scarlett ch 36
The lower the client's viral load,
the longer the survival time. Explanation: The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretrovial therapy is to achieve and maintain durable viral suppression.
Which client is more at risk of becoming infected with human immunodeficiency virus (HIV)?
A person having casual intercourse with multiple partners Explanation: People who have casual intercourse with multiple partners are at a greater risk of acquiring HIV. Women who have never had intercourse are at the least risk because HIV spreads through body fluids, such as semen, vaginal secretions, and blood. The risks of women who have had deliveries after the age of 40 or men who use sildenafil (Viagra) before having intercourse are yet to be established.
A client with acquired immunodeficiency syndrome is admitted with Pneumocystis carinii pneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse do?
Listen and show interest as the client expresses feelings. Explanation: The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only after further assessment. Stating that the client's friends aren't true friends would discount the client's feelings.
A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?
Nausea and vomiting Explanation: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and pruritus are less common adverse effects.
A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care?
The client can state that he is at his home. Explanation: The most appropriate outcome for the nursing diagnosis would be that the client can state that he is in his home, which indicates that he is aware of his surroundings and location. Remaining free of injury when out of bed would be appropriate if the nursing diagnosis was risk for injury. Nodding by the client may or may not indicate that the client understands instructions. Although engaging in diversional activities would help the client focus, it would be a more appropriate outcome for social isolation or deficient diversional activity.
When preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home, the nurse should be sure to include which instruction?
"Avoid sharing such articles as toothbrushes and razors." Explanation: The human immunodeficiency virus (HIV), which causes AIDS, is most concentrated in the blood. For this reason, the client shouldn't share personal articles that may be blood-contaminated, such as toothbrushes and razors, with other family members. HIV isn't transmitted by bathing or by eating from plates, utensils, or serving dishes used by a person with AIDS.
A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate?
"Although AIDS is an immune deficiency, your child's condition is different from AIDS." Explanation: Primary immune deficiencies should be not be confused with AIDS. They are not the same condition. In addition, a primary immune disorder does not increase the child's risk for developing AIDS later in life. Primary immune deficiency diseases are serious, but they are rarely fatal and can be controlled. Testing will reveal the evidence of a primary immune disease, not AIDS. AIDS is classified as a seconary immunodeficiency.
A client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate?
"Your body may not have developed antibodies yet, so we need to follow up." Explanation: A negative test result means that antibodies to HIV are not in the blood at this time. The person may not be infected or the person's body may not yet have produced antibodies. (The "window" period is 3 weeks to 6 months). The client needs follow-up testing and must continue to take precautions. The negative test result does not mean that the client is immune to HIV, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet.
A client with acquired immune deficiency syndrome (AIDS) comes to the clinic reporting difficulty swallowing. The client says, "It hurts so much when I swallow." Inspection reveals creamy white patches in the client's mouth. What will the nurse suspect?
Candidiasis Explanation: The client's complaints and physical examination suggest oral candidiasis. Wasting syndrome involves involuntary weight loss greater than 10% of the client's baseline body weight and either chronic diarrhea for more than 10 days or chronic weakness and documented intermittent or constant fever in the absence of any concurrent illness that could explain these findings. Cryptococcus neoformans is a fungal infection that affects the neurologic system. Clostridium difficile is a common cause of chronic diarrhea in clients with AIDS.
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?
Chronic diarrhea Explanation: 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.
A client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?
Enzyme-linked immunosorbent assay (ELISA) Explanation: The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. If the ELISA is positive twice then the Western Blot test is run. A CBC and a Schick test are not screening tests for HIV.
Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV?
Gay, bisexual, and other men who have sex with men Explanation: Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 63% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.
The nurse care plan for a client with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care?
Keep the client's bed linens free of wrinkles. Explanation: Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding tight or restrictive clothing. Fluid intake should be adequate, and must be monitored, but maximizing fluid intake is not a goal. TPN is a nutritional intervention of last resort.
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS?
Liquids Explanation: The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.
The nurse is aware that the most prevalent cause of immunodeficiency worldwide is
Malnutrition Explanation: The most prevalent cause of immunodeficiency worldwide is severe malnutrition.
Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?
Primary infection Explanation: A result between 500 and 1500 CD4+ T lymphocytes/mm3 indicates CDC stage 1.
A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention?
Teach the client guided imagery. Explanation: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other clients this may exacerbate feelings of anxiety or loss. Granting the client control has the potential to reduce anxiety, but the client is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.
