Saunders: HIV and AIDS
The nurse has been assigned to care for a client with an immune disorder. In developing a plan of care for this client, the nurse incorporates knowledge that the immune system consists of specific major types of cells. Which types of cells are associated with the immune system? Select all that apply. - Dendritic cells - B lymphocytes - Red blood cells - Helper T lymphocytes - Cytolytic T lymphocytes
- Dendritic cells - B lymphocytes - Helper T lymphocytes - Cytolytic T lymphocytes Immunity is composed of many cell functions that protect against the effects of injury or invasion. The immune system has 5 major types of cells: dendritic cells, B lymphocytes or B cells, helper T lymphocytes or CD4+ cells, cytolytic T lymphocytes or CD8+ cells, and macrophages.
The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understands that this has been confirmed by which finding? - Swelling in the genital area - Swelling in the lower extremities - Positive punch biopsy of the cutaneous lesions - Appearance of reddish-blue lesions noted on the skin
Positive punch biopsy of the cutaneous lesions Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis through the upper body and then to the face and oral mucosa. They can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions.
The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? - Protecting the client from infection - Providing emotional support to decrease fear - Encouraging discussion about lifestyle changes - Identifying factors that decreased the immune function
Protecting the client from infection The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options 2, 3, and 4 may be components of care but are not the priority.
A client with acquired immunodeficiency syndrome (AIDS) is experiencing nausea and vomiting. The nurse should include which measure in the dietary plan? - Provide large, nutritious meals. - Serve foods while they are hot. - Add spices to food for added flavor. - Remove dairy products and red meat from the meal.
Remove dairy products and red meat from the meal. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The client with AIDS who has nausea and vomiting should avoid fatty products such as dairy products and red meat. Meals should be small and frequent to lessen the chance of vomiting. The client should avoid spices and odorous foods because they aggravate nausea. Foods are best tolerated cold or at room temperature.
A CD4+ lymphocyte count is performed in a client with human immunodeficiency virus (HIV) infection. When providing education about the testing, what should the nurse tell the client? - "It establishes the stage of HIV infection." - "It confirms the presence of HIV infection." - "It identifies the cell-associated proviral DNA." - "It determines the presence of HIV antibodies in the bloodstream."
"It establishes the stage of HIV infection." Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A CD4+ lymphocyte count is performed to establish the stage of HIV infection, to help with decisions regarding the timing of initiation of antiretroviral therapy and prophylaxis for opportunistic infections, and to monitor treatment effectiveness. The remaining options are unrelated to the CD4+ lymphocyte count.
A client has requested and undergone testing for human immunodeficiency virus (HIV) infection. The client asks what will be done next because the result of the enzyme-linked immunosorbent assay (ELISA) has been positive. Which diagnostic study should the nurse be aware of before responding to the client? - No further diagnostic studies are needed. - A Western blot will be done to confirm these findings. - The client probably will have a bone marrow biopsy done. - A CD4+ cell count will be done to measure T helper lymphocytes.
A Western blot will be done to confirm these findings. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. If the result of the ELISA is positive, the Western blot is done to confirm the findings. If the result of the Western blot is positive, the client is considered to be seropositive for the infection and to be infected with the virus. The remaining options are incorrect.
A client reports to the health care clinic for testing for human immunodeficiency virus (HIV) immediately after being exposed to HIV. The test results are negative, and the client expresses relief about not contracting HIV. What should the nurse emphasize when explaining the test results to the client? - No further testing is needed. - The test should be repeated in 1 month. - A negative HIV test result is considered accurate. - A negative HIV test result is not considered accurate immediately after exposure.
A negative HIV test result is not considered accurate immediately after exposure. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A test for HIV should be repeated if results are negative. Seroconversion is the point at which antibodies appear in the blood. The average time for seroconversion is 2 months, with a range of 2 to 10 months. For this reason, a negative HIV test result is not considered accurate immediately after exposure. The remaining options are incorrect.
A client with acquired immunodeficiency syndrome has been started on therapy with zidovudine. The nurse assesses the complete blood cell (CBC) count, knowing that which is an adverse effect of this medication? - Polycythemia - Leukocytosis - Thrombocytosis - Agranulocytopenia
Agranulocytopenia Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a neucloside-nucleotide reverse transcriptase inhibitor used to the virus. An adverse effect of this medication is agranulocytopenia with anemia. The nurse carefully monitors CBC count results for changes that could indicate this occurrence. With early infection in the client who is asymptomatic, the CBC count is monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, the CBC count is monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The remaining options are not side or adverse effects of the medication.
A client with acquired immunodeficiency syndrome (AIDS) is receiving didanosine. When the nurse reviews the client's laboratory test results, which result should be most closely monitored? - Protein - Glucose - Amylase - Cholesterol
Amylase Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Didanosine is toxic to the pancreas and the liver. A serum amylase level that is increased by 1.5 to 2 times normal may signify pancreatitis and may be fatal in the client with AIDS. Therefore, the nurse should monitor the results of amylase and liver function studies closely. Alterations in protein, glucose, and cholesterol levels are unrelated to this medication.
The nurse is assigned to care for a client with acquired immunodeficiency syndrome (AIDS) suspected of having Kaposi's sarcoma. The nurse should prepare the client for which test to confirm this diagnosis? - Biopsy - Blood culture - Computerized tomography - Magnetic resonance imaging
Biopsy Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Kaposi's sarcoma is the most common AIDS-related malignancy. It manifests as small purplish brown, raised lesions if they occur on the skin. Dyspnea occurs if they occur in the lungs. Lymph node swelling occurs if they are located in the lymph nodes. Kaposi's sarcoma also can occur in the gastrointestinal (GI) tract and manifests as an altered bowel pattern, including diarrhea or constipation. Chest x-ray, bronchoscopy, upper GI exam, colonoscopy, and computed tomography scan may be used to aid the diagnosis, but whether Kaposi's sarcoma manifests as a skin lesion or in the lungs or GI tract, the diagnosis is confirmed with a biopsy.
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has begun to experience multiple opportunistic infections. Which laboratory test would be most helpful in assessing the client's need for reassessment of treatment? - Western blot - B lymphocyte count - CD4+ cell or T lymphocyte count - Enzyme-linked immunosorbent assay (ELISA)
CD4+ cell or T lymphocyte count Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The T lymphocyte or CD4+ cell count indicates whether the client is responding to the medication treatment. The count should increase if the client is responding and should decrease if the client's response is poor. The Western blot and ELISA are tests to assist in diagnosing human immunodeficiency virus infection. The B lymphocyte count is not a priority marker to monitor with AIDS clients.
The nurse is caring for a client with acquired immunodeficiency syndrome and detects early infection with Pneumocystis jiroveci by monitoring the client for which clinical manifestation? - Fever - Cough - Dyspnea at rest - Dyspnea on exertion
Cough Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. The client with P. jiroveci infection usually has a cough as the first sign. The cough begins as nonproductive and then progresses to productive. Later signs and symptoms include fever, dyspnea on exertion, and finally dyspnea at rest.
A client with acquired immunodeficiency syndrome (AIDS) is receiving ganciclovir. The nurse should take which priority action in caring for this client? - Monitor for signs of hyperglycemia. - Administer the medication without food. - Administer the medication with an antacid. - Ensure that the client uses an electric razor for shaving.
Ensure that the client uses an electric razor for shaving. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Because ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects, the nurse monitors for signs and symptoms of bleeding and implements the same precautions as for a client receiving anticoagulant therapy. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach or without food and should not be taken with an antacid.
The nurse is assigned to care for a client with human immunodeficiency virus (HIV) infection. The nurse reviews the client's health care record and notes documentation of toxoplasmosis encephalitis. On the basis of this information, the nurse would assess for which manifestation? - Lesions on the skin - Mental status changes - Changes in bowel pattern - Lesions on the oral mucosa
Mental status changes Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Toxoplasmosis encephalitis, caused by Toxoplasma gondii, is acquired through contact with contaminated cat feces or by ingesting infected, undercooked meat. It manifests with signs and symptoms such as an altered mental status, neurological deficits, headaches, and fever. Additional manifestations include difficulties with speech, gait, and vision; and seizures. The other options are not associated with toxoplasmosis.
The nurse is assigned to care for a client with human immunodeficiency virus (HIV) infection. The nurse notes recent documentation of herpes simplex in the client's medical record. On assessment, the nurse would expect to note which type of lesion? - Macular lesions - Ecchymotic lesions - Creamy white patches - Vesicular lesions that rupture
Vesicular lesions that rupture Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. HSV in people with HIV or acquired immunodeficiency syndrome (AIDS) occurs in the perirectal, oral, and genital areas. Numbness of tingling at the site of infection occurs up to 24 hours before blisters form. Lesions are painful, with chronic open areas after blisters rupture. The nurse should assess for fever, pain, bleeding, and enlarged lymph nodes in the affected area. The nurse should also assess for headache, myalgia, and malaise. The other options are not characteristic of herpesvirus infection.
A client with human immunodeficiency virus (HIV) infection is diagnosed with herpes simplex virus (HSV). The nurse should prepare the client for which diagnostic test to determine the presence of herpes virus infection? - Chest x-ray - Viral culture - Stool culture - Neurological exam
Viral culture Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. HSV in people with HIV or acquired immunodeficiency syndrome (AIDS) occurs in the perirectal, oral, and genital areas. Numbness of tingling at the site of infection occurs up to 24 hours before blisters form. Lesions are painful, with chronic open areas after blisters rupture. Diagnostic tests for herpes simplex include a viral culture and gross examination. The tests in the other options will not diagnosis herpes simplex.
The nurse works with high-risk clients in an urban outpatient setting. Which groups should be tested for human immunodeficiency virus (HIV)? Select all that apply. - Injection drug abusers - Prostitutes and their clients. - People with sexually transmitted infections (STIs) - People who have had frequent episodes of pneumonia - People who recently received a blood transfusion for a surgical procedure
- Injection drug abusers - Prostitutes and their clients - People with sexually transmitted infections (STIs) Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Injection drug abusers, those engaged in prostitution, and people with STIs are high-risk groups that should be tested for HIV per the Centers for Disease Control and Prevention's recommendations. Those who have had frequent episodes of pneumonia and those who recently received a blood transfusion for a surgical procedure are not at risk for HIV unless another compounding factor places them at risk. However, if a blood transfusion was received between 1978 and 1985, the client should be tested.
A CD4 T-cell count is measured in a client newly diagnosed with human immunodeficiency virus (HIV). In planning care, the nurse understands that which is accurate regarding the CD4 T-cell count? Select all that apply. - Falls in response to a declining viral load - Is a primary marker of immunocompetence - Plays a role in the cell-mediated immune response - Is a direct measure of the magnitude of HIV replication - Guides decision making regarding timing of initiation of treatment
- Is a primary marker of immunocompetence - Plays a role in the cell-mediated immune response - Guides decision making regarding timing of initiation of treatment Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. CD4 T-cells are a subgroup of lymphocytes that play an important role in the cell-mediated immune response; as such, CD4 T-cells are a primary marker of immunocompetence. Viral load is the direct measure of the magnitude of HIV replication. The CD4 T-cell count rises in response to a declining viral load. CD4 T-cell counts also guide decision making regarding initiation of treatment, when to change medications when treatment is failing, and the need for initiation of treatment against opportunistic infections.
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing interventions would be helpful in managing this symptom? Select all that apply. - Keep liquids at the bedside. - Place a towel over the pillowcase. - Make sure the pillow has a plastic cover. - Keep a change of bed linens nearby in case they are needed. - Administer an antipyretic after the client has a spike in temperature.
- Keep liquids at the bedside. - Place a towel over the pillowcase. - Make sure the pillow has a plastic cover. - Keep a change of bed linens nearby in case they are needed. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. For clients with AIDS who experience night fever and night sweats, the nurse may offer the client an antipyretic of choice before the client goes to sleep rather than waiting until the client spikes a temperature. Keeping a change of bed linens and night clothes nearby for use also is helpful. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if diaphoresis is profuse. The client should have liquids at the bedside to drink.
A client asks the nurse about obtaining a home test kit to test for human immunodeficiency virus (HIV) status. What should the nurse tell the client? - Home test kits are not available for testing at this time. - Home test kits may not be as reliable as laboratory blood tests. - Home test kits are most reliable immediately after a risk event occurs. - Home test kits should not be used; rather, it is important to contact the primary health care provider (PHCP) with concerns about the HIV status.
Home test kits may not be as reliable as laboratory blood tests. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Should a client wish to know his or her HIV status, testing is available from a PHCP or a local public health clinic, or a home test kit can be used. Some test kits may not be as reliable as a laboratory blood test. It is also recommended that a home test be performed at least 3 months after a risk event occurs. If a positive result on a home test occurs, then the individual requires additional testing.
The nurse is preparing to care for a client with immunodeficiency. The nurse should plan to address which problem as the priority? - Anxiety - Fatigue - Risk for infection - Need for social isolation
Risk for infection The client with immunodeficiency has inadequate or no immune bodies and is at risk for infection. The priority concern would be risk for infection. The question presents no data indicating that the client is experiencing anxiety. Fatigue may be a problem and the client may need to be placed on protective isolation, but these are not the priority problems for this client. Infection can be life-threatening and is the priority.
A client with acquired immunodeficiency syndrome (AIDS) is experiencing fatigue. The nurse should plan to teach the client which strategy to conserve energy after discharge from the hospital? - Bathe before eating breakfast. - Sit for as many activities as possible. - Stand in the shower instead of taking a bath. - Group all tasks to be performed early in the morning.
Sit for as many activities as possible. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The client is taught to conserve energy by sitting for as many activities as possible, including dressing, shaving, preparing food, and ironing. The client also should sit in a shower chair instead of standing while bathing. The client needs to prioritize activities, such as eating breakfast before bathing, and should intersperse each major activity with a period of rest.
The nurse is caring for a client with human immunodeficiency virus (HIV) infection and notes a diagnosis of cryptococcosis in the client's medical record. The nurse understands that this opportunistic infection most likely was diagnosed by which test? - Skin biopsy - Viral culture - Sputum culture - Bone marrow biopsy
Sputum culture Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Cryptococcosis is a fungal infection caused by Cryptococcus neoformans. It usually affects the lungs and central nervous system (brain and spinal cord), but it can also affect other parts of the body. Symptoms of lung involvement include cough, shortness of breath, chest pain, and fever. When it spreads to the brain, manifestations include headache, fever, neck pain, nausea and vomiting, sensitivity to light, confusion, or changes in behavior. Diagnostic tests to confirm its presence in the lungs include chest x-ray studies and a sputum culture.
A client with human immunodeficiency virus (HIV) infection has a fever, and histoplasmosis is suspected. The nurse should prepare the client for which diagnostic test to confirm the presence of histoplasmosis? - Skin biopsy - Sputum culture - Western blot test - Upper gastrointestinal series
Sputum culture Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Histoplasmosis is an opportunistic infection that affects the lungs and can occur in the client with HIV infection. Diagnostic tests include chest x-ray, sputum culture, lung biopsy, and bronchoscopy. The other options are incorrect. A Western blot test is used to confirm a diagnosis of HIV. A skin biopsy may be done if the client had Kaposi's sarcoma. Gastrointestinal series are done for a client suspected to have a gastrointestinal disorder.
A client with human immunodeficiency virus infection has signs and symptoms of cryptosporidiosis. The nurse should prepare the client for which test that will assist in confirming the diagnosis? - Stool culture - Bronchoscopy - Sputum culture - Chest x-ray study
Stool culture Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Cryptosporidiosis is an intestinal infection caused by Cryptosporidium organisms. The client with cryptosporidiosis will present with signs and symptoms of watery diarrhea, flatus, abdominal distention, pain, and fever. It is important for the nurse to monitor for an electrolyte imbalance. Diagnostic tests include a stool culture with a bowel biopsy. The other options are incorrect.
A client with acquired immunodeficiency syndrome (AIDS) has a concurrent diagnosis of histoplasmosis. During the assessment, the nurse notes that the client has enlarged lymph nodes. How should the nurse interpret this assessment finding? - The histoplasmosis is resolving. - The client has disseminated histoplasmosis infection. - This is a side effect of the medications given to treat AIDS. - The client probably has another infection that is developing.
The client has disseminated histoplasmosis infection. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Histoplasmosis is caused by Histoplasma capsulatum and usually starts as a respiratory infection in the client with AIDS and then becomes a disseminated infection, with enlargement of lymph nodes, spleen, and liver. The client experiences dyspnea, fever, cough, and weight loss. The remaining options are incorrect.
A client with acquired immunodeficiency syndrome (AIDS) has a respiratory infection from Pneumocystis jiroveci and has been experiencing difficulty breathing and resultant problems with gas exchange. Which finding indicates that the expected outcome of care has yet to be achieved? - The client limits fluid intake. - The client has clear breath sounds. - The client expectorates secretions easily. - The client is free of complaints of shortness of breath.
The client limits fluid intake. Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. The status of the client with a problem concerning gas exchange would be evaluated against the standard outcome criteria for a P. jiroveci infection. These would include options 2, 3, and 4 where breath sounds are clear, the nurse notes that secretions are being coughed up effectively, and the client states that breathing is easier. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.
A client is tested for human immunodeficiency virus (HIV) infection with an enzyme-linked immunosorbent assay (ELISA), and the test result is positive. What should the nurse tell the client? - HIV infection has been confirmed. - The client probably has a gastrointestinal infection. - The test will need to be confirmed with a Western blot. - A positive test result is normal and does not mean that the client has acquired HIV.
The test will need to be confirmed with a Western blot. Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A negative result on an ELISA indicates that infection is absent or that not enough time has passed since exposure for seroconversion. A positive ELISA result must be confirmed with a Western blot. The other options are incorrect.
The nurse reviews the record of a client with acquired immunodeficiency syndrome (AIDS) and notes that the client has a diagnosis of Candida. When performing history-taking and assessment, which finding should the nurse anticipate? - Hyperactive bowel sounds - Complaints of watery diarrhea - Red lesions on the upper arms - Yellowish-white, curd-like patches in the oral cavity
Yellowish-white, curd-like patches in the oral cavity Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Candidiasis is caused by Candida albicans, which is a part of the intestinal tract's natural flora. Fungal infection occurs by overgrowth of normal body flora. In a person with AIDS, candidiasis (overgrowth of the Candida fungus) occurs because the immune system can no longer control fungal growth. Candida stomatitis or esophagitis occurs often in AIDS. On examination of the mouth and throat, the nurse would note cottage cheese-like, yellowish white plaques and inflammation. The remaining options are not findings in this disorder.