Chapter 37: Immunodeficiency, HIV, & AIDS

When assisting the client to interpret a negative HIV test result, the nurse informs the client that the results mean that: a. the client is immune to the AIDS virus b. the body has not produced antibodies to the AIDS virus c. antibodies to the AIDS virus are in his blood d. the client has not been infected with HIV

b. the body has not produced antibodies to the AIDS virus rationale: a negative test result indicates at the time of blood sample, antibodies were not present in blood. A negative test does NOT mean the patient has not been infected with AIDS. The body takes 3 weeks to 6 months or longer to produce antibodies. Therefore, more testing is needed.

The nurse is seeing clients at a drop-in primary health clinic. Which client does the nurse teach about the risks of acquiring HIV? a. Middle-aged woman with a new sexual partner b. Young male who has male sexual partners c. All clients who come to the clinic d. Young woman having her first gynecologic examination

c. All clients who come to the clinic All sexually active people should know their HIV status, and all people need to have education on their risk of acquiring HIV infection. Anyone who engages in sexual activity has some risk.

The nurse is caring for a client who is HIV positive. The client has become confused over the course of the shift, and the client's pupils are no longer reacting to light equally. The nurse anticipates an order for which medication? a. Prednisone (Deltazone) b.Trimethoprim/sulfamethoxazole (Bactrim) c. Pentamidine isethionate (Pentam) d.Ketoconazole (Nizoral)

a. Prednisone (Deltazone) Confusion and changes in pupillary assessment in an HIV-positive client indicate increased intracranial pressure (ICP). Increased ICP in these clients is managed with corticosteroids like prednisone. Bactrim is an antibiotic, Pentam is an antiprotozoal, and Nizoral is an antifungal medication.

When do most perinatal infections occur? a. in utero b. through breastfeeding c. through casual contact d. after exposure during delivery

after exposure during delivery rationale: mother to child transmission of HIV-1 may occur in utero or through breastfeeding. However, most perinatal infections are thought to occur AFTER exposure during DELIVERY.

A client verbalizes a fear of contracting HIV because she has a history of intravenous substance abuse. What instructions does the nurse provide to the client to help minimize this risk? a. "Boil all needles and syringes for at least 20 minutes before using them again and be sure not to share them." b. "Rinse used needles and syringes with water followed by laundry bleach after using them." c. "Rinse used needles and syringes with rubbing alcohol before and after using them." d. "Run all needles and syringes through the dishwasher with an extra rinse cycle before using them again."

b. "Rinse used needles and syringes with water followed by laundry bleach after using them." To minimize the risk for HIV transmission, needles should be cleaned with laundry bleach after use. Boiling needles and syringes and rinsing with alcohol are not recommended. Running needles and syringes through the dishwasher will not sanitize them sufficiently. The client should be encouraged not to share needles and syringes.

The 28-year-old female client in the outpatient clinic has been told that her test for the human immune deficiency virus (HIV) is positive. Which interventions should the nurse implement? Select all that apply. 1. Discuss having regular gynecological examinations. 2. Assist the client to make her funeral arrangements. 3. Refer the client to a social worker. 4. Encourage the client to take the highly active antiretroviral therapy (HAART). 5. Teach the client to follow a healthy life style.

1, 4 and 5 are correct. 1. Females who are HIV positive are at risk for multiple gynecological problems. 2. This is not in the scope of practice of a nurse, and clients newly diagnosed are living 20 years or longer with the virus. 3. Nothing in the stem indicated a need for this referral. 4. HAART regimens are responsible for the improved prognosis of HIV+ clients. 5. A healthy life style will improve the client's ability to maintain her health.

An HIV-positive client is taking lopinavir/ritonavir (Kaletra) and reports nausea, abdominal pain, and diarrhea. What orders does the nurse anticipate? a. Renal function studies b. Liver enzymes c. Blood glucose monitoring d. Albumin and prealbumin

b. Liver enzymes Kaletra can cause liver complications, and clients taking it should have liver function studies. The client's symptoms could indicate a liver problem. Renal function and blood glucose are not affected by Kaletra. The client may have an albumin and a prealbumin drawn if he or she has lost a great deal of weight and malnutrition is suspected, but the more common diagnostic test for a client taking Kaletra would be liver function studies.

Treatment for MAC infections may involve what 2 medications?

- clarithromycin - azithromycin

The nurse caring for a client newly diagnosed with protein calorie malnutrition secondary to acquired immune deficiency syndrome (AIDS) writes a nursing problem of "altered nutrition: less than body requirements." Which nursing interventions should the nurse implement? Select all that apply. 1. Place the client on daily weights. 2. Have the client identify preferred foods. 3. Refer to the dietician. 4. Monitor bedside glucose levels four times a day. 5. Perform central line dressing changes every 72 hours

. 1, 2, and 3 are correct. 1. The client's daily weights will provide information as to fluid balance and nutrition deficits. 2. The client's preferred foods can be used to help increase the client's appetite and should be provided whenever possible on the meal trays. 3. The dietician can be the nurse's best ally when caring for a client with nutritional problems. 4. Glucose levels are monitored when a client is on total parenteral nutrition (TPN), not for a client newly diagnosed with a nutritional problem. 5. This would be appropriate for a client on TPN.

A client diagnosed with AIDS dementia is angry and yells at everyone entering the room. None of the critical care staff want to be assigned to this client. Which intervention would be most appropriate for the nurse manager to use in resolving this situation? 1. Explain that this attitude is a violation of the client's rights. 2. Request the HCP to transfer the client to the medical unit. 3. Discuss some possible options with the nursing staff. 4. Try to find a nurse who does not mind being assigned to the client.

3. Discuss some possible options with the nursing staff. This would be the most appropriate intervention because it allows the staff to have input into resolving the problem. When staff have input into resolving the situation, then there is ownership of the problem. 4. One nurse cannot

A client with AIDS has been admitted with fever, night sweats, and weight loss of 6 pounds in 2 weeks. The client's purified protein derivative (PPD) test, placed 3 days ago in the clinic, is negative. Which action by the nurse is most appropriate? a. Place the client in Airborne Precautions. b. Facilitate the client's chest x-ray. c. Initiate a 3-day calorie count. d. Start an IV of normal saline.

A. place the client in airborne precautions The client's symptoms are indicative of tuberculosis (TB). With AIDS, the client's CD4+ T-cell count is so low that the client cannot mount an immune response to the PPD; thus it appears negative. The client needs to be placed in Airborne Precautions until other diagnostic tests rule out TB. The other interventions are appropriate, but they do not take priority over infection control principles.

Which lab value is most important to look at when considering the initiation of Antiretroviral therapy (ART)?

CD4 count

A client receiving atazanavir requires what priority intervention?

Cardiac Assessment! Rationale: This medication may cause prolongation of the PR interval and first-degree AV block. Clients with underlying conduction deficits may develop problems. A cardiac assessment will assist in determining whether the client has underlying problems that could be exacerbated by this drug therapy.

Which microorganism is known to cause retinitis in people with HIV/AIDS?

Cytomegalovirus Cytomegalovirus is a herpes virus

Which blood test confirms the presence of HIV antibodies?

Enzyme-Linked Immunoabsorbent Assay (ELISA) ELISA and western blotting identify and confirm the presence of antibodies to HIV.

TRUE OR FALSE" "Other than abstinence, the only proven way to DECREASE risk of HIV infection is through the use of condoms. Condoms must be used consistantly and correctly."

TRUE

True or False: "Pneumocystis jiroveci pneumonia is an opportunistic infection that will not cause disease in staff with healthy immune systems. Standard Precautions should be used for this client. Contact, Airborne, or Droplet Precautions are not indicated for this client. Health care staff do not get vaccinated for this infection."

TRUE!

The nurse is accidentally stuck with a needle used to administer an intradermal injection for a PPD. Which intervention should the nurse implement first? 1. Complete the accident/occurrence report. 2. Immediately wash the area with soap and water. 3. Ask the client whether he or she has AIDS or hepatitis. 4. Place an antibiotic ointment and bandage on the site.

The nurse should wash the area with soap and water

A patient who has had HIV for the past 5 years comes into urgent care reporting headache, memory deficit, difficulty concentrating, and confusion. What condition would you suspect?

These are all EARLY symptoms of HIV encephalopathy LATER stages of HIV encephalopathy include hyperreflexia, a vacant stare, and hallucinations

Which diagnostic test measures HIV RNA in the plasma?

Viral Load Rationale: a viral load test measures the quantity of HIV RNA in the blood.

What test will the nurse assess to determine the client's response to antiretroviral therapy?

Viral Load! Rationale: viral load should be measured at baseline and on a regular basis thereafter bc viral load is the most important indicator of response to ART.

The nurse is caring for a young woman at the primary health clinic. Which assessment findings leads the nurse to question the client about risk factors for HIV? a. 6 vaginal yeast infections in the last 12 months b. unable to become pregnant for last 2 years c. severe cramping and irregular periods d. very heavy periods and breakthrough bleeding

a. 6 vaginal yeast infections in the last 12 months rationale: persistant or recurrent vaginal candidiasis may be the first symptom of HIV in women. Decreased immunity allows overgrowth of this fungus. Infertility, heavy periods, and cramping are generally indicative of HIV.

A client with AIDS is prescribed octreotide acetate. The nurse understands that this medication will assist in alleviating which problem?

chronic severe diarrhea

The nurse is teaching a client who has AIDS how to avoid infection at home. Which statement indicates that additional teaching is needed? a. "I will wash my hands whenever I get home from work." b. "I will make sure to have my own tube of toothpaste at home." c. "I will run my toothbrush through the dishwasher every evening." d. "I will be sure to eat lots of fresh fruits and vegetables every day."

d. "I will be sure to eat lots of fresh fruits and vegetables every day." The client should avoid eating raw fruits, vegetables, and salads because of the risk of infection. Hands should be washed whenever returning home, and immune compromised clients should not share toothbrushes or toothpaste. Toothbrushes should be run through the dishwasher nightly.

A client is administered foscarnet to treat a case of cytomegalovirus (CMV) retinitis. Which adverse effects should the nurse closely monitor in this client? a. peripheral neuropathy b. anemia c. hypotension d. electrolyte imbalance

electrolyte imbalances rationale: alterations in renal function, nausea, electrolyte imbalances and diarrhea are the most common adverse effects of foscarnet and should be closely monitored. The drug does NOT cause hypotension. However, peripheral neuropathy is an adverse effect of administering drugs such as didanosine and zalcitabine. Anemia is an adverse effect of administering zidovudine.

What intervention is appropriate before the client begins taking efavirenz therapy?

testing for Stevens-Johnson Syndrome Rationale: a client should be tested for the gene for Stevens-Johnson syndrome before receiving any drugs that potentially can cause this condition.

A client diagnosed with AIDS develops pneumocystitis pneumonia (PCP). When planning care for the client, which medication would the nurse anticipate being prescribed?

trimethoprim-sulfamethaxazole (TMP-SMZ) rationale: TMP-SMZ is the treatment of choice for PCP in clients with AIDS as well as for the immunocompromised clients with HIV infection.

A client who is receiving highly active antiretroviral therapy (HAART) tells the nurse, "The doctor said that my viral load is reduced. What does this mean?" What is the nurse's best response? a. "The HAART medications are working well right now." b. "You are not as contagious as you were anymore." c. "Your HIV infection is becoming resistant to your medications." d. "You are developing an opportunistic infection."

A. the HAART medications are working well right now The fact that the amount of virus is reduced means that the HAART regimen is working well to suppress viral replication. The risk of becoming infected by an HIV-positive person is always present. The reduced viral load is not related to an opportunistic infection or to resistance to medication.

The nurse is caring for an HIV-positive client. What assessment finding assists the nurse in confirming progression of the client's diagnosis to AIDS? a. Generalized lymphadenopathy b. HIV-positive status for 8 years c. Low-grade fever for the last 10 days d. Thick white patches on the client's tongue

d. Thick white patches on the client's tongue Candidiasis, which presents with thick white patches on the tongue and oral mucosa, is associated with the development of AIDS after HIV infection. The fact that the client has been positive for 8 years or has a low-grade fever is not significant.

A client being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the best action by the nurse?

Administer megestrol acetate, an appetite stimulant. Rationale: appetite stimulants are successfully used in clients with AIDS-related anorexia. The anorexia is compounded by medications that cause nausea and vomiting. The anorexia has a physiologic cause and this must be addressed. Having family members bring in the client's favorite foods or making favorite foods may have little or no effect on client's appetite as this is a PHYSIOLOGIC problem rather than physcological.

The nurse is caring for a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which client problem is priority? 1. Body image disturbance. 2. Impaired coping. 3. Risk for infection. 4. Self-care deficit.

Clients diagnosed with acquired immunodeficiency syndrome (AIDS) may have body image disturbance issues related to weight loss and Kaposi's sarcoma lesions, but these are psychological problems, and physiological problems have priority. 2. Impaired coping is a psychological problem, and physiological problems are priority. 3. The basic problem with a client diagnosed with AIDS is that the immune system is not functioning normally. This increases the risk for infection. This is the priority client problem. 4. Self-care deficit is a psychosocial problem, not a physiological problem.

A client with HIV who is taking highly active antiretroviral therapy (HAART) medications is in radiology waiting for a chest x-ray when medications are due. What action by the nurse is best? a. Call radiology to see when the client will be brought back to the nursing unit. b. Send the nursing assistant to radiology to bring the client back to the nursing unit. c. Take the client's medications to radiology and administer them there if possible. d. Stagger the next dose of the medication if the current dose is given late.

c. Take the client's medications to radiology and administer them there if possible. HAART medications must be given on time and in the correct dose when an HIV client is in the hospital. Missing or delaying even a few doses can lead to drug resistance. The best option would be for the nurse to administer the medications in radiology as the client continues to wait for the x-ray. Calling the radiology department might give the nurse information but does not ensure that the client receives the medication on time. Bringing the client back to the nursing unit might delay the x-ray.

Which intervention is a priority when treating a client with HIV/AIDS? a. assessing neurologic status b. monitoring skin integrity c. assessing fluid and electrolyte imbalance d. monitoring psychological status

c. assessing fluid and electrolyte balance rationale: fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS , and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored, but it is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high of a priority as fluid and electrolyte imbalance

The nurse has been exposed to HIV through splashing of urine from a client who is HIV positive with a low viral load. The urine came into contact with the nurse's face. Which drug regimen does the nurse prepare to initiate? a. Retrovir (zidovudine) for 14 days b. Retrovir (zidovudine) for 28 days c. Retrovir (zidovudine) and Epivir (lamivudine) for14 days d. Retrovir (zidovudine) and Epivir (lamivudine) for 28 days

d. Retrovir (zidovudine) and Epivir (lamivudine) for 28 days The Centers for Disease Control and Prevention have developed guidelines for postexposure prophylaxis (PEP). This nurse's exposure requires basic PEP with two drugs for 28 days.

A LOWER viral load is associated with ________________________ _________________.

longer survival rationale: the lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis