Chapter 37 Nursing Management: Patients With Immunodeficiency, HIV Infection, and AIDS

A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? Venous stasis and phlebitis formation Deep purple cutaneous lesions Severe joint pain Lymphedema of the lower extremities

Deep purple cutaneous lesions Localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of clients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

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) Complete blood count (CBC) Schick Western Blot

Enzyme-linked immunosorbent assay (ELISA) 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.

HIV is harbored within which type of cell? Lymphocyte Nerve Erythrocyte Platelet

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.

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

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.

A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? blindness hearing impairment diarrhea fatigue

blindness CMV can infect the choroid and retinal layers of the eye, leading to blindness. It does not lead to hearing impairment. Fatigue and diarrhea may occur but are not as critical as blindness.

A patient has been newly diagnosed with AIDS. The patient is a 32-year-old mother of two young children. When the nurse is performing the patient's initial assessment, the patient expresses fear of dying. How should the nurse best respond to the patient? "Everyone dies eventually." "It's possible that you'll live for several years." "Would you like to talk to someone?" "What concerns you most about death?"

"What concerns you most about death?" The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help facilitate the patient to identify fears about being diagnosed with a life-threatening, chronic illness.

A patient has been newly diagnosed with AIDS. The patient is a 32-year-old mother of two young children. When the nurse is performing the patient's initial assessment, the patient expresses fear of dying. How should the nurse best respond to the patient? "Would you like to talk to someone?" "What concerns you most about death?" "Everyone dies eventually." "It's possible that you'll live for several years."

"What concerns you most about death?" The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help facilitate the patient to identify fears about being diagnosed with a life-threatening, chronic illness.

The nurse is preparing to administer the recommended dose of intravenous gamma-globulin for a 60-kg male client. How many grams will the nurse administer? 60 g 30 g 15 g 90 g

30 g The optimal dose is determined by the client's response. In most instances, an IV dose of 200-800 mg/kg of body weight is administered every 3-4 weeks to ensure adequate serum levels of immunoglobulin G (IgG).

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? AIDS SCID DAF CVID

AIDS AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response? Encourage large, high-fat meals. Increase the intake of iron and zinc. Avoid residue, lactose, fat, and caffeine. Reduce food intake.

Avoid residue, lactose, fat, and caffeine. Diarrhea may subside when the client avoids residue, 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, 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.

A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included? If the client experiences nausea, omit the dose. This medication is commonly used for many inflammatory reactions and is relatively safe. Be alert for signs and symptoms of infection and report them immediately to the physician. The client should be alert for joint aches.

Be alert for signs and symptoms of infection and report them immediately to the physician. Instruct the client about signs and symptoms of and the increased risk for infection. Instruct the client to report signs and symptoms of infection immediately to the physician. Early treatment promotes a shorter duration of illness and reduced complication. Tell the client to avoid high-risk activities, such as being in crowds, during periods of immunosuppression. The client should not omit a dose if nausea is experienced; he may take the medication with food. There are many side effects and required laboratory work to detect the side effects from immunosuppressive therapy. Joint aches are vague symptoms and are not a priority for reporting purposes.

A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's: White blood cell (WBC) count Abdominal girth Oral mucus membranes Electrolyte levels

Electrolyte levels Electrolyte imbalances, such as decreased serum sodium, potassium, calcium, magnesium, and chloride, typically result from profuse diarrhea. This problem does not affect the patient's abdominal girth or mucus membranes. WBC levels are not directly related to the development or complications of diarrhea.

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Iron and zinc Gluten Liquids Sucrose

Liquids 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.

A public health nurse has identified that a community's HIV education strategy does not address the educational needs of older adults, even though this population is vulnerable to infection with the virus. Which of the following factors puts older adults at risk of HIV infection? Select all that apply. Older adults are uniquely vulnerable to airborne transmission. Rates of condom use are low among older adults. Overall immune function is diminished as a result of age-related changes. Many older adults are not aware of the risk of HIV infection. Older adults' mucus membranes are highly vulnerable to viral infection.

Rates of condom use are low among older adults. Overall immune function is diminished as a result of age-related changes. Many older adults are not aware of the risk of HIV infection. Knowledge deficits, low rates of condom use, and age-related declines in immune function contribute to a significant risk of HIV infection among older adults. HIV is not transmitted by airborne routes, and the mucus membranes of older adults do not have a particular susceptibility.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? Bathing or hygiene self-care deficit Ineffective cerebral tissue perfusion Risk for injury Complicated grieving

Risk for injury In a client with AIDS, central nervous system (CNS) deterioration can lead to AIDS-related dementia. This type of dementia impairs cognition and judgment, placing the client at risk for injury. Although Bathing or hygiene self-care deficit and Complicated grieving may be relevant in AIDS, these diagnoses don't take precedence in a client with AIDS-related dementia. Because CNS deterioration results from infection, Ineffective cerebral tissue perfusion isn't applicable.

A client taking fosamprenavir reports "getting fat." What is the nurse's best action? Have the client increase exercise. Arrange for a psychological counseling. Assess the client's diet. Teach the client about medication side effects.

Teach the client about medication side effects. The client needs to be aware of the potential for fat redistribution. Exercise, diet, and counseling will not change the outcome of this side effect.

Ataxia refers to difficulty swallowing. inability to understand spoken words. uncoordinated muscle movement. vascular lesions caused by dilated blood vessels.

uncoordinated muscle movement. Ataxia-telangiectasia is an autosomal recessive disorder affecting both T-cell and B-cell immunity. Telangiectasia refers to vascular lesions caused by dilated blood vessels. Receptive aphasia is an inability to understand spoken words. Dysphagia refers to difficulty swallowing.

A client with chronic mucocutaneous candidiasis, an autosomal recessive disorder, asks the nurse, "Will my children have this disease?" Which response by the nurse is appropriate? "All of your children will be carriers of the recessive gene but may not develop the disease." "All of your children will develop the disease." "Only your male children are at risk for developing this disease." "Your female children will be carriers for the disease, but only male children will develop the disease."

"All of your children will be carriers of the recessive gene but may not develop the disease." Chronic mucocutaneous candidiasis is a rare T-cell disorder, which is thought to be an autosomal recessive disorder that affects both males and females. In pedigrees, an autosomal recessive disorder is revealed by the appearance of the phenotype in the male and female progeny of unaffected individuals. Parents must both be heterozygotes, C/c. (That is, both must have a c allele in order to contribute one to create a homozygote affected child with a cc phenotype displaying the disease.) A child born with Cc will be phenotypically normal but carry the recessive trait.

The nurse is teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed? "I will avoid contact with people who are sick or who have recently been vaccinated." "I will make sure to have my own toothbrush and tube of toothpaste at home." "I will wash my hands whenever I get home from work." "I will be sure to eat lots of fresh fruits and vegetables every day."

"I will be sure to eat lots of fresh fruits and vegetables every day." The client should avoid eating raw fruits and vegetables. All foods should be cooked thoroughly and all leftover food should be refrigerated immediately to prevent infection.

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? Ask the dietician to prepare the client's favorite meals. Ask the client's family to bring in food the client enjoys. Talk to the client about his unwillingness to eat. Administer megestrol acetate.

Administer megestrol acetate. 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. Bringing in favorite foods or making favorite foods may have little or no effect on the client's appetite; it is physiological rather than psychological.

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

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

Which of the following indicates that a client with HIV has developed AIDS? Severe fatigue at night Weight loss of 10 lb over 3 months Herpes simplex ulcer persisting for 2 months Pain on standing and walking

Herpes simplex ulcer persisting for 2 months A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

A majority of clients with CVID develop which type of anemia? Sickle cell Hemolytic Macrocytic Pernicious

Pernicious A majority of clients with CVID develop pernicious anemia. They majority do not develop the other types of anemia listed.

A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? Pernicious anemia Hyperthyroidism Gastric ulcer Sickle cell anemia

Pernicious anemia More than 50% of clients with CVID develop pernicious anemia. Lymphoid hyperplasia of the small intestine and spleen and gastric atrophy, which is detected by biopsy of the stomach, are common findings. Gastrointestinal malabsorption may occur.

A client with acquired immune deficiency syndrome (AIDS) is exhibiting shortness of breath, cough, and fever. What type of infection will the nurse most likely suspect? Pneumocystis jiroveci Cytomegalovirus Mycobacterium avium complex Legionella

Pneumocystis jiroveci Although mycobacterium, legionella, and cytomegalovirus may cause the signs and symptoms described, the most common infection in people with AIDS is pneumocystis pneumonia caused by pneumocystis jiroveci. It is the most common opportunistic infection associated with AIDS.

Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? An intrauterine device (IUD) A diaphragm Oral estrogen contraceptives The female condom

The female condom The female condom, the first barrier method controlled by women, is the only proven, effective method to prevent the transmission of HIV and sexually transmitted infections (STI).

When the nurse administers intravenous gamma-globulin infusion, she recognizes that which symptom, if reported by the client, may indicate an adverse effect of the infusion? Tightness in the chest Burning urination Increased thirst Nasal stuffiness

Tightness in the chest Flank pain, tightness in the chest, or hypotension indicates adverse effects of gamma-globulin infusion. Nasal stuffiness and increased thirst are not recognized as adverse effects of gamma-globulin infusion. Burning urination is a sign of urinary tract infection, not an adverse effect of gamma-globulin infusion.

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? "Your child does not have AIDS but this condition puts your child at risk for it later in life." "We need to do some more testing before we will know if your child's condition is AIDS." "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." "Although AIDS is an immune deficiency, your child's condition is different from AIDS."

"Although AIDS is an immune deficiency, your child's condition is different from AIDS." 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 secondary immunodeficiency.

An experienced medical nurse has provided care for patients who have immunodeficiencies that are primary, as well as for patients who have secondary immunodeficiencies. Which of the following individuals is most clearly exhibiting secondary immunodeficiency? A woman whose diagnosis of sepsis is attributable to her recent chemotherapy A child who had an allergic reaction to a scheduled immunization A man who developed deep vein thrombosis (DVT) after being immobilized during recovery from orthopedic surgery An elderly resident of a long-term care facility who has been diagnosed with the Norwalk virus

A woman whose diagnosis of sepsis is attributable to her recent chemotherapy Secondary immunodeficiencies affect the normal immune system of the patient, resulting in increased susceptibility to infection and certain types of cancer. Chemotherapy is an example of a factor that can precipitate this susceptibility. Development of postoperative DVT and allergic reactions are not example of secondary immunodeficiency. Infection often results from a secondary immunodeficiency, but not every infection is attributable to this factor.

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? He is immune to HIV. Antibodies to HIV are not present in his blood. He has not been infected with HIV. Antibodies to HIV are present in his blood.

Antibodies to HIV are not present in his blood. A negative test result indicates that antibodies to HIV 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 take from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk patient must be encouraged. The test result does not mean that the patient is immune to the virus, nor does it mean that the patient is not infected. It just means that the body may not have produced antibodies yet. When antibodies to HIV are detected in the blood, the test is interpreted as positive.

A nurse on a medical unit is caring for a patient who has experienced a recent exacerbation of HIV. The nurse is being vigilant in assessments and preventative measures related to the common complications of HIV infection. What assessment addresses the most common opportunistic infection related to HIV? Palpating the patient's pedal pulses and monitoring for peripheral edema Inspecting the patient's skin and monitoring for signs of skin breakdown Gauging the patient's orientation, insight, and judgment on a daily basis Auscultating the patient's lungs and monitoring oxygen saturation and respiratory rate

Auscultating the patient's lungs and monitoring oxygen saturation and respiratory rate The most common infection in people with AIDS is Pneumocystis pneumonia (PCP). Nursing assessment for this infection includes vigilant respiratory assessment.

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? Nausea and vomiting Anorexia Oral candida Chronic diarrhea

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.

A nurse on a medical unit is providing care for a patient who has been admitted because of the simultaneous development of several complications of AIDS. For the past several days, the patient has been experiencing six to eight watery bowel movements each day. The nurse should consequently assess the patient's: Abdominal girth Electrolyte levels Oral mucus membranes White blood cell (WBC) count

Electrolyte levels Electrolyte imbalances, such as decreased serum sodium, potassium, calcium, magnesium, and chloride, typically result from profuse diarrhea. This problem does not affect the patient's abdominal girth or mucus membranes. WBC levels are not directly related to the development or complications of diarrhea.

A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for? T-and C-cell assays Plasmapheresis Enzyme-linked immunosorbent assay Complete chemistry panel

Enzyme-linked immunosorbent assay T-cell and B-cell assays (or counts) and the enzyme-linked immunosorbent assay may be performed. A C-cell assay and plasmapheresis are distractors for this question. A complete chemistry panel is not a diagnostic test for an immune system disorder.

A client is admitted with a tentative diagnosis of acquired immunodeficiency syndrome (AIDS). The client undergoes biopsies of facial lesions and the preliminary report indicates Kaposi's sarcoma. Which action by the nurse is most appropriate? Tell the client that Kaposi's sarcoma is common in people with AIDS. Inform the client of the biopsy results and support the client emotionally. Explore the client's feelings about facial disfigurement. Pretend not to notice the lesions on the client's face.

Explore the client's feelings about his facial disfigurement. The nurse should help the client explore his or her feelings about facial disfigurement because facial lesions can contribute to decreased self-esteem and an altered body image. Discussing AIDS with a client whose diagnosis isn't final may be inappropriate and doesn't provide emotional support. Pretending not to notice visible lesions ignores the client's concerns. The health care provider, not the nurse, should inform the client of the biopsy results.

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? Antibiotic therapy Immunosuppressive agents Anticoagulation Chest physiotherapy

Immunosuppressive agents For a client undergoing a hematopoietic stem cell transplant, immunosuppression is started to ensure engraftment of depleted bone marrow. Antibiotic therapy may or may not be indicated. Chest physiotherapy would be appropriate for clients with ataxia-telangiectasis who have chronic lung disease. Anticoagulation would not be used.

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

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

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? Blood specimen for electrolyte studies Stool specimen for ova and parasites Sputum specimen for acid fast bacillus Urine specimen for culture and sensitivity

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 patient is being tested for HIV using enzyme immunoassay (EIA). The EIA shows antibodies. The nurse expects the health care provider to order what test to confirm the EIA test results? Viral load test Another EIA test CD4:CD8 ratio Western blot test

Western blot test The Western blot test detects antibodies to HIV and is used to confirm EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4:CD8 ratio test evaluates the ratio of CD4 to CD8 cells. HIV kills CD4 cells, which results in an impaired immune system, and this test is used to assess the immune system.

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: T4-cell count for confirmation of diagnosis. polymerase chain reaction test for confirmation of diagnosis. p24 antigen test for confirmation of diagnosis. Western blot test for confirmation of diagnosis.

Western blot test for confirmation of diagnosis. The enzyme-linked immunosorbent assay (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. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.

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

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.

A client is infected with human immunodeficiency virus (HIV) after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection? 1 to 2 weeks 6 to 18 weeks 3 to 6 weeks 3 to 12 weeks

3 to 12 weeks When a person is infected with HIV, the immune system responds by producing antibodies against the virus, usually within 3 to 12 weeks after infection.

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when scheduling a return visit for viral load testing at which time? 12 weeks 24 weeks 6 weeks 18 weeks

6 weeks Viral load tests are measured immediately before initiating antiretroviral therapy and then again in 2 to 8 weeks. In most clients, adherence to a regimen of potent antiretroviral agents should result in a large decrease in the viral load by 2 to 8 weeks. Therefore, a return visit at 6 weeks would be in this time frame. By 16 to 20 weeks, the viral load should continue to decline, dropping below detectable levels.

There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. "You will now be more likely to develop cancer in the future." "Your diagnosis was inherited." "Your condition will predispose you to frequent and recurring infections." "Your immune system was most likely affected by an underlying disease process."

"Your immune system was most likely affected by an underlying disease process." A secondary immunodeficiency is the result of an underlying disease process or the treatment of a disorder. It is not genetically inherited. Some examples of a secondary immunodeficiency are chronic stress and diabetes mellitus.

The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? Assist with chest physiotherapy every 2 to 4 hours. Maintain the client in a supine or side-lying position. Encourage client to ambulate frequently in the halls. Limit fluid intake to 1 1/2 to 2 liters per day.

Assist with chest physiotherapy every 2 to 4 hours. The nurse should include interventions such as assisting with and/or performing chest physiotherapy every 2 to 4 hours to prevent stasis of secretions, assist the client to attain the semi- or high Fowler's position to facilitate breathing and airway clearance, allow for frequent rest periods to prevent excessive fatigue, and maintain a fluid intake of at least 3 liters per day unless contraindicated.

The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? The client has another infection present that is causing a decrease in the CD4+ cell count. The client's CD4+ cell count has decreased due to the pneumocystis pneumonia. The client has advanced HIV infection. The client has converted from HIV infection to AIDS.

The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased CD4+ cell count from a normal level of 500 to 1000/mm³ and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The CD4+ cell count is not decreasing due to an infection.

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. urine vaginal secretions breast milk semen blood

semen breast milk blood vaginal secretions There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? nystatin trimethoprim-sulfamethoxazole fluconazole amphotericin B

trimethoprim-sulfamethoxazole To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

A client diagnosed with AIDS develops pneumocystis pneumonia (PCP). When planning the care for the client, which medication would the nurse anticipate being prescribed? trimethoprim-sulfamethoxazole (TMP-SMZ) pentamidine clarithromycin acyclovir

trimethoprim-sulfamethoxazole (TMP-SMZ) TMP-SMZ is the treatment of choice for PCP in clients with AIDS as well as for immunocompromised clients without HIV infection. Pentamidine, an antiprotozoal medication, is used as an alternative agent for combating PCP. Treatment for MAC infections involves use of either clarithromycin or azithromycin. Oral acyclovir, famciclovir, or valacyclovir may be used to treat infections caused by herpes simplex or herpes zoster.

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication." "The client probably has a case of the flu and you should give acetaminophen." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."

"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." A fungal infection, Cryptococcus neoformans is another common opportunistic infection among clients with AIDS, and it causes neurologic disease. Cryptococcal meningitis is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.

A hospice nurse has been providing care for a man who has AIDS. Among the manifestations of the man's disease has been a profound weight loss over the past several weeks. Consequently, the nurse is adjusting the patient's plan of care to reprioritize this problem. When planning interventions for the patient's weight loss, the nurse should be aware that: The patient's weight loss is attributable to psychological factors rather than pathophysiological factors. Nutritional interventions may not necessarily resolve the patient's weight loss. The patient should simultaneously receive total parenteral nutrition (TPN) and oral nutritional supplements. The patient's weight loss is a sign of the progression of AIDS but is not a direct threat to his health.

Nutritional interventions may not necessarily resolve the patient's weight loss. In some AIDS-associated illnesses, patients experience a hypermetabolic state in which excessive calories are burned and lean body mass is lost. As a result, nutritional interventions (including TPN) may not necessarily be effective. This weight loss has profound implications for the patient's overall health and prognosis.