destroy intracellular virus as well as lowering the viral load. d. increase the number of CD4+ cells available to fight the HIV.

A Rationale: The three groups of antiretroviral drugs work in different ways to decrease the ability of the virus to replicate. The drugs do not work by boosting the ability of the immune system or CD4 cells to fight the virus. The viral load detected in the blood is decreased with effective therapy, but intracellular virus is still present. Cognitive Level: Application Text Reference: pp. 256-257 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse is presenting information to a community group on safer sex practices. The nurse should teach that which sexual practice is the riskiest? a. Anal intercourse b. Masturbation c. Oral sex d. Vaginal intercourse

A ~ Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating a portal of entry for human immune deficiency virus.

An HIV-negative client who has an HIV-positive partner asks the nurse about receiving Truvada (emtricitabine and tenofovir). What information is most important to teach the client about this drug? a. Truvada does not reduce the need for safe sex practices. b. This drug has been taken off the market due to increases in cancer. c. Truvada reduces the number of HIV tests you will need. d. This drug is only used for postexposure prophylaxis.

A ~ Truvada is a new drug used for pre-exposure prophylaxis and appears to reduce transmission of human immune deficiency virus (HIV) from known HIV-positive people to HIV-negative people. The drug does not reduce the need for practicing safe sex. Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3 months. This drug has not been taken off the market and is not used for postexposure prophylaxis.

Which findings are AIDS-defining characteristics? (Select all that apply.) a. CD4+ cell count less than 200/mm3 or less than 14% b. Infection with Pneumocystis jiroveci c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) d. Presence of HIV wasting syndrome e. Taking antiretroviral medications

A, B, D ~ A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as Pneumocystis jiroveci and HIV wasting syndrome. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.

A client with acquired immune deficiency syndrome (AIDS) is hospitalized with Pneumocystis jiroveci pneumonia and is started on the drug of choice for this infection. What laboratory values should the nurse report to the provider as a priority? (Select all that apply.) a. Aspartate transaminase, alanine transaminase: elevated b. CD4+ cell count: 180/mm3 c. Creatinine: 1.0 mg/dL d. Platelet count: 80,000/mm3 e. Serum sodium: 120 mEq/L

A, D, E ~ The drug of choice to treat Pneumocystis jiroveci pneumonia is trimethoprim with sulfamethoxazole (Septra). Side effects of this drug include hepatitis, hyponatremia, and thrombocytopenia. The elevated liver enzymes, low platelet count, and low sodium should all be reported. The CD4+ cell count is within the expected range for a client with an AIDS-defining infection. The creatinine level is normal.

The client has had an anaphylactic reaction to insect venom, a bee sting. Which discharge instruction should the nurse discuss with the client? 1. Take a corticosteroid dose pack when stung by a bee. 2. Take antihistamines prior to outdoor activities. 3. Use a cromolyn sodium (Intal) inhaler prophylactically. 4. Carry a bee sting kit, especially when going outside.

Answer 4. The kit usually includes a prefilled syringe of epinephrine and an epinephrine nebulizer, which allows prompt self-treatment for any future exposures to insect venom or other potential allergen exposure. 1. Corticosteroids may be used in both systemic and topical forms for many types of hypersensitivity responses but must be ordered by a health-care provider and are not automatically taken after a bee sting. 2. Antihistamines are the major class of drugs used to treat hypersensitivity responses, but they are not taken prophylactically. They are used when a reaction occurs. 3. This drug treats allergic rhinitis and asthma prophylactically. It does not help bee stings or insect bites. Content - Medical: Integrated Nursing Process - Planning: Client Needs - Physiological Integrity, Physiological Adaptation: Cognitive Level - Synthesis: Concept - Immunity.

Which is the highest priority nursing intervention for the client who is having an anaphylactic reaction? 1. Administer parenteral epinephrine, an adrenergic agonist. 2. Prepare for immediate endotracheal intubation. 3. Provide a calm assurance when caring for the client. 4. Establish and maintain a patent airway.

Answer 4. Establishing a patent airway is priority because facial angioedema, bronchospasm, and laryngeal edema occur with an anaphylactic reaction. Inserting a nasopharyngeal or oropharyngeal airway is the priority intervention to save the client's life. 1. Epinephrine is the drug of choice for an anaphylactic reaction. It is a potent vasoconstrictor and bronchodilator counteracting the effects of histamine, but this is not the priority intervention. 2. This is an important intervention, but it is not the priority intervention. 3. Decreasing the client's anxiety is important, but it is not the priority intervention. Content - Medical/Immune System: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Synthesis: Concept - Immunity.

The home health-care nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa? 1. The client has a positive HIV viral load. 2. The client's white blood cell (WBC) count is 5,000/mm3. 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3.

Answer: 4 The client with a CD4 count of less than 300/mm3 is at risk for developing PJP. Trimethoprim sulfa (Bactrim) is prophylaxis for PJP. Normal levels for CD4 are 450 to 1,400/mm3. 1. The client who is HIV positive could be expected to have a positive viral load. This is a reason to institute HAART, but not trimethoprim sulfa (Bactrim). 2. This is a normal WBC count and is not a reason to start a prophylactic antibiotic. 3. This client is showing symptoms of Pneumocystis jiroveci pneumonia (PJP); any treatment now would not be prophylactic.

A client with HIV/AIDS asks the nurse why gabapentin (Neurontin) is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best? a. Gabapentin can be used as an antidepressant too. b. I have no idea why you should be taking this drug. c. This drug helps treat the pain from nerve irritation. d. You are at risk for seizures due to fungal infections.

C ~ Many classes of medications are used for neuropathic pain, including tricyclic antidepressants such as gabapentin. It is not being used as an antidepressant or to prevent seizures from fungal infections. If the nurse does not know the answer, he or she should find out for the client.

The decision to begin antiretroviral therapy is based on: A. the CD4 cell count B. the plasma viral load C. the intensity of the patient's clinical symptoms. D. All of the above.

D

The nurse is preparing to give the following medications to an HIV-positive patient who is hospitalized with PCP. Which is most important to administer at the right time? a. Nystatin (Mycostatin) tablet for vaginal candidiasis b. Aerosolized pentamadine (NebuPent) for PCP infection c. Oral acyclovir ((Zovirax to treat systemic herpes simplex d. Oral saquinavir (Inverase) to suppress HIV infection

D Rationale: It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day. Cognitive Level: Application Text Reference: pp. 258, 264-265 Nursing Process: Implementation NCLEX: Physiological Integrity

The client is experiencing an anaphylactic reaction to bee venom. Which interventions should the nurse implement? List in order of priority. 1. Establish a patent airway. 2. Administer epinephrine, an adrenergic agonist, IVP. 3. Start an IV with 0.9% saline. 4. Teach the client to carry an EpiPen when outside. 5. Administer diphenhydramine (Benadryl), an antihistamine, IVP.

In order of priority: 1, 3, 2, 5, 4. 1. Airway is always the first priority for any process in which the airway might be compromised. 3. The nurse should start an IV so medications can be administered to treat the anaphylactic reaction. 2. Epinephrine is the drug of choice for the treatment of anaphylaxis. The medication is administered every 10 to 15 minutes until the reaction has subsided. Epinephrine is given for its vasoconstrictive action. 5. Benadryl, an antihistamine, is given to block histamine release, reducing capillary permeability. 4. Teaching is important to prevent or treat further reactions, but this will be done after the crisis is over. Content - Medical: Integrated Nursing Process - Implementation: Client Needs - Safe Effective Care Environment, Management of Care: Cognitive Level - Analysis: Concept - Immunity.

The client with acquired immunodeficiency syndrome (AIDS) has oral candidiasis. Who among these clients can safely be roomed-in with the client? a) the client with chronic renal failure who is undergoing hemodialysis b) the client with hepatitis B (HBV) infection c) the client who is human immunodeficiency virus (HIV) positive with streptococcal infection d) the client with viral pneumonia

b) the client with hepatitis B (HBV) infection