Patients With Immunodeficiency, HIV Infection, and AIDS

Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies a. develop early in life after protection from maternal antibodies decreases. b. occur most commonly in the aged population. c. develop as a result of treatment with antineoplastic agents. d. disappear with age.

a. develop early in life after protection from maternal antibodies decreases. These disorders may involve one or more components of the immune system. Primary immunodeficiencies are seen primarily in infants and young children. Primary immunodeficiencies are rare disorders with genetic origins. Without treatment, infants and children with these disorders seldom survive to adulthood.

What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? a. Bone marrow transplantation b. Antibiotics c. Radiation therapy d. Removal of the thymus gland

a. Bone marrow transplantation Treatment options for SCID include stem cell and bone marrow transplantation.

The nursing instructor is going over laboratory results for patients with HIV/AIDS. The instructor tells the students that, upon interpretation of a patient's laboratory results, the nurse should recognize that a patient with HIV is considered to have AIDS when the CD4 T-lymphocyte cell count drops below what level? a. 200 cells/mm3 of blood b. 300 cells/mm3 of blood c. 400 cells/mm3 of blood d. 500 cells/mm3 of blood

a. 200 cells/mm3 of blood When CD4 T cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS. Patients with CD4 T-cell levels greater than 200 cells/mm3 of blood are considered to have HIV.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? a. CD4+ counts b. HIV RNA c. Western blotting assay d. ELISA

a. CD4+ counts The most important consideration in decisions to initiate antiretroviral therapy is CD4+ counts.

The clinic nurse is caring for a patient who has a longstanding diagnosis of HIV. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what? a. HIV encephalopathy b. B-cell lymphoma c. Kaposi's syndrome d. Wasting syndrome

a. HIV encephalopathy HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions.

What does the nurse understand will result if the patient has a deficiency in the normal level of complement? a. Increased susceptibility to infection b. Decrease in vascularity to the extremities c. Development of congestive heart failure d. Risk of stroke

a. Increased susceptibility to infection The complement system is an integral part of the immune system, and deficiencies in normal levels of complement result in increased susceptibility to infectious diseases and immune-mediated disorders.

HIV is harbored within which type of cell? a. Lymphocyte b. Platelet c. Erythrocyte d. Nerve

a. Lymphocyte Because HIV is harbored within lymphocytes, a type of white blood cell, any exposure to infected blood results in significant risk of infection. HIV infection is not harbored in platelets, erythrocytes, or nerve cells.

The nurse teaches the client that reducing the viral load will have what effect? a. Shorter time to AIDS diagnosis b. Longer survival c. Shorter survival d. Longer immunity

b. Longer survival The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

A nurse is assessing a client with a primary immunodeficiency. Afterward the nurse documents that the client displayed ataxia. The nurse makes this documentation because the client has a. vascular lesions caused by dilated blood vessels. b. an inability to understand the spoken word. c. uncoordinated muscle movements. d. difficulty swallowing.

c. uncoordinated muscle movements. Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination).

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: a. alcohol. b. applying skin moisturizers. c. seafood. d. exposure to sunlight.

a. alcohol. The nurse should advise a client taking antihistamines not to take it with alcohol or other central nervous system depressants because additive sedative effects can occur.

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is a. Malnutrition b. Neutropenia c. Hypocalcemia d. Chronic diarrhea

a. Malnutrition The most prevalent cause of immunodeficiency worldwide is severe malnutrition.

A nurse practitioner who works in an inner-city health clinic would recommend HIV testing to the patient who is most likely to have a diagnosis of HIV. Which of the following is most likely to have this diagnosis? a. African American gay man b. African American woman who is recently divorced c. Caucasian woman with multiple heterogeneous sex partners d. Hispanic woman who is bisexual

a. African American gay man Using common statistics and the risk factors of race/ethnicity and sex, 49% of those with HIV are African Americans. Men who have sex with other men have a disproportionately high incidence. The rate for African American women is 20 times that of Caucasian women.

The nurse is caring for a client whose most recent laboratory values reveal a neutrophil level of 21,000 mm3. When preparing to assess the client, the nurse should prioritize what assessment? a. Assessing the client for signs and symptoms of infection b. Assessing the client's activity level and functional status c. Assessing the client for indications of internal or external hemorrhage d. Assessing the client for signs of venous thromboembolism

a. Assessing the client for signs and symptoms of infection Normal neutrophil levels range from 3,000 to 7,000 mm3. Levels rise in response to infection, so the nurse should monitor the client closely for signs and symptoms of infection. Increased neutrophil levels do not normally affect coagulation or energy levels.

A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? a. Avoid fibrous foods, lactose, fat, and caffeine. b. Consume large, high-fat meals. c. Reduce food intake. d. Increase intake of iron and zinc.

a. Avoid fibrous foods, lactose, fat, and caffeine. Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

Nursing students are reviewing information about the various types of primary immunodeficiencies. The students demonstrate understanding of the material when they identify which of the following as an example of a primary immunodeficiency involving B-lymphocyte dysfunction? a. CVID b. Ataxia-telangiectasia c. Wiskott-Aldrich syndrome d. Hyperimmunoglobulinemia E syndrome

a. CVID CVID is an example of B-cell deficiency that results from a lack of differentiation of B cells into plasma cells. Ataxia-telangiectasia and Wiskott-Aldrich syndrome are examples of combined B- and T-lymphocyte dysfunction. Hyperimmunoglobulin E syndrome is an example of a primary immunodeficiency involving platelet dysfunction.

Which of the following is the first barrier method that can be controlled by the woman? a. Female condom b. IUD c. Diaphragm d. Birth control pills

a. Female condom The female condom has the distinction of being the first barrier method that can be controlled by the woman. The IUD may increase the risk for HIV transmission through an inflammatory foreign body response. The female condom is as effective in preventing pregnancy as other barrier methods, such as the diaphragm and the male condom. Birth control pills are not a barrier method.

When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? a. The body has not produced antibodies to the AIDS virus. b. The client has not been infected with HIV. c. The client is immune to the AIDS virus. d. Antibodies to the AIDS virus are in the client's blood.

a. The body has not produced antibodies to the AIDS virus. A negative test result indicates that antibodies to the AIDS virus are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that, if infected, the body has not produced antibodies (which takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk client must be encouraged. The test result does not mean that the client is immune to the virus, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? a. Anorexia b. Chronic diarrhea c. Nausea and vomiting d. Oral candida

b. Chronic diarrhea Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (AIDS) can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: a. Anorexia. b. Chronic diarrhea. c. Nausea and vomiting. d. Oral candida.

b. Chronic diarrhea. Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

Which of the following would a nurse be least likely to identify as a cause of secondary immunodeficiency? a. Burns b. Genetics c. Chronic stress d. Diabetes

b. Genetics Genetics most likely would be a cause of primary immunodeficiency. Burns, chronic stress, and diabetes are associated causes of secondary immunodeficiency.

A nurse was administering a scheduled subcutaneous dose of heparin to a patient who has HIV when the needle penetrated the nurse's thumb. What prophylactic action should the nurse first take? a. Apply negative pressure to the wound site using suction tubing. b. Perform a thorough wash of the injury site with soap and water. c. Apply chlorhexidine to the wound site and to all the skin in a 3-inch radius. d. Maintain the hand in a dependent position.

b. Perform a thorough wash of the injury site with soap and water. If a nurse sustains a puncture injury, such as a needle stick, he or she should immediately wash the area thoroughly with soap and water. Negative pressure, disinfectants, and dependent positioning are not components of accepted postexposure prophylactic practices.

A client with human immunodeficiency virus (HIV) develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this client? a. Mycobacterium avium complex (MAC) b. Pneumocystis pneumonia c. Tuberculosis d. Community-acquired pneumonia

b. Pneumocystis pneumonia The most common life-threatening infection in those living with acquired immune deficiency syndrome (AIDS) is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly P. carinii) (Durham & Lashley, 2010). Without prophylactic therapy, most people infected with HIV will develop PCP. The clinical presentation of PCP in HIV infection is generally less acute than in people who are immunosuppressed as a result of other conditions. Clients with HIV infection initially develop nonspecific signs and symptoms, such as nonproductive cough, fever, chills, shortness of breath, dyspnea, and occasionally chest pain. Arterial oxygen concentrations in clients who are breathing room air may be mildly decreased, indicating minimal hypoxemia.

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? a. Depression, memory impairment, and coma b. Respiratory or urinary system infections c. Rheumatoid arthritis d. Cardiac dysrhythmias and heart failure

b. Respiratory or urinary system infections Secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. Abnormalities of the immune system affect both natural and acquired immunity. Because immunodeficiencies result in a compromised immune system and pose a high risk for infection, careful assessment of the client's immune status is essential. The nurse assesses and monitors the client for signs and symptoms of infection.

Kaposi sarcoma (KS) is diagnosed through a. skin scraping. b. biopsy. c. visual assessment. d. computed tomography.

b. biopsy. KS is diagnosed by biopsy of the suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count.

Kaposi sarcoma (KS) is diagnosed through a. skin scraping. b. biopsy. c. visual assessment. d. computed tomography.

b. biopsy. KS is diagnosed through biopsy of the suspected lesions. Visual assessment will not confirm a diagnosis. A computed tomography scan will not assist in determining skin cell changes. Skin scraping is a procedure to collect cells, not to evaluate cells.

The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed? a. "I will let my neighbor have my pet iguana." b. "I will apply lotion following every bath to prevent dry skin." c. "I can take my child to the beach, as long as we play in the sand rather than swim in the water." d. "I will avoid letting my child drink any juice that has been sitting out for more than an hour."

c. "I can take my child to the beach, as long as we play in the sand rather than swim in the water." Parents should verbalize ways to plan for regular exercise and activity that does not pose a risk of infections. Immunocompromised clients should avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses, including the steps in the process of HIV entering the host cell. What would the nurse describe as the first step? a. Cleavage b. Budding c. Attachment d. Uncoating

c. Attachment Once HIV enters the host cell, attachment occurs in which the glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors. This is followed by uncoating, in which HIV's viral core is emptied into the CD4+ T cell. Cleavage and budding occur as the last steps.

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? a. Urine specific gravity of 1.010 b. Hypernatremia c. Hypokalemia d. Proteinuria

c. Hypokalemia Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

Which nursing action is essential before an EIA test is performed? a. Performing Western blotting b. Performing a polymerase chain reaction test c. Obtaining a general consent for medical care from the client d. Obtaining a written consent from the client

c. Obtaining a general consent for medical care from the client Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Western blotting is performed if the results of an EIA test are positive. A polymerase chain reaction test, which measures viral loads, is used if a positive diagnosis is confirmed.

The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? a. The use of condoms b. What vaccinations to have c. Side effects of drug therapy d. The action of each antiretroviral drug

c. Side effects of drug therapy Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

A hospital educator is reiterating the importance of Standard Precautions to a group of nursing students who will soon begin a clinical rotation on the unit. Which of the following statements best describes the application of Standard Precautions? a. Standard Precautions should be used when providing care for any patient who has a white blood cell (WBC) count of 10.8 × 109/L or greater. b. Standard Precautions should be applied in the care of any patient who has an actual or suspected primary or secondary immunodeficiency. c. Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. d. Standard Precautions should be used in the care of any patient whose diagnosis is attributable to an infectious process.

c. Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. Standard Precautions incorporate the major features of Universal Precautions (designed to reduce the risk of transmission of bloodborne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances); they are applied to all patients in health care facilities regardless of their diagnosis or presumed infectious status.

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? a. Urine specimen for culture and sensitivity b. Blood specimen for electrolyte studies c. Stool specimen for ova and parasites d. Sputum specimen for acid fast bacillus

c. Stool specimen for ova and parasites A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? a. Reverse the HIV+ status to a negative status. b. Treat mycobacterium avium complex. c. Eliminate the risk of AIDS. d. Bring the viral load to a virtually undetectable level

d. Bring the viral load to a virtually undetectable level The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.

Which blood test confirms the presence of antibodies to HIV? a. Erythrocyte sedimentation rate (ESR) b. p24 antigen c. Reverse transcriptase d. Enzyme immunoassay (EIA)

d. Enzyme immunoassay (EIA) EIA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA.

The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? a. Cytomegalovirus b. Legionnaire's disease c. Mycobacterium tuberculosis d. Pneumocystis pneumonia

d. Pneumocystis pneumonia Pneumocystic pneumonia (PCP) is one of the first and most common opportunistic infections associated with AIDS. It may be present despite the absence of crackles. If untreated, PCP progresses to cause significant pulmonary impairment and respiratory failure.

Which statement reflects treatment of HIV infection? a. Treatment should be offered to all clients once they reach CDC category B: HIV symptomatic. b. Treatment should be offered to only select clients once they reach CDC category B: HIV symptomatic. c. Treatment should be offered to clients with plasma HIV RNA levels less than 55,000 copies/mL (RT-PCR assay). d. Treatment of HIV infection for an individual client is based on the client's clinical condition, CD4 T cell count, and HIV RNA (viral load).

d. Treatment of HIV infection for an individual client is based on the client's clinical condition, CD4 T cell count, and HIV RNA (viral load). Although specific therapies vary, treatment of HIV infection for an individual client is based on three factors: the patient's clinical condition, CD4 T cell count, and HIV RNA (viral load). Treatment should be offered to all clients with the primary infection (acute HIV syndrome). In general, treatment should be offered to clients with fewer than 350 CD4+ T cells/mm or plasma HIV RNA levels exceeding 55,000 copies/mL (RT-PCR assay).