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

More than 50% of individuals with this disease develop pernicious anemia: 1- Bruton disease 2- Common variable immunodeficiency (CVID) 3- DiGeorge syndrome 4- Nezelaf syndrome

2

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? 1- The client has converted from HIV infection to AIDS. 2- The client has advanced HIV infection. 3- The client's T4-cell count has decreased due to the pneumocystis pneumonia. 4- The client has another infection present that is causing a decrease in the T4-cell count.

1

The nursing instructor is going over laboratory results for patients with HIV/AIDS. The instructor tells the students that, upon interpretation of a patient's laboratory results, the nurse should recognize that a patient with HIV is considered to have AIDS when the CD4 T-lymphocyte cell count drops below what level? 1- 200 cells/mm3 of blood 2- 300 cells/mm3 of blood 3- 400 cells/mm3 of blood 4- 500 cells/mm3 of blood

1

A majority of clients with CVID develop which type of anemia? 1- Hemolytic 2- Pernicious 3- Macrocytic 4- Sickle cell

2

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement? 1- "We can ask our family members to donate blood for stem cell harvesting." 2- "The only treatment option is thymus gland transplantation." 3- "We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." 4- "Hematopoietic stem cell transplantation cannot be performed until the age of 5 years."

3

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? 1- Gastric ulcer 2- Pernicious anemia 3- Hyperthyroidism 4- Sickle cell anemia

2

A patient has come into the free clinic for HIV testing. The test comes back positive, and the patient is told she has HIV. While assessing the patient, the nurse is aware that many patients with HIV utilize various alternative or complementary therapies. How does the nurse address complementary or alternative therapy? 1- "Complementary therapies such as acupuncture or herbal therapy are dangerous to patients with HIV, and we discourage you from exploring these types of therapy." 2- "Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available." 3- "We see many patients with HIV who are using some type of alternative therapy, and there are benefits and risks. Are there any types of alternative or complementary therapies that you follow, or are there any herbs that you take?" 4- "You surely do not take herbs or practice some type of alternative medicine such as acupuncture, massage therapy, hypnosis or diet therapy, do you?"

3

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? 1- "I will wash my hands whenever I get home from work." 2- "I will make sure to have my own toothbrush and tube of toothpaste at home." 3- "I will avoid contact with people who are sick or who have recently been vaccinated." 4- "I will be sure to eat lots of fresh fruits and vegetables every day."

4

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: 1- alcohol. 2- applying skin moisturizers. 3- seafood. 4- exposure to sunlight.

1

A client suspected of having human immunodeficiency virus (HIV) asks the nurse what causes AIDS. What is the best response by the nurse? 1- The human immunodeficiency virus 2- The streptococcal bacteria 3- The Epstein-Barr virus 4- The staphylococcal bacteria

1

A nurse is teaching the parents of an infant about primary immunodeficiencies. Which statement verifies that the parents understand the teaching? 1- "The majority of primary immunodeficiencies are diagnosed in infancy." 2- "Girls are diagnosed with primary immunodeficiencies more often than boys." 3- "My baby cannot survive into childhood with a diagnosis of primary immunodeficiency." 4- "The primary immunodeficiency will disappear with age."

1

HIV is harbored within which type of cell? 1- Lymphocyte 2- Platelet 3- Erythrocyte 4- Nerve

1

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is 1- Malnutrition 2- Neutropenia 3- Hypocalcemia 4- Chronic diarrhea

1

Which type of phagocytic disorder (formerly known as Job syndrome) occurs when white blood cells cannot initiate an inflammatory response to infectious organisms? 1- Agammaglobulinemia 2- Hyperimmunoglobulinemia E 3- Panhypoglobulinemia 4- Telangiectasia

1

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next? 1- ELISA 2- Western Blot 3- T4/T8 ratio 4- Polymerase chain reaction

2

The lower the client's viral load, 1- the shorter the time to AIDS diagnosis. 2- the longer the survival time. 3- the shorter the survival time. 4- the longer the time immunity.

2

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? 1- "The client probably has a case of the flu and you should give acetaminophen." 2- "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." 3- "This is one of the side effects from antiretroviral therapy and will require changing the medication." 4- "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider."

2

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? 1- Depression, memory impairment, and coma 2- Respiratory or urinary system infections 3- Rheumatoid arthritis 4- Cardiac dysrhythmias and heart failure

2

Which condition is an early manifestation of HIV encephalopathy? 1- Hyperreflexia 2- Headache 3- Vacant stare 4- Hallucinations

2

Which term means a lack of one or more of the five immunoglobulins? 1- Agammaglobulinemia 2- Hypogammaglobulinemia 3- Panhypoglobulinemia 4- Telangiectasia

2

A hospital educator is reiterating the importance of Standard Precautions to a group of nursing students who will soon begin a clinical rotation on the unit. Which of the following statements best describes the application of Standard Precautions? 1- Standard Precautions should be used when providing care for any patient who has a white blood cell (WBC) count of 10.8 × 109/L or greater. 2- Standard Precautions should be applied in the care of any patient who has an actual or suspected primary or secondary immunodeficiency. 3- Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. 4- Standard Precautions should be used in the care of any patient whose diagnosis is attributable to an infectious process.

3

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? 1- Active substance abuse 2- Depression 3- Past substance abuse 4- Lack of social support

3

A client diagnosed with AIDS develops pneumocystis pneumonia (PCP). When planning the care for the client, which medication would the nurse anticipate being prescribed? 1- trimethoprim-sulfamethoxazole (TMP-SMZ) 2- pentamidine 3- clarithromycin 4- acyclovir

1

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? 1- 6 weeks 2- 12 weeks 3- 18 weeks 4- 24 weeks

1

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often." What should the nurse consult with the physician regarding? 1- testing the client for the presence of HIV 2- instructing the client to wear cotton underwear 3- having the client abstain from sexual activity for 6 weeks while the medication is working 4- using a medicated douche in order to keep the vaginal pH normal

1

A nurse is teaching a health education class to a group of young adults and perceives that misinformation exists about the signs, symptoms, and trajectory of HIV infection. The nurse should inform participants that the first symptoms of HIV exposure include: 1- Fever, headache, and malaise 2- Pneumonia-like symptoms and increased sputum production 3- Rapid weight loss and anorexia 4- Painful lesions on the vulva or the shaft of the penis

1

Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? 1- Primary immunodeficiencies develop early in life after protection from maternal antibodies decreases. 2- occur most commonly in the aged population. 3- develop as a result of treatment with antineoplastic agents. 4- disappear with age.

1

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? 1- Antibodies to HIV are not present in his blood. 2- He has not been infected with HIV. 3- He is immune to HIV. 4- Antibodies to HIV are present in his blood.

1

Which is a major manifestation of Wiskott-Aldrich syndrome? 1- Thrombocytopenia 2- Ataxia 3- Episodes of edema 4- Bacterial infection

1

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? 1- CD4+ counts 2- HIV RNA 3- Western blotting assay 4- ELISA

1

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. 1- semen 2- urine 3- breast milk 4- blood 5- vaginal secretions

1,3,4,5

The nurse teaches the client that reducing the viral load will have what effect? 1- Shorter time to AIDS diagnosis 2- Longer survival 3- Shorter survival 4- Longer immunity

2

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. 1- Older adults are uniquely vulnerable to airborne transmission. 2- Rates of condom use are low among older adults. 3- Older adults' mucus membranes are highly vulnerable to viral infection. 4- Overall immune function is diminished as a result of age-related changes. 5- Many older adults are not aware of the risk of HIV infection.

2,4,5

A client with HIV will be started on a medication regimen of three medications. What drug will the nurse instruct the client about? 1- Protease inhibitor 2- Integrase inhibitors 3- Reverse transcriptase inhibitors 4- Hydroxyurea

3

A nurse is working in a support group for clients with acquired immunodeficiency syndrome (AIDS). Which point is most important for the nurse to stress? 1- Avoiding the use of recreational drugs and alcohol 2- Refraining from telling anyone about the diagnosis 3- Following safer-sex practices 4- Telling potential sex partners about the diagnosis, as required by law

3

When do most perinatal HIV infections occur? 1- Through breastfeeding 2- In utero 3- After exposure during delivery 4- Through casual contact

3

Antiretroviral medications should be offered to clients with T-cell counts less than 1- 50 cells/mm3. 2- 150 cells/mm3. 3- 250 cells/mm3. 4- 350 cells/mm3.

4

The clinic nurse is caring for a patient who has a longstanding diagnosis of HIV. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what? 1- HIV encephalopathy 2- B-cell lymphoma 3- Kaposi's syndrome 4- Wasting syndrome

1

The nurse is obtaining an assessment and health history from the parents of a 6-month-old infant with an elevated temperature. Which statement by the parents alerts the nurse to a possible immunodeficiency disorder? 1- "This is the third infection with a high fever the baby has had in the past month." 2- "I usually feed the baby a bottle every 4 to 6 hours during the day." 3- "My husband's family has a history of hemophilia; could this be the problem?" 4- "I had a good prenatal care and vaginal birth, although they had to use forceps."

1

A nursing student is preparing a teaching plan for a client with an immunodeficiency disorder. The student is going to include the cardinal symptoms in teaching. Which of the following would the student include? Choose all that apply. 1- Chronic diarrhea 2- Chronic or recurrent severe infections 3- Poor response to treatment of infections 4- Chronic fatigue 5- Facial edema

1,2,3

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? 1- Western Blot 2- Schick 3- Enzyme-linked immunosorbent assay (ELISA) 4- Complete blood count (CBC)

3

The nurse is caring for a client whose most recent laboratory values reveal a neutrophil level of 21,000 mm3. When preparing to assess the client, the nurse should prioritize what assessment? 1- Assessing the client for signs and symptoms of infection 2- Assessing the client's activity level and functional status 3- Assessing the client for indications of internal or external hemorrhage 4- Assessing the client for signs of venous thromboembolism

1

The majority of patient with primary immunodeficiency are in which age group? 1- Younger than 20 2- 20 to 40 3- 41 to 50 4- 51 to 60

1

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? 1- Antibiotic therapy 2- Immunosuppressive agents 3- Chest physiotherapy 4- Anticoagulation

2

A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? 1- Distal sensory polyneuropathy (DSP) 2- Candidiasis 3- HIV encephalopathy 4- Cytomegalovirus (CMV)

3

Which microorganism is known to cause retinitis in people with HIV/AIDS? 1- Cytomegalovirus 2- Cryptococcus neoformans 3- Mycobacterium avium 4- Pneumocystis carinii

1

Which blood test confirms the presence of antibodies to HIV? 1- Erythrocyte sedimentation rate (ESR) 2- p24 antigen 3- Reverse transcriptase 4- Enzyme immunoassay (EIA)

4

A patient with a recent diagnosis of HIV is soon to begin highly active antiretroviral treatment (HAART). When performing health education related to the patient's new medication regimen, the nurse should prioritize interventions relevant to which of the following nursing diagnoses? 1- Ineffective adherence 2- Delayed growth and development 3- Risk for caregiver role strain 4- Social isolation

1

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? 1- A woman whose diagnosis of sepsis is attributable to her recent chemotherapy 2- An elderly resident of a long-term care facility who has been diagnosed with the Norwalk virus 3- A child who had an allergic reaction to a scheduled immunization 4- A man who developed deep vein thrombosis (DVT) after being immobilized during recovery from orthopedic surgery

1

The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed? 1- "I will let my neighbor have my pet iguana." 2- "I will apply lotion following every bath to prevent dry skin." 3- "I can take my child to the beach, as long as we play in the sand rather than swim in the water." 4- "I will avoid letting my child drink any juice that has been sitting out for more than an hour."

3

Which of the following is the first barrier method that can be controlled by the woman? 1- Female condom 2- IUD 3- Diaphragm 4- Birth control pills

1

A client with severe combined immunodeficiency disease is receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures. What is the priority nursing care for this client? 1- Continuous monitoring of cardiac status 2- Meticulous infection control precautions 3- Daily weight measurements and strict monitoring of intake and output 4- Daily oral assessment and oral care every 4 hours

2

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? 1- Anorexia 2- Chronic diarrhea 3- Nausea and vomiting 4- Oral candida

2

The nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? 1- Oral temperature of 100°F 2- Tachypnea and restlessness 3- Frequent loose stools 4- Weight loss of 1 pound since yesterday

2

The nurse is performing an admission assessment on a patient with AIDS. When assessing the patient's gastrointestinal (GI) system what is most likely to be the priority nursing diagnosis? 1- Imbalanced nutrition: more than body requirements 2- Diarrhea 3- Bowel incontinence 4- Constipation

2

The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 1- 1.5 mL/min 2- 3 mL/min 3- 6 mL/min 4- 10 mL/min

2

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? 1- If the client experiences nausea, omit the dose. 2- The client should be alert for joint aches. 3- This medication is commonly used for many inflammatory reactions and is relatively safe. 4- Be alert for signs and symptoms of infection and report them immediately to the physician.

4

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? 1- Mycobacterium avium complex 2- Legionella 3- Cytomegalovirus 4- Pneumocystis jiroveci

4

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? 1- Palpating the patient's pedal pulses and monitoring for peripheral edema 2- Inspecting the patient's skin and monitoring for signs of skin breakdown 3- Gauging the patient's orientation, insight, and judgment on a daily basis 4- Auscultating the patient's lungs and monitoring oxygen saturation and respiratory rate

4

Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? 1- Oral estrogen contraceptives 2- An intrauterine device (IUD) 3- A diaphragm 4- The female condom

4

The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? 1- Obtain counseling. 2- Call the lab to draw the nurse's blood. 3- Fill out a risk management report. 4- Report the incident to the supervisor.

4

A 33-year-old man with AIDS is being treated for cytomegalovirus retinitis and has been prescribed ganciclovir. The nurse who is participating in this patient's care should recognize that this treatment necessitates which of the following assessments? 1- Daily assessment of the patient's orientation and cognition 2- Close monitoring of the patient's WBC differential 3- Ultrasound bladder scanning 4- Auscultation of the patient's apical heart rate

2

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? 1- "I won't go to see my sister while she has a cold." 2- "I can eat whatever I want as long as it's low in fat." 3- "I stopped smoking last year; this year I'll quit drinking alcohol." 4- "I won't go to see my nephew right after he gets his vaccines."

2

A nurse was administering a scheduled subcutaneous dose of heparin to a patient who has HIV when the needle penetrated the nurse's thumb. What prophylactic action should the nurse first take? 1- Apply negative pressure to the wound site using suction tubing. 2- Perform a thorough wash of the injury site with soap and water. 3- Apply chlorhexidine to the wound site and to all the skin in a 3-inch radius. 4- Maintain the hand in a dependent position.

2

As part of HAART therapy, a client is prescribed a non-nucleoside reverse transcriptase inhibitor (NNRTI). What would be an example of a drug from this class? Select all that apply. 1- Abacavir 2- Delavirdine 3- Amprenavir 4- Efavirenz 5- Stavudine

2,4

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? 1- "Your child does not have AIDS but this condition puts your child at risk for it later in life." 2- "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." 3- "Although AIDS is an immune deficiency, your child's condition is different from AIDS." 4- "We need to do some more testing before we will know if your child's condition is AIDS."

3

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? 1- "You should take the drug with an antacid." 2- "It doesn't matter if you take this drug with or without food." 3- "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." 4- "When you take this drug, eat a high-fat meal immediately afterwards."

3

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient? 1- Test for HIV without informing the patient. 2- Test for HIV, requiring the patient to sign a permit. 3- Inform the patient that it would be beneficial to test for HIV. 4- Administer treatment for the STI and discharge the patient.

3

A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately? 1- Mouth sores 2- Sneezing 3- Constipation 4- Tickle in the throat

4

The nurse is working with a parent whose child has just been diagnosed with selective immunoglobulin A deficiency. The parent asks the nurse, "Does this mean that my child is going to die?" How should the nurse respond? 1- "Your child may die without proper medication and treatment." 2- "Selective immunoglobulin A deficiency is the term used to describe the early stages of AIDS." 3- "If left untreated, selective immunoglobulin A deficiency can cause uncontrolled muscle movements with progressive neurologic deterioration." 4- "Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract."

4

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? 1- Deficient knowledge related to the effects of the disease 2- Risk for infection related to the immune system dysfunction 3- Disturbed body image related to loss of fat in the face and arms 4- Risk for impaired liver function related to drug therapy effects

3