Immunology and HIV Practice Questions
The nurse is reviewing the laboratory reports of four clients. Which client is in the third stage of human immune virus (HIV) disease? A. CD4 count is 180 B. CD4 count is 250 C. CD4 count is 380 D. CD4 count is 600
A Rationale According to HIV disease classification, a client with HIV disease is in the third stage of the disease if the CD4+ T-cell count is less than 200 cells/mm 3. Therefore, client A is in third stage of HIV disease. A client is in second stage of HIV disease if the CD4+ T-cell count is between 200 and 499 cells/mm 3. Therefore, client B and client C are in the second stage of HIV disease. A client is in the first stage of HIV disease if the CD4+ T-cell count is greater than 500 cells/mm 3. Therefore, client D is in first stage of HIV disease.
What is an example of a type I hypersensitivity reaction? A. Anaphylaxis B. Serum sickness C. Contact dermatitis D. Blood transfusion reaction
A Rationale An example of a type I hypersensitivity reaction is anaphylaxis. Serum sickness is a type III immune complex reaction. Contact dermatitis is a type IV delayed hypersensitivity reaction. A blood transfusion reaction is a type II cytotoxic reaction.
A nurse is caring for a client with pruritic lesions from an IgE-mediated hypersensitivity reaction. Which mediator of injury is involved? A. Histamine B. Cytokine C. Neutrophil D. Macrophage
A Rationale Histamine is one of the mediators of injury involving IgE-mediated injury that may cause pruritus. Cytokines are the mediators of injury in delayed hypersensitivity reaction. Neutrophils are involved in immune complex-mediated hypersensitivity reactions. Macrophages in tissues are involved in cytotoxic reactions.
Which dietary modifications can help improve the nutritional status of a client with acquired immunodeficiency syndrome (AIDS)? A. Refraining from consuming fatty foods B. Refraining from consuming frequent meals C. Refraining from consuming high-calorie foods D. Refraining from consuming high-protein foods
A Rationale Many clients with AIDS become intolerant to fat due to the disease and the antiretroviral medications. Therefore the client should be instructed to refrain from consuming fatty foods. The client should be encouraged to eat small and frequent meals to improve nutritional status. High-calorie and high-protein foods are beneficial to clients with AIDS because they provide energy and build immunity.
Which is the most common opportunistic infection in a client infected with human immunodeficiency virus (HIV)? A. Oropharyngeal candidiasis B. Cryptosporidiosis C. Toxoplasmosis encephalitis D. Pneumocystis jiroveci pneumonia
A Rationale Oropharyngeal candidiasis is the most common infection associated with HIV because the immune system can no longer control Candida fungal growth. Pneumocystis jiroveci pneumonia (PCP) is the more common in a client infected with AIDs. It causes tachypnea and persistent dry cough. Cryptosporidiosis, an intestinal infection caused by Cryptosporidium organisms, presents in clients with AIDS as does toxoplasmosis encephalitis, which is caused by Toxoplasma gondii and is acquired through contact with contaminated cat feces or by ingesting infected undercooked meat.
A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take when caring for this client? A. Use standard precautions. B. Employ airborne precautions. C. Plan interventions to limit direct contact. D. Discourage long visits from family members.
A Rationale The Centers for Disease Control and Prevention (Canada: Public Health Agency of Canada) states that standard precautions should be used for all clients; these precautions include wearing of gloves, gown, mask, and goggles when there is risk for exposure to blood or body secretions. There is no indication that airborne precautions are necessary. Planning interventions to limit direct contact and discouraging long visits from family members will unnecessarily isolate the client.
A nurse is caring for a client who is human immunodeficiency virus (HIV) positive. Which complication associated with this diagnosis is most important for the nurse to teach prevention strategies? A. Infection B. Depression C. Social isolation D. Kaposi sarcoma
A Rationale The client has a weakened immune response. Instructions regarding rest, nutrition, and avoidance of unnecessary exposure to people with infections help reduce the risk for infection. Clients can be taught cognitive strategies to cope with depression, but the strategies will not prevent depression. The client may experience social isolation as a result of society's fears and misconceptions; these are beyond the client's control. Although Kaposi sarcoma is related to HIV infection, there are no specific measures to prevent its occurrence
Which age-related effects on the immune system are seen in the older client? A. Increased autoantibodies B. Increased expression of IL-2 receptors C. Increased delayed hypersensitivity reaction D. Increased primary and secondary antibody responses
A Rationale The effects of aging on the immune system include increased autoantibodies. Expression of IL-2 receptors, delayed hypersensitivity reaction, and primary and secondary antibody responses decrease in older adults because of the effects of aging on the immune system.
The nurse is reviewing blood screening tests of the immune system of a client with acquired immunodeficiency syndrome (AIDS). What does the nurse expect to find? A. A decrease in CD4 T cells B. An increase in thymic hormones C. An increase in immunoglobulin E D. A decrease in the serum level of glucose-6-phosphate dehydrogenase
A Rationale The human immunodeficiency virus (HIV) infects helper T-cell lymphocytes; therefore 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS. The thymic hormones necessary for T-cell growth are decreased. An increase in immunoglobulin E is associated with allergies and parasitic infections. A decrease in the serum level of glucose-6-phosphate dehydrogenase is associated with drug-induced hemolytic anemia and hemolytic disease of the newborn.
The nurse is reviewing the laboratory report of four clients. Which lymphocyte count does the nurse suspect to have acquired immunodeficiency syndrome (AIDS)? A. 3000 cells/mm3 B. 5000 cells/mm3 C. 7000 cells/mm3 D. 9000 cells/mm3
A Rationale The normal lymphocyte count is between 5000 and 10,000 cells/mm 3. A client with AIDS is leukopenic and has a lymphocyte count less than 3500 cells/mm 3. Therefore, client A has AIDS. Clients B, C, and D have normal lymphocyte counts.
Which are examples of a type IV hypersensitivity reaction? Select all that apply. A. Poison ivy allergic reaction B. Sarcoidosis C. Myasthenia gravis D. Rheumatoid arthritis E. Systemic lupus erythematosus
A, B Rationale Sarcoidosis and poison ivy reactions are examples of type IV hypersensitivity reactions. In type IV hypersensitivity, the inflammation is caused by a reaction of sensitized T cells with the antigen and the resultant activation of macrophages due to lymphokine release. Myasthenia gravis is an example of a type II or cytotoxic hypersensitivity reaction. Rheumatoid arthritis and systemic lupus erythematosus are examples of type III immune complex-mediated reactions.
Which conditions may result from immunoglobulin IgE antibodies on mast cells reacting with antigens? Select all that apply. A. Asthma B. Hay fever C. Sarcoidosis D. Myasthenia gravis E. Rheumatoid arthritis
A, B Rationale Clinical conditions such as asthma and hay fever are considered type I hypersensitive reactions that are mediated by a reaction between IgE antibodies with antigens. It results in the release of mediators such as histamines. Type IV hypersensitivity reactions such as sarcoidosis result from reactions between sensitized T cells with antigens. Myasthenia gravis results from a type II hypersensitivity reaction that occurs due to an interaction between immunoglobulin IgG and the host cell membrane. Rheumatoid arthritis is a type III hypersensitivity reaction that results from the formation of immune complexes between antigens and antibodies that results in inflammation.
Which conditions in clients are examples of cell-mediated immunity? Select all that apply. A. Tuberculosis B. Graft rejection C. Allergic rhinitis D. Contact dermatitis E. Anaphylactic shock
A, B, D Rationale Conditions such as tuberculosis, graft rejection, contact dermatitis, and fungal infections are examples of cell-mediated immunity. T lymphocytes and macrophages sensitize T cells and cytokines to provide protection against fungus, viruses (intracellular), chronic infectious agents, and tumor cells. Allergic rhinitis and anaphylactic shock are examples of humoral immunity that are mediated by antibodies released by B lymphocytes.
Which are examples of actively acquired specific immunity? Select all that apply. A. Recovery from measles B. Recovery from chickenpox C. Maternal immunoglobulin in the neonate D. Immunization with live or killed vaccines E. Injection of human gamma immunoglobulin
A, B, D Rationale Naturally acquired active-type immunity is seen in a client who has recovered from measles or chickenpox or who has been immunized with a live- or killed-virus vaccine. Maternal immunoglobulin in a neonate and an injection of human gamma immunoglobulin into a client are examples of passively acquired specific immunity.
What should the nurse identify as responses to the release of histamine during a type I rapid hypersensitivity reaction? Select all that apply. A. Pruritus B. Erythema C. Fibrotic changes D. Nasal mucus secretion E. Conjunctival mucus secretion
A, B, D, E Rationale Histamine causes itching or pruritus, erythema, and nasal and conjunctival mucus secretion. Fibrotic changes occur with type III immune complex reactions.
Which leukocyte values should be assessed to determine the adequacy of a client's response to inflammation? Select all that apply. A. Monocytes B. Neutrophils C. Plasma cells D. T-helper cells E. Macrophage
A, B, E Rationale In response to inflammation, monocytes destroy bacteria and cellular debris; neutrophils ingest and phagocytize microorganisms and foreign protein; and macrophages destroy bacteria and cellular debris. Plasma cells are a part of antibody-mediated immunity and secrete immunoglobulins in response to the presence of a specific antigen. T-helper cells are a part of cell-mediated immunity and enhance immune activity through the secretion of various factors, cytokines, and lymphokines.
A nurse is teaching a health class about human immunodeficiency virus (HIV). Which basic methods are used to reduce the incidence of HIV transmission? Select all that apply. A. Using condoms B. Using separate toilets C. Practicing sexual abstinence D. Preventing direct casual contacts E. Sterilizing the household utensils
A, C Rationale HIV is found in body fluids such as blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, and cerebrospinal fluid. Therefore a client should use condoms to prevent contact between the vaginal mucus membranes and semen. Practicing sexual abstinence is the best method to prevent transmission of the virus. The HIV virus is not transmitted by sharing the same toilet facilities, casual contacts such as shaking hands and kissing, or by sharing the same household utensils.
What functions of leukocytes are involved in inflammation? Select all that apply. A. Destruction of bacteria and cellular debris B. Selective attack and destruction of non-self cells C. Release of vasoactive amines during allergic reactions D. Secretion of immunoglobulins in response to a specific antigen E. Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines
A, C Rationale Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines during allergic reactions to limit these reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.
In addition to Pneumocystis jiroveci, a client with acquired immunodeficiency syndrome (AIDS) also has an ulcer 4 cm in diameter on the leg. Considering the client's total health status, what is the most critical concern? A. Skin integrity B. Gas exchange C. Social isolation D. Nutritional status
B Rationale P. jiroveci, now believed to be a fungus, causes pneumonia in immunosuppressed hosts; it can cause death in 60% of the clients. The client's respiratory status is the priority. Although skin integrity, social isolation, and nutritional status are concerns, the client's respiratory status is the priority.
A client has received ABO-incompatible blood from a donor by mistake. Which type of hypersensitivity reaction will occur in the client? A. Type I B. Type II C. Type III D. Type IV
B Rationale A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. Naturally acquired antibodies to antigens of the ABO blood group are in the recipient's serum but are not present on the erythrocyte membranes. Anaphylactic reactions are type I reactions that occur only in susceptible people who are highly sensitized to specific allergens. Tissue damage in immune-complex reactions, which are type III reactions, occur secondary to antigen-antibody complexes. Although cell-mediated responses are usually protective mechanisms, tissue damage occurs in delayed hypersensitivity reactions. The tissue damage in a type IV reaction does not occur in the presence of antibodies or complement.
A client who has been living in another country for 10 years is undergoing diagnostic testing to identify the causative organisms of the infection that has been acquired. When caring for this client, what should the nurse recall about active immunity? A. Protein antigens are formed in the blood to fight invading antibodies. B. Protein substances are formed within the body to neutralize antigens. C. Blood antigens are aided by phagocytes in defending the body against pathogens. D. Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens.
B Rationale Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the agent (antigen) should it enter the body again. Antigens do not fight antibodies; they trigger antibody formation that in turn attacks the antigen. Antigens are foreign substances that enter the body and trigger antibody formation. Sensitized lymphocytes do not act as antibodies.
Which type of immunity will clients acquire through immunizations with live or killed vaccines? A. Natural active immunity B. Artificial active immunity C. Natural passive immunity D. Artificial passive immunity
B Rationale Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.
A registered nurse is educating a client with acquired immune deficiency syndrome about safe sexual practices. Which statement made by the client indicates a need for further education? A. "I should use a dental dam during oral sex." B. "I can participate in anal intercourse safely without using condoms." C. "I should ask my partner to use a female condom while engaging in sexual activity." D. "I should use condoms even while receiving highly active antiretroviral therapy (HAART)."
B Rationale Having anal intercourse indicates the client needs more teaching because this statement is incorrect. The client should wear a condom or use other genital barriers to prevent the transmission of human immunodeficiency virus (HIV). Anal intercourse is a risky sexual practice that allows contact between the seminal fluid and the rectal mucous membranes. Anal intercourse also tears the mucous membranes, making an infection more likely. All the other statements are correct and do not indicate further education is needed. Barriers such as female condoms and dental dams are recommended while participating in sexual activity. Though the viral load may decrease with the use of HAART, the risk for transmission still exists. Therefore the client should use condoms during sexual contact.
A registered nurse is teaching a nursing student about the various mechanisms that antiviral drugs use to control human immune deficiency (HIV) infections. Which statement made by the nursing student needs correction? A. "Maraviroc blocks CCR 5 receptors on CD4+ T-cells." B. "Saquinavir blocks the fusion between HIV and the host cell." C. "Zidovudine acts as a counterfeit base for reverse transcriptase." D. "Nelfinavir prevents the breakup of viral protein strand into smaller fragments."
B Rationale Saquinavir is a protease inhibitor that works by blocking the HIV enzyme protease; it is not a fusion inhibitor. Saquinavir prevents the viral protein strand from being lysed into active smaller fragments. Entry inhibitors such as maraviroc block CCR 5 receptors on CD4+ T-cells. Zidovudine is a nucleoside reverse transcriptase inhibitor that acts as a counterfeit base for the HIV enzyme reverse transcriptase. Protease inhibitors such as nelfinavir prevent the breakup of viral protein strand into smaller active viral particles.
What causes medications used to treat AIDS to become ineffective? A. Taking the medications 90% of the time B. Missing doses of the prescribed medications C. Taking medications from different classifications D. Developing immune reconstitution inflammatory syndrome (IRIS)
B Rationale The most important reason for the development of drug resistance in the treatment of AIDS is missing doses of drugs. When doses are missed, the blood drug concentrations become lower than what is needed to inhibit viral replication. The virus replicates and produces new particles that are resistant to the drugs. Taking the medications 90% of the time prevents medications from becoming ineffective. Taking medications from different classes prevents the drugs from becoming ineffective. Immune reconstitution inflammatory syndrome (IRIS) occurs when T-cells rebound with medication therapy and become aware of opportunistic infections.
A client who works manufacturing latex gloves presents with dryness, pruritus, fissuring, and cracking of the skin followed by redness and inflammation about 24 hours after contact. The nurse identifies it as an allergic reaction. Which condition most likely has occurred? A. Type I allergic reaction B. Type IV contact dermatitis reaction C. Immune complex reaction D. Cytotoxic hypersensitivity reaction
B Rationale Type IV contact dermatitis is caused by the chemicals used in the manufacturing process of latex gloves. It is characterized by dryness, pruritus, fissuring, and cracking of the skin and occurs within 6 to 48 hours of contact. Type I allergic reaction is a response to the natural rubber latex proteins and occurs within minutes of contact with the proteins; skin redness, urticaria, rhinitis, and conjunctivitis are the clinical manifestations. Immune-complex reaction is a type III hypersensitivity. The kidneys, skin, joints, blood vessels and lungs are common sites for deposit. Cytotoxic hypersensitivity reactions involve the direct binding of IgG or IgM antibodies to an antigen on the cell surface and is a type II hypersensitivity.
The nursing staff has a team conference on acquired immunodeficiency syndrome (AIDS) and discusses the routes of transmission and risk of exposure to human immunodeficiency virus (HIV). Which action poses no risk of exposure to HIV to an uninfected individual? A. Has intercourse with just the spouse B. Makes a donation of a pint of whole blood C. Uses a condom each time there is sexual intercourse D. Limits sexual contact to those without HIV antibodies
B Rationale: Equipment used in blood donation is disposable; the donor does not come into contact with anyone else's blood. The risk depends on the spouse's previous 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.
Which conditions result in humoral immunity? Select all that apply. A. Tuberculosis B. Atopic diseases C. Bacterial infection D. Anaphylactic shock E. Contact dermatitis
B, C, D Rationale Atopic diseases, bacterial infections, and anaphylactic shock are disease conditions that trigger humoral immunity. Tuberculosis and contact dermatitis result in cell-mediated immunity.
A nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? Select all that apply. A. Mosquito bites B. Sharing syringe needles C. Breastfeeding a newborn D. Dry kissing the infected partner E. Anal intercourse
B, C, E Rationale Fluids such as blood and semen are highly concentrated with HIV. HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or dry kissing.
What are the mediators of injury in IgE-mediated hypersensitivity reactions? Select all that apply. A. Cytokines B. Mast cells C. Histamines D. Neutrophils E. Leukotrienes
B, C, E Rationale Mast cells, histamines, and leukotrienes are the mediators of injury in IgE-mediated hypersensitivity reactions. Cytokines are the mediators of injury in the delayed type of hypersensitivity reaction. Neutrophils are the mediators of injury in the immune-complex type of hypersensitivity reaction.
A client with acquired immunodeficiency syndrome (AIDS) and Cryptococcal pneumonia frequently is incontinent of feces and urine and produces copious sputum. When giving this client a bath, which protective equipment should the nursemake it a priority to use? Select all that apply. A. Goggles B. Surgical mask C. Shoe covers D. Gown E. Gloves F. N95 hepa mask
B, D, E Rationale A gown, mask, and gloves when bathing the client prevent contact with feces, sputum, or other body fluids during intimate body care. Goggles would only be important if the client was on mechanical ventilation to avoid contact with sputum. An N95 hepa mask would be necessary if the client had tuberculosis, but not for Cryptococcal pneumonia alone. Shoe covers are designed for protecting a sterile environment such as a surgery suite and are not necessary for giving client care at the bedside.
Which finding in the client's laboratory report enables the nurse to conclude that the client has a stage 3 human immunodeficiency (HIV) infection according to the Centers for Disease Control and Prevention (CDC) classification? Select all that apply. A. CD4+ T-cell count 800 cells/mm 3 or a percentage of 32% B. CD4+ T-cell count 100 cells/mm 3 or a percentage of 11% C. CD4+ T-cell count of an unknown percentage and Kaposi's sarcoma D. CD4+ T-cell count of an unknown percentage and Burkitt's lymphoma E. CD4+ T-cell count 150 cells/mm 3 or a percentage of 12% and Kaposi's sarcoma
B, E Rationale The CDC has classified four stages of HIV infection. Stage 3 is characterized by a CD4+ T-cell count less than 200 cells/mm 3 or a percentage less than 14%. A T-cell count of greater than 500 cells/mm 3 or a percentage of 29% or greater is regarded as stage 1 HIV. A client whose HIV infection is confirmed with no information on the CD4+ T-cell count but who has an acquired immunodeficiency syndrome-defining illness such as Kaposi's sarcoma or Burkitt's lymphoma is considered to be in stage 4 HIV.
The registered nurse instructs the nursing student about caring for a hospitalized client with a human immunodeficiency (HIV) infection. Which action made by the nursing student indicates effective learning? A. Keeping fresh flowers in the client's room B. Encouraging the client to eat fresh fruits and vegetables C. Keeping a dedicated disposable glove box in the client's room D. Changing gauze-containing wound dressings every other day
C Rationale A client with an HIV infection is at a high risk of contracting infections. Therefore the nurse should keep a dedicated disposable glove box in the client's room and avoid using supplies from a common area. The nurse should refrain from keeping potted plants and flowers in the client's room because they act as source of potentially infectious bacteria and fungi. A client with an HIV infection should be discouraged from consuming raw fruits and vegetables and should be given well-cooked food to reduce risk of food borne pathogens. In order to reduce the risk of infections, the nurse should change gauze-containing wound dressings every day.
After assessing an older client's medical report, the nurse finds that the client is at an increased risk for bacterial and fungal infections. Which change in immune function may have occurred? A. Decline in natural bodies B. Reduction of neutrophil function C. Decrease in circulating T-lymphocytes D. Reduction of colony-forming B-lymphocytes
C Rationale A decrease in circulating T-lymphocytes occurs with cell-mediated immunity, resulting in an increased risk of bacterial and fungal infections. A client would need booster shots for old vaccinations and immunizations when there is a decline in natural antibodies. A reduced neutrophil function may be an implication when neutrophil function is decreased. The older adult should receive immunizations, such as flu shots, when the number of colony-forming B-lymphocytes is diminished.
While receiving a blood transfusion, a client develops flank pain, chills, and fever. What type of transfusion reaction does the nurse conclude that the client probably is experiencing? A. Allergic B. Pyrogenic C. Hemolytic D. Anaphylactic
C Rationale A hemolytic transfusion reaction results from a recipient's antibodies that are incompatible with transfused red blood cells; it is called a type II hypersensitivity. The clinical findings are a result of red blood cell hemolysis, agglutination, and capillary plugging. An allergic transfusion reaction is the result of an immune sensitivity to foreign serum protein; it is called a type I hypersensitivity, and associated clinical findings include urticaria, wheezing, dyspnea, and shock. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; associated clinical findings include fever and chills, but not flank pain. An anaphylactic reaction may occur with an allergic transfusion reaction.
A registered nurse is teaching a student nurse regarding the interventions for a client with human immunodeficiency virus (HIV) infection. Which statement by the student nurse indicates the nurse needs to follow up? A. "I will ask the client to avoid exposure to new infectious agents." B. "I will ask the client about intake of vitamins and micronutrients." C. "I will ask the client to avoid involvement in community activities." D. "I will ask the client if he or she is up to date with recommended vaccines."
C Rationale HIV-infected clients may feel isolated and lonely; therefore they should be involved in support groups and community activities. The nurse should follow up to correct this misconception. All the other statements are correct. The HIV infection decreases the client's immunity making the client prone to infection. Therefore HIV-infected clients should avoid exposure to new infectious agents. They should consume nutritional support to maintain lean body mass and ensure appropriate levels of vitamins and micronutrients. They need to be updated with recommended vaccines to prevent vaccine-preventable diseases.
Which type of immunity is acquired through the transfer of colostrum from the mother to the child? A. Natural active immunity B. Artificial active immunity C. Natural passive immunity D. Artificial passive immunity
C Rationale Natural passive immunity is acquired through the transfer of colostrum from the mother to the child. Natural active immunity is acquired when there is a natural contact with an antigen through a clinical infection. Artificial active immunity is acquired through immunization with an antigen. Artificial passive immunity is acquired by injecting serum from an immune human.
The nurse instructs the son of an older client about age-related immune system changes and associated care measures. Which statement made by the son during a follow-up visit indicates a need for further instruction? A. "My parent has a private room at home." B. "My parent has received the pneumococcal vaccination recently." C. "My parent comes in for check-ups only whenever he or she has a fever." D. "My parent has been given a second dose of the pertussis vaccination."
C Rationale Older clients should have regular check-ups even in the absence of fever. Because aging causes reduced neutrophil function, some infections may not show fever symptoms. Older adults should have a private room at home to avoid other adults who may have viral infections. Because older adults have a decreased production of antibodies against new antigens, the caretaker should ensure that the older client has received updated vaccinations against infectious diseases such as pneumococcus and pertussis.
The nurse is caring for a client on antiretroviral therapy who has Pneumocystis jiroveci pneumonia. Which action is priority? A. Assisting the client in eating and drinking B. Maintaining fluid balance in the client C. Providing adequate oxygenation for the client D. Encouraging the client to perform breathing exercise
C Rationale Pneumocystis jiroveci pneumonia may cause difficulty in breathing; therefore the client should be provided adequate oxygenation. A client with human immunodeficiency virus and mouth lesions may need assistance in eating and drinking. An important nursing concern in a client with dehydration is maintaining fluid balance. Encouraging regular breathing exercises may be incorporated when the client is stable and is not the priority
Which client has the highest risk for human immunodeficiency virus (HIV) infection? A. A client who is involved in mutual masturbation B. A client who undergoes voluntary prenatal HIV testing C. A client who shares equipment to snort or smoke drugs D. A client who engages in insertive sex with a non-infective partner
C Rationale Clients who use equipment to snort (straws) and smoke (pipes) drugs are at the highest risk for becoming infected with HIV as their judgment may be impaired regarding the high-risk behaviors. Safe activities that prevent the risk of contracting HIV include mutual masturbation, masturbation, and other activities that meet the "no contact" requirements. A client who undergoes perinatal HIV voluntary testing may reduce the chances of getting infected. Insertive sex between partners who are not infected with HIV are not at risk of becoming infected with HIV.
A nurse is caring for a client with a diagnosis of acquired immunodeficiency syndrome (AIDS). The IV infiltrates and needs to be restarted. What is necessary to protect the nurse when restarting the IV? Select all that apply. A. Mask B. Gown C. Gloves D. Face shield E. Hand hygiene
C, E Rationale Wearing gloves protects the nurse from potential contamination. Gloves are appropriate when there is a risk of the hands coming into contact with a client's blood or body fluids. Hand hygiene is the most effective way to prevent the spread of microorganisms. Wearing a mask is necessary for procedures where splashing of body fluids is anticipated or a risk. Wearing a gown is necessary for procedures where splashing of body fluids is anticipated or a risk. Wearing a face shield is necessary for procedures where splashing of body fluids is anticipated.
A client who abused intravenous drugs was diagnosed with the human immunodeficiency virus (HIV) several years ago. What does the nurse explain to the client regarding the diagnostic criterion for acquired immunodeficiency syndrome (AIDS)? A. Contracts HIV-specific antibodies B. Develops an acute retroviral syndrome C. Is capable of transmitting the virus to others D. Has a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%)
D Rationale AIDS is diagnosed when an individual with human immunodeficiency virus (HIV) develops one of the following: a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%), wasting syndrome, dementia, one of the listed opportunistic cancers (e.g., Kaposi sarcoma [KS], Burkitt lymphoma), or one of the listed opportunistic infections (e.g., Pneumocystis jiroveci pneumonia, Mycobacterium tuberculosis). The development of HIV-specific antibodies (seroconversion), accompanied by acute retroviral syndrome (flulike syndrome with fever, swollen lymph glands, headache, malaise, nausea, diarrhea, diffuse rash, joint and muscle pain) 1 to 3 weeks after exposure to HIV reflects acquisition of the virus, not the development of AIDS. A client who is HIV positive is capable of transmitting the virus with or without the diagnosis of AIDS.
A nurse is caring for a 26-year-old client recently diagnosed with human immunodeficiency virus (HIV) and has a CD4 count of 150. The client needs an update on immunizations and asks which ones are needed. Which vaccines are required to comply with the recommended immunization schedule for a client with HIV? A. Influenza; measles, mumps, rubella (MMR); varicella; and hepatitis A vaccines B. Pneumococcal, MMR, influenza, and varicella vaccines C. Diphtheria, tetanus, hepatitis A, and hepatitis C vaccines D. Tetanus, hepatitis B, influenza, and pneumococcal vaccines
D Rationale According to recent recommendations, adults with HIV should receive tetanus, influenza, hepatitis B, and pneumococcal vaccines. Live pathogen vaccines (MMR, varicella) are contraindicated for individuals whose CD4 count is less than 200. Currently there is no immunization for hepatitis C, and the diphtheria vaccine is not recommended.
Which is the first antibody formed after exposure to an antigen? A. IgA B. IgE C. IgG D. IgM
D Rationale IgM (immunoglobulin M) is the first antibody formed by a newly sensitized B-lymphocyte plasma cell. IgA has very low circulating levels and is responsible for preventing infection in the upper and lower respiratory tracts, and the gastrointestinal and genitourinary tracts. IgE has variable concentrations in the blood and is associated with antibody-mediated hypersensitivity reactions. IgG is heavily expressed on second and subsequent exposures to antigens to provide sustained, long-term immunity against invading microorganisms.
What is the function of a client's natural killer cells? A. Secrete immunoglobulins in response to the presence of a specific antigen B. Heighten selectively and destroy non-self cells, including virally infected cells C. Enhance immune activity through secretion of various factors, cytokines, and lymphokines D. Attack non-selectively on non-self cells, especially mutated and malignant cells
D Rationale Natural killer cells attack non-selectively on non-self cells, especially body cells that have undergone mutation and become malignant. Plasma cells secrete immunoglobulins in response to the presence of a specific antigen. Cytotoxic T-cells attack selectively and destroy non-self cells, including virally infected cells. Helper T-cells enhance immune activity through secretion of various factors, cytokines, and lymphokines.
A client with acquired immunodeficiency syndrome (AIDS) reports painless, white, raised lesions on the lateral aspect of the tongue. Which disease does the nurse suspect? A. Oral thrush B. Genital herpes C. Kaposi sarcoma D. Oral hairy leukoplakia
D Rationale Oral hairy leukoplakia is found in a client with AIDS. The symptoms of oral hairy leukoplakia are painless, white, raised lesions on the lateral aspect of the tongue. The symptoms of oral thrush are white lesions in the mouth. The symptoms of genital herpes are the presence of fluid-filled vesicles in the genital area. The symptoms of Kaposi's sarcoma are malignant vascular lesions on the skin.
Which parameter should the nurse consider while assessing the psychologic status of a client with acquired immune deficiency syndrome (AIDS)? A. Sleep pattern B. Severity of pain C. Cognitive changes D. Presence of anxiety
D Rationale Presence of anxiety should be considered while assessing the psychologic status of a client with AIDS. Sleep patterns and severity of pain are related to the assessment of activity and rest, a physical status. Cognitive changes are related to the assessment of neurologic status.
Which type of hypersensitivity reaction is present in a client with a body temperature of 102 °F, severe joint pain, rashes on the extremities, and enlarged lymph nodes from serum sickness? A. Delayed reaction B. Cytotoxic reaction C. Immediate reaction D. Immune complex-mediated reaction
D Rationale Serum sickness is a type III immune complex-mediated reaction. A delayed reaction is a type IV hypersensitivity reaction that may include poison ivy skin rashes, graft rejection, and sarcoidosis. A cytotoxic reaction is a type II hypersensitivity reaction that includes autoimmune hemolytic anemia, Goodpasture syndrome, and myasthenia gravis. An immediate reaction is a type I hypersensitive reaction that includes allergic asthma, hay fever, and anaphylaxis.
Which type of hypersensitivity reaction will occur when the client's T cytotoxic cells are involved as the mediators of injury? A. Type I B. Type II C. Type III D. Type IV
D Rationale Type IV hypersensitivity reaction will occur when the T cytotoxic cells are involved as the mediators of injury. Type I IgE-mediated reaction will occur when histamine is involved as the mediators of injury. Type II cytotoxic reaction will occur when complement lysis is the mediator of injury. Type III immune complex reaction will occur when neutrophils are involved as the mediators of injury.
The nurse is caring for four clients with hypersensitivity reactions. Which client should the nurse suspect to have a type IV hypersensitive reaction? (Antibody involved: Skin test results) A. IgE: Wheal and flare B. IgM: None C. IgG: Erythema after four hours D. None: Erythema and edema after 24 hours
D Rationale Type IV or delayed hypersensitive reactions are cell-mediated immune responses that involve T lymphocytes, not antibodies. These cause erythema and edema in client D within 24 to 48 hours after a skin test. Type I hypersensitivity reaction is known as an anaphylactic reaction mediated by IgE antibodies; it shows wheal and flare around the site of injection in client A. Type II hypersensitivity reactions are known as cytotoxic reactions that involve IgM and IgG antibodies and show no response to the skin test in client B. Type III hypersensitivity reactions are known as immune-complex reactions that involve IgG and IgM antibodies. These show erythema and edema after 3 to 8 hours of a skin test in client C.
A construction worker sustains a puncture from a rusty nail. It is unknown when the worker had the last immunization for tetanus, and the primary health care provider prescribes tetanus immune globulin. What protection does this type of immunization offer? A. Lifelong passive immunity B. Long-lasting active protection C. Stimulation of antibody production D. Immediate passive short-term immunity
D Rationale Tetanus immune globulin contains ready-made antibodies and confers short-term passive immunity. Passive immunity lasts a short time, not throughout life. Immune globulins confer passive artificial immunity, not long-lasting active immunity. Immune globulins are antibodies; they do not stimulate the production of antibodies.
After several years of unprotected sex, a client is diagnosed as having acquired immunodeficiency syndrome (AIDS). The client states, "I'm not worried because they have a cure for AIDS." What is the best response by the nurse? A. "Repeated phlebotomies may be able to rid you of the virus." B. "You may be cured of AIDS after prolonged pharmacologic therapy." C. "Perhaps you should have worn condoms to prevent contracting the virus." D. "There is no cure for AIDS, but there are drugs that can slow down the virus."
D Stating "There is no cure for AIDS, but there are drugs that can slow down the virus" is an honest response that corrects the client's misconception about the effectiveness of the current antiviral medications. Phlebotomy is not the treatment used to remove the virus from the client's body. Current pharmacologic treatment does not eliminate the virus from the body; it can slow its progress and may even effect a remission (although the medications are never discontinued), but there is no known cure. Stating "Perhaps you should have worn condoms to prevent contracting the virus" is a nontherapeutic, judgmental response that can alienate the client and precipitate feelings of guilt.
A nurse is reviewing the laboratory reports of four clients. Which client's laboratory report indicates acquired immunodeficiency syndrome (AIDS)? (CD4 Count: HIV disease) A. 750 cells/mm3: positive B. 550 cells/mm3: positive C. 175 cells/mm3: positive D. 450 cells/mm3: positive
c Rationale The diagnosis of AIDS requires that the person should be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm 3 (200 cells/uL) or less than 14% or an opportunistic infection. Therefore client 3, with a CD4+ T-cell count of less than 200 cells/mm 3 (200 cells/uL) and who is HIV positive, is having AIDS-defining illness. A healthy client usually has at least 800 to 1000 CD4+ T-cells per cubic millimeter (mm 3) of blood. This number is reduced in the client with HIV disease. Client 1, with a CD4+ T-cell count of 750 cells/mm 3 and HIV positive, does not have AIDS. Client 2, with a CD4+ T-cell count of 550 cells/mm 3 and HIV positive, does not have AIDS. Client 4, having a CD4+ T-cell count of 450 cells/mm 3 and HIV positive does not have AIDS.
