Med Surg CH 14- HIV
When reviewing the assessment data of a human immunodeficiency virus (HIV) patient, the nurse notes that the patient's CD4 cell count is below 200, and that the patient has lost more than 10% of his or her ideal body weight. What does the nurse suspect is occurring with this patient? 1 Kaposi sarcoma 2 Cytomegalovirus (CMV) 3 Pneumocystis jiroveci pneumonia (PCP) 4 Acquired immunodeficiency syndrome (AIDS)
4 A patient with HIV is diagnosed with AIDS when the CD4 T cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS.
A patient has been diagnosed with human immunodeficiency virus (HIV). The patient does not want to take more than one antiretroviral drug. What explanation can the nurse give to the patient regarding the importance of combination antiretroviral therapy? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs
The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.
A patient with acquired immunodeficiency syndrome (AIDS) comes into the clinic reporting yellow skin color, fatigue, and knee pain. What does the nurse suspect the patient is experiencing? 1 Hepatitis B virus (HBV) 2 Hepatitis C virus (HCV) 3 Cytomegalovirus (CMV) 4 Mycobacterium avium complex (MAC)
1 Although all of these are opportunistic infections that AIDS patients may acquire, HBV is correct here because clinical manifestations consist of jaundice, fatigue, and joint pain. HCV is incorrect because HCV clinical manifestations do not include joint pain. CMV is incorrect because CMV is broken down into several specific categories that include retinitis, esophagitis, pneumonitis, and neurologic disease, in which none have the clinical manifestations of fatigue, jaundice, or joint pain. MAC is incorrect because MAC clinical manifestations include gastroenteritis, watery diarrhea, and weight loss.
A nurse who is providing ambulatory care for patients with human immunodeficiency virus (HIV) is assisting the patients as they struggle to resolve end-of-life issues. Which question posed by the nurse may help the patients to address life and death issues? 1 "Do you desire support from a spiritual counselor?" 2 "Have you been able to make amends with your God?" 3 "Would you like me to help you find someone to put your affairs in order?" 4 "Do you need a social worker to help you sort out financial and legal issues?"
1 Asking patients whether they desire support from a spiritual counselor can help them to resolve life and death issues. Asking a patient whether he or she has made amends with his or her God assumes that the patient believes in God, which may not be a valid assumption. Asking about putting their affairs in order and sorting out financial and legal issues will not directly help patients to address spiritual life or death issues.
The patient has a new prescription to receive ceftazidime. The nurse would hold the medication and notify the health care provider if the patient reported a history of anaphylaxis to which class of medication? 1 Penicillins 2 Macrolides 3 Sulfa-containing medications 4 Nonsteroidal antiinflammatory drugs (NSAIDs)
1 Ceftazidime is a third-generation cephalosporin. In patients with anaphylaxis to penicillins, there is a 5% cross-sensitivity to cephalosporins. Before administration, the nurse should notify the provider of this known allergy. Ceftazidime will not interact with NSAIDs, sulfa, or macrolide antibiotics.
When educating a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? 1 "I will need to isolate any tissues I use so as not to infect my family." 2 "I will notify all of my sexual partners so they can get tested for HIV." 3 "Unprotected sexual contact is the most common mode of transmission." 4 "I do not need to worry about spreading this virus to others by sweating at the gym."
1 HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching.
A patient has received a prescription for nevirapine. The patient asks about the benefit of the drug in HIV infections. What is the most appropriate response by the nurse? 1 The drug combats HIV by inhibiting the action of reverse transcriptase. 2 The drug works by preventing binding of HIV to cells, and preventing its entry. 3 The drug works by preventing the protease enzyme from fragmenting HIV proteins. 4 The drug combats HIV by inserting a piece of DNA into the developing HIV DNA chain, thereby blocking its development.
1 Nevirapine is a nonnucleoside reverse transcriptase inhibitor. It inhibits the action of reverse transcriptase, which is required to convert HIV RNA into HIV DNA. Protease inhibitors prevent the protease enzyme from cutting HIV proteins into the proper lengths needed to allow viable virions to assemble and bud out from the cell membrane. Entry inhibitors prevent binding of HIV to cells, thus preventing entry of HIV into cells where replication would occur. Nucleoside reverse transcriptase inhibitors act by inserting a piece of DNA into the developing HIV DNA chain. This further blocks the development of the chain, leaving the production of the new strand of HIV DNA incomplete.
A patient is admitted to the medical-surgical unit with a diagnosis of pertussis. The nurse plans to implement what necessary precaution? 1 Droplet 2 Contact 3 Airborne 4 Standard
1 Pertussis is a respiratory disease that is spread through the air at close contact, so droplet precautions must be in place to prevent the spread of the disease. Although standard precautions are used to reduce the risk and transmission of microorganisms, it is not the most accurate response. Airborne precautions are used to prevent the spread of infection of diseases that can go over long distances when suspended in the air, such as tuberculosis or rubeola. Contact precautions are used to prevent the spread of pathogens that are acquired from direct or indirect contact, such as methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE).
A patient is concerned about receiving a bite from an unknown dog. What disease should the nurse be concerned about that is caused by rhabdovirus? 1 Rabies 2 Measles 3 Encephalitis 4 Gastroenteritis
1 Rhabdovirus is a virus that causes rabies. Measles is caused by the virus rubeola. Both the West Nile virus and the arbovirus cause encephalitis. Viruses such as rotaviruses, respiratory syncytial virus, parvovirus, cytomegalovirus, echoviruses, and coxsackieviruses A and B cause gastroenteritis.
The nurse performs an assessment on a patient, observing a large chancre on the penis that the patient states is painless. The patient is suspected of being infected with Treponema pallidum. Which diagnosis does the nurse anticipate? 1 Syphilis 2 Gonorrhea 3 Chlamydia 4 Genital warts
1 Syphilis is caused by Treponema pallidum, a disease causing bacteria. Gonorrhea is caused by Neisseria gonorrhoeae. Genital warts are caused by a herpes virus. Chlamydia is caused by chlamydia trachomatis.
Which patient is at the highest risk for developing a healthcare-associated infection (HAI)? 1 A 66-year-old patient with an indwelling Foley catheter 2 A 45-year-old patient scheduled for a partial colectomy 3 A 75-year-old patient admitted to the coronary care unit with acute angina 4 A 35-year-old patient status post (s/p) emergent laparoscopic cholecystectomy
1 The 66-year-old patient with an indwelling Foley catheter is at the greatest risk for an HAI because elderly adults have weaker immune systems and an indwelling catheter provides a reservoir for the transmission of bacteria from the device to the bladder. A 35-year-old patient s/p emergent laparoscopic cholecystectomy, an elderly patient with angina, and a 45-year-old patient scheduled for a partial colectomy have comparatively lower risks for infection due to their younger ages and potentially shorter treatments and tests.
The nurse is teaching a group of nursing students about caring for a patient who has human immunodeficiency syndrome (HIV). The nurse correctly identifies the most frequent form of work-related HIV transmission as what? 1 Puncture wounds from contaminated needles 2 Failure to wear gloves when changing the patient's bed 3 Splash contamination while emptying an indwelling urinary catheter 4 Contamination of an open wound with blood from an HIV-infected patient
1 The most frequent cause of HIV transmission in the workplace is due to needle puncture with contaminated blood. The incidence of transmission from contaminated needles in the workplace is approximately three to four in 1,000 patients. Splash contamination from emptying a urinary catheter or open wound is less likely to result in HIV transmission. Failure to wear gloves while changing the patient's bed holds little if any risk related to transmission.
A woman infected with human immunodeficiency virus (HIV) delivers a baby with congenital anomalies. The patient was put on Atripla (tenofovir DF+emtricitabine+efavirenz) during pregnancy to control infection. The nurse recognizes that what is the probable cause for the fetal malformations? 1 Adverse effects of efavirenz 2 Adverse effects of tenofovir DF 3 Adverse effects of emtricitabine 4 Immune deficiency due to HIV
1 The use of efavirenz in large doses in pregnant women may cause fetal anomalies. Tenofovir and emtricitabine are usually not associated with fetal malformations. Tenofovir and emtricitabine are used for preexposure prophylaxis. Immune deficiency due to HIV rarely causes fetal malformation.
A nurse is educating a patient about ways to decrease the risk of antibiotic-resistant infection. Which instructions should the nurse include in the teaching? Select all that apply. 1 Wash your hands frequently. 2 Follow directions as prescribed. 3 Complete the full course of antibiotics. 4 Request antibiotics for faster resolution of flu. 5 Retain leftover antibiotics for future use if needed.
1,2,3 Washing hands frequently is the most important way to prevent any kind of infection, and the caregivers should be encouraged to follow this practice. Antibiotics should not be stopped just because the symptoms have subsided. The antibiotic course should be completed as prescribed. Antibiotics should be taken as directed by the primary health care provider. Not following the instructions or skipping the doses can lead to resistance of the bacteria toward the antibiotic. Antibiotics are not effective against colds and flu; therefore, respect the primary health care provider's decision not to prescribe antibiotics when not needed. Leftover antibiotics should not be kept for later use, because they may not be effective for the particular disease in the future and may lose their effectiveness.
The nurse is reviewing home medications with a patient diagnosed with human immunodeficiency virus (HIV). Which medications and over-the-counter pills may have interactions with HIV therapy? Select all that apply. 1 Antiacids 2 St. John's wort 3 Protease inhibitors 4 Integrase inhibitors 5 Proton pump inhibitors
1,2,5 Antacids, proton pump inhibitors, and St. John's wort all interact with HIV drug therapy. Protease inhibitors and integrase inhibitors are drugs used to treat HIV.
Which instructions should the nurse include when teaching preexposure prophylaxis (PrEP) to a group of adults at high risk of sexually acquired HIV infection? Select all that apply. 1 Safe sex practices 2 Regular HIV testing 3 Frequent hand washing 4 Discreet use of antibiotics 5 Risk reduction counseling
1,2,5 Preexposure prophylaxis refers to strategies that aim to prevent HIV infection in adults at high risk of developing sexually acquired HIV infection. The strategies include safe sex practice, regular HIV testing for screening and early detection, and risk reduction counseling. Frequent hand washing helps to prevent transmission of infection in general, but not specifically sexually acquired HIV infection. Discreet use of antibiotics is helpful in preventing antibiotic-resistant infections, but not specifically HIV infection.
The nurse is caring for a patient with hepatitis B. What isolation precautions should the nurse follow for this type of infection? Select all that apply. 1 Take measures to avoid splash contamination. 2 Wear an N-95 nonrebreather when caring for the patient. 3 Wear gloves and a gown when providing direct patient care. 4 Instruct the patient and family on how to follow droplet precautions. 5 Educate the patient and family on how to follow contact precautions.
1,3,5 According to the Centers for Disease Control and Prevention, contact precautions should be taken with a patient with hepatitis B. As such, the nurse should wear gloves, a gown, and other PPE when providing direct care and take any other measures to prevent splash contamination. The patient and family should be educated on how to follow contact precautions. An N-95 nonrebreather mask is used for airborne precautions. Droplet precautions do not apply to a patient with hepatitis B.
A goal of Healthy People 2020 is to prevent the transmission of human immunodeficiency virus (HIV) and early detection of those infected. Which are strategies aimed at meeting this goal? Select all that apply. 1 Increased accessibility to HIV testing facilities 2 Mandatory HIV testing as a routine part of health care 3 Denial of sterile intravenous equipment to drug abusers 4 Inclusion of voluntary HIV testing in routine prenatal care 5 Advocacy for safer sex practices including use of condoms
1,4,5 Strategies aimed at prevention and early detection of HIV include increasing accessibility to HIV testing facilities (e.g., drug and alcohol treatment centers and community-based organizations); offering voluntary HIV testing as part of routine prenatal care; and advocating for safer sex practices (including use of condoms). Mandated HIV testing may result in avoidance of routine health care. Taking measures to prevent drug abusers from sharing needles is imperative. Many needle/syringe exchange programs have decreased the incidence of HIV among intravenous drug abusers.
A patient with chronic acquired immunodeficiency syndrome (AIDS) is taking antiretroviral therapy (ART) as well as medication for tuberculosis. What does the nurse anticipate observing when reviewing laboratory studies for this patient? Select all that apply. 1 Neutropenia 2 Lymphopenia 3 High platelet count 4 Normal hemoglobin levels 5 Abnormal liver function tests
1,5 The patient may have abnormal liver function tests due to treatment with antitubercular drugs such as isoniazid (INH) and rifampin (RIF). These drugs are hepatotoxic and may derange the liver function tests. The patient is treated on ART, which may also cause neutropenia. A high platelet count, normal hemoglobin levels, and lymphopenia may not be significant findings when on therapy with ART and antitubercular drugs.
The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? 1 Droplet precautions 2 Contact precautions 3 Airborne precautions 4 Standard precautions
2 Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., tuberculosis, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.
A patient with acquired immunodeficiency syndrome (AIDS) tells the home care nurse, "I brought the disease upon myself." The patient tells the nurse, I stopped going to church and speaking with those who previously provided spiritual support." What would a priority goal related to spirituality during this terminal phase be? 1 Encouraging the patient and family to reconnect with their faith 2 Assisting the patient to reconcile with his or her God or higher being 3 Facilitating emotional and spiritual acceptance of the finite nature of life 4 Scheduling an appointment for the patient with the facility's faith provider
2 During this phase of care for a terminally ill patient dealing with AIDS, the nurse needs to support the patient as he or she emotionally and spiritually accepts the potential end of life. Because the patient is blaming the disease on his or her religious failure, the priority is to help the patient reconcile these feelings. Encouraging the patient and family to reconnect with their faith may or may not be part of this reconciliation. Facilitating emotional and spiritual acceptance of the finite nature of life may be part of the coping process, but it doesn't address this patient's feelings of guilt and failure. Scheduling an appointment for the patient with the facility's faith provider may be a part of helping the patient reconcile with his or her God, but this is not the priority action.
The nurse is monitoring the CD4 counts from a patient with human immunodeficiency virus (HIV). When does the nurse determine that the patient will need to observe for signs of immune problems? 1 The CD4 count is 1200. 2 The CD4 count falls to 500. 3 The CD4 count falls below 200. 4 The CD4 count is greater than 500.
2 Immune problems start to occur when the count drops below 500 CD4 T cells. When it drops below 200 CD4 T cells, severe immune problems will develop and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 to 1200 CD4 T cells is normal for adults who do not have any immune dysfunction.
A nurse working in a long-term care unit assesses that a patient with an indwelling catheter is confused with behavioral changes and afebrile. What does the nurse suspect that these symptoms indicate? 1 The patient is depressed. 2 The patient has an infection. 3 The patient has a psychotic illness. 4 The patient is developing dementia.
2 Patients living in long-term care facilities are at an increased risk of developing infections. The risk is higher in patients who have an indwelling catheter. Elderly patients may not have fever when they have an infection. Cognitive or behavioral changes are early indications of the presence of infection. Dementia is a slow and progressive disease and does not have acute symptoms. Depression, until severe, does not manifest as cognitive and behavioral change. Whereas cognitive and behavioral changes may indicate a psychotic illness, other possibilities are more likely in this patient.
A patient is being placed on efavirenz with a once-a-day dose. Which instructions should the nurse give to help the patient cope with the side effects? 1 Use electronic reminders, timers, and beepers. 2 Take the dose at bedtime before going to sleep. 3 Have tests regularly to assess viral load in the body. 4 Inform the health care provider about other drugs being taken.
2 Take the dose at bedtime before going to sleep. The antiretroviral drug efavirenz is associated with side effects like dizziness and confusion. Therefore the nurse should teach the patient to take the drug dose at bedtime to cope better with the side effects. Electronic reminders, timers, and beepers are used to increase adherence to drug regimens. Informing the health care providers about concurrent medicines is important to decrease adverse drug interactions, but may not help in coping with side effects of the drug. Regular testing should be done to assess the viral load on the body and, in turn, indicate the efficacy of the drug therapy.
A patient has developed West Nile virus after being bitten by a mosquito. What type of infection does the nurse recognize the patient has contracted? 1 Mycotic 2 Emerging 3 Nosocomial Incorrect4 Opportunistic
2 The increase in West Nile virus infections is an example of an emerging infection. Emerging infections increase in incidence and threaten to increase in the future unless prevention and intervention measures are discovered and implemented. Mycotic infections, such as Tinea corporis, are caused by fungi. Nosocomial infections are contracted in the healthcare setting. Opportunistic infections are caused by pathogens invading an immunosuppressed person.
The nurse is planning care for a patient with human immunodeficiency virus (HIV). Which priority nursing action will most help the patient prevent complications? 1 Encourage the patient to eat three high-protein meals each day. 2 Educate the patient about the importance of adherence to drug therapy. 3 Plan an exercise regimen for the patient to adhere to three times a week. 4 Obtain a prescription for the patient to take antibiotics prophylactically to prevent infections.
2 The priority nursing action is to be sure the patient understands the importance of adhering to the antiviral medication regimen to prevent increasing viral loads. It is not required that the patient eat three high-protein meals per day, and if there is any kidney impairment, this could create problems. Taking antibiotics prophylactically may cause an antibiotic-resistant infectious process, and it is only necessary to take the antibiotics when there is a diagnosed infection. Some form of exercise should be performed regularly, but it is not the most important factor in preventing complications due to HIV.
The nurse is preparing to administer an antibiotic for a patient with methicillin-resistant staphylococcus aureus (MRSA). Which antibiotic does the nurse administer that will be most effective for treatment? 1 Methicillin 2 Penicillin G 3 Ceftazidime 4 Vancomycin
4 Vancomycin is the preferred antibiotic in treating MRSA. By definition, MRSA is resistant to methicillin. Penicillin G can be used to treat Enterococcus faecium because this organism is resistant to vancomycin, streptomycin, and gentamicin. Klebsiella pneumonia strains that are resistant to ceftazidime should be treated with imipenem and cilastatin (Primaxin) or meropenem.
In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? Select all that apply. 1 Platelets 2 T lymphocytes 3 B lymphocytes 4 Red blood cells 5 Immunoglobulins
2,3 In the early stages of HIV infection, B cells and T cells protect the body from infections. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T-cells. Platelets do not take part in providing immunity to the human body. They are required for clotting mechanism. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections.
A patient came to a clinic for a pregnancy test because she had missed her last menstrual period. Despite the use of a condom, the test was positive. What information should be given to this patient by the nurse? Select all that apply. 1 Discuss antiretroviral therapy (ART). 2 Tell her that failure of condoms is possible. 3 Offer access to voluntary HIV-antibody testing. 4 Advise her that she can choose abortion if she wants. 5 Advise her to get her partner tested for human immunodeficiency virus (HIV).
2,3,4 Condoms are used for contraception and prevention of sexually transmitted diseases. Condoms may slip off the penis after ejaculation or break due to improper application or physical damage. If she wants to choose abortion, she can do so without consent from her husband. The current standard of care is for all women who are pregnant to be routinely offered access to voluntary HIV-antibody testing, and, if infected, offered optimal ART. Because she is not yet diagnosed with HIV infection, ART is not required. There is no need to get her partner tested for HIV because she is not diagnosed with HIV infection.
The nurse educates a patient not to take leftover antibiotics. The patient later asks the nurse for the rationale behind the health care provider's advice. What is the best response by the nurse? Select all that apply. 1 The risk of contamination of tablets is reduced. 2 Leftover antibiotics may be fatal for the patient. 3 Bacteria may develop resistance to the antibiotics. 4 The patient's illness may not be a bacterial infection. 5 Leftover antibiotic may not be appropriate for the patient.
2,3,4,5 Leftover antibiotics may lose their effectiveness or sometimes may even be fatal. Inappropriate use of antibiotics may lead to the development of bacterial resistance. The patient may have a disease other than a bacterial infection, so antibiotics may not be helpful. Leftover antibiotics may not provide a sufficient dose to cure the infection, or they may not be helpful for the particular type of infection. Usually tablets do not get contaminated.
As part of an awareness program for high school students on acquired immunodeficiency syndrome (AIDS), a public nurse is giving information about routes of transmission. What information should the nurse provide to students regarding the routes of transmission? Select all that apply. 1 A person can be infected by donating a pint of whole blood. 2 A person can be infected by having intercourse with one stable partner. 3 A person can be infected even if a condom is used each time there is sexual intercourse. 4 A person can get infected while hugging or shaking hands with a person infected with HIV. 5 A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies.
2,3,5 The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. Equipment used in donation is disposable, and the donor does not come into contact with anyone else's blood. Hence, transmission cannot occur by donating blood. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting.
A nurse is providing discharge instructions to a patient with an infection who is prescribed antibiotic therapy. Which of the instructions should the nurse include to help reduce the incidence of antibiotic-resistant organisms? Select all that apply. 1 "Stop taking the antibiotic when you feel better." 2 "Be sure to take your antibiotics as directed by the prescriber." 3 "If your mother has leftover antibiotics, just use those to save money." 4 "Be sure to take all antibiotic doses prescribed even if you feel better." 5 "Save any leftover antibiotics so you can take them anytime you feel ill."
2,4 Patients should be instructed to finish the entire antibiotic prescription even if they feel better. Otherwise, the stronger bacteria may survive, resulting in the development of an antibiotic-resistant infection. Patients should be advised to take antibiotics exactly as prescribed. For example, if the order indicates that the medication should be taken twice a day, the patient should follow those instructions exactly. The patient should not stop taking them when he or she feels better and should finish the entire course as prescribed. The nurse should not recommend that a patient take another person's leftover antibiotics; this is not safe.
A patient was admitted to the hospital with a ruptured abscess on the right thigh. Culture and sensitivity of the drainage showed methicillin-resistant Staphylococcus aureus (MRSA). Why should the nurse be concerned about this infection? Select all that apply. 1 There is no cure for infections due to MRSA. 2 Community-acquired MRSA is more virulent than hospital-acquired MRSA. 3 Hospital-acquired MRSA is more virulent than community-acquired MRSA. 4 MRSA is a form of Staphylococcus aureus that does not respond to methicillin therapy. 5 MRSA is a form of Staphylococcus aureus that does not respond to penicillin-based therapy.
2,4,5 Community-acquired MRSA (CA-MRSA) is more virulent (able to cause disease or infection) compared with health care-associated MRSA (HA-MRSA). CA-MRSA has been known to cause rapidly forming skin infections and systemic diseases, including pneumonia and sepsis. Rates of CA-MRSA infections appear to be on the rise. MRSA is a form of Staphylococcus aureus that does not respond to methicillin- or penicillin-based therapies. The drug of choice for treating CA-MRSA is now believed to be vancomycin (Vancocin); HA-MRSA is susceptible to vancomycin. Newer drugs, such as linezolid (Zyvox) and daptomycin (Cubicin), are effective against both CA-MRSA and HA-MRSA. Linezolid is now felt to be the best drug for treating MRSA pneumonia.
A patient with human immunodeficiency virus (HIV) recently started on antiretroviral therapy, but does not fully understand the purpose of the medication. What should the nurse include in the explanation to improve the patient's understanding? Select all that apply. 1 To cure the HIV disease 2 To decrease the viral load 3 To stop the HIV disease from progressing 4 To prevent transmission of the HIV disease 5 To maintain or increase the CD4 cell counts 6 To prevent HIV-related opportunistic infections
2,4,5,6 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or increase CD4 T cell counts, prevent HIV-related symptoms and opportunistic infections, delay disease progression, and prevent HIV transmission. Curing the HIV disease is incorrect because there is currently no cure for the HIV disease. Stopping the HIV disease from progressing is incorrect because it cannot stop the progression of the HIV disease, but only delay the HIV disease progression.
A public health nurse is teaching a group of people about preventing transmission of contagious infection. Which infections that are airborne and require transmission-based precautions should the nurse include in the teaching? Select all that apply. 1 Cholera 2 Rubeola 3 Influenza 4 Pertussis 5 Tuberculosis
2,5 Transmission-based precautions include airborne precautions, droplet precautions, and contact precautions. Tuberculosis and rubeola are contagious diseases, and the organism can cause infection over long distances when suspended in the air. Therefore airborne precautions are required to prevent transmission of infection. Droplet precautions are used to minimize contact with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Cholera is spread through contaminated water or food.
Which is a microorganism capable of causing disease? 1 Lipase 2 Antigen 3 Pathogen 4 Microorganism
3 A pathogen is a microorganism, such as a bacteria or virus, capable of causing disease. A pathogen can invade the body, multiply, produce disease, and cause harm to the host. An organism that can only be seen with a microscope is termed a microorganism. An antigen is a toxin or foreign substance that enters the body and initiates the immune response. Lipase is a pancreatic enzyme.
A patient that is presently homeless is admitted to the healthcare facility with a respiratory infection suspected to be caused by tuberculosis (TB). Which isolation precaution should the healthcare team initiate? 1 Contact 2 Droplet 3 Airborne 4 Standard
3 Because tuberculosis is a respiratory infection that can be easily spread through the air and via respiratory secretions, airborne precautions are required until the presence or absence of infection is confirmed. Droplet precautions are appropriate for larger molecule pathogens such as bacterial meningitis. Standard precautions are instituted for all patients to prevent the spread of healthcare-associated infections. Contact precautions are used for infections that spread by skin-to-skin contact, such as methicillin-resistant staphylococcus aureus (MRSA).
The nurse is traveling to a third world country to assist with medical care to an underserved population. Dengue fever is a concern in this part of the world, and the nurse recognizes that what virus causes this disease? 1 Ebola virus 2 Hantavirus 3 Flavivirus 4 West Nile virus
3 Flavivirus causes dengue fever. Ebola virus causes Ebola hemorrhagic fever. Hantavirus causes hemorrhagic fever associated with severe pulmonary syndrome. West Nile virus causes West Nile fever.
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1 "The baby probably will be infected with HIV." 2 "Only an abortion will keep your baby from having HIV." 3 "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4 "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
3 On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism are two variables that influence whether transmission of HIV occurs. Volume, virulence, and concentration of the organism, as well as host immune status, are variables related to transmission via blood, semen, vaginal secretions, or breast milk.
The nurse is educating a patient that has human immunodeficiency virus (HIV) about monitoring for the development of opportunistic diseases. What statement made by the patient demonstrates an understanding of the education provided? 1 "These diseases are usually benign." 2 "Opportunistic diseases are not treatable if they occur." Correct3 "They don't usually occur in people with healthy immune systems." 4 "Opportunistic diseases only occur at the end stages of HIV infection."
3 Opportunistic diseases generally do not occur in the presence of a functioning immune system. Organisms that do not cause severe disease in people with functioning immune systems can cause debilitating, disseminated, and life-threatening infections during this stage. Several opportunistic diseases may occur at the same time, compounding the difficulties of diagnosis and treatment. Advances in HIV treatment have decreased the occurrence of opportunistic diseases. These diseases can occur early in the process of HIV infection and sometimes are used to diagnose the presence of HIV.
A nurse is assessing a patient's human immunodeficiency virus (HIV) risk. Which questions should the nurse ask to assess for an increased risk? Select all that apply. 1 "Have you ever had oral thrush?" 2 "Have you ever been hospitalized?" 3 "Have you ever had a blood transfusion?" 4 "Have you ever had unprotected sexual intercourse?" 5 "Have you ever had a sexually transmitted infection?"
3,4,5 To help a patient assess risk of HIV, the nurse should ask questions regarding history of blood transfusion, unprotected sexual intercourse, and sexually transmitted disease. These questions provide the minimum information needed to initiate a risk assessment. A positive response to any of these questions should be followed by an in-depth exploration of issues related to the identified risk. A history of oral thrush or hospitalization may not indicate risky behavior and may not contribute to risk assessment.
A woman who is three months pregnant finds out that she is human immunodeficiency virus (HIV)-positive on routine HIV testing. She wishes to continue her pregnancy. What information should be given to this patient? Select all that apply. 1 Advise her to consider abortion. 2 Inform her that the infant will not be infected. 3 Advise her to consider tubectomy after delivery. 4 Advise her to follow a healthy lifestyle with nutritious food and regular exercise. 5 Advise her that antiretroviral therapy (ART) can decrease the risk of transmission.
3,4,5 Women who are already infected with HIV should be asked about their reproductive desires. Those who choose not to have children should undergo family planning methods like tubectomy. The current standard of care is for all women who are pregnant or contemplating pregnancy to be counseled about HIV, routinely offered access to voluntary HIV-antibody testing, and, if infected, offered optimal ART. In this case, the possibility of maintaining the pregnancy and using ART to decrease the risk of transmission should be discussed. Abortion is not mandatory in such cases. If HIV-infected pregnant women are appropriately treated during pregnancy, the rate of perinatal transmission can be decreased from 25% to less than 2%, but it cannot be guaranteed that the infant will not be infected. The patient should eat a healthy and nutritious diet and do regular exercise to remain active and delay the progression of disease.
A patient with a history of multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false-negative report. 3 The patient is HIV positive, but the viral load is not detectable. 4 The test should be repeated at three weeks, six weeks, and three months.
4 An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at three weeks, six weeks, and three months. The test is unlikely to give a false-negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he or she is HIV positive.
The nurse reviews a plan of care for a patient who has sustained a deep laceration to an extremity. Which goal listed on the plan is inappropriate and should be questioned by the nurse? 1 The patient will be free of signs and symptoms of infection. 2 The patient will demonstrate how to change the sterile dressing on the laceration. 3 The patient will report any change in sensation of the extremity distal to the laceration. 4 The patient will stop taking the antibiotics after two days if he or she detects no signs of infection.
4 If antibiotics are prescribed, the patient should not stop them; rather, the entire course should be taken even if there are no signs of infection. Appropriate goals for this patient are to be free of signs and symptoms of infection, to maintain a dry and intact dressing, and to report changes in the distal extremity.
A patient's laboratory report reveals that the patient's CD4+ T-cell count has dropped below 200 cells/µL. The patient is diagnosed with Burkitt's lymphoma and has herpes simplex with chronic ulcers. The nurse weighs the patient and finds that there is a loss of 10% of body mass. Which infection is likely to be found in this patient? 1 Parvovirus 2 Varicella-zoster 3 Adenoviruses infection 4 Human immunodeficiency virus infection
4 In human immunodeficiency virus infection, the CD4+ T-cell count drops below 200 cells/µL due to the destruction of the white blood cells. As a result, immunity decreases. Due to the decreased immunity, opportunistic infections such as herpes simplex and Burkitt's lymphoma may occur. Due to the ongoing infectious process, the body goes into a state of catabolism, resulting in significant weight loss. Parvovirus produces gastroenteritis. Varicella-zoster virus causes chickenpox and shingles. Adenoviruses cause upper respiratory tract infections and pneumonia.
An older adult patient from a local nursing home is admitted to the medical floor with fever and a productive cough. What precautions should the nurse institute for this patient? 1 Contact 2 Universal 3 Standard 4 Transmission-based
4 The patient should be placed under transmission-based precautions. Depending on further clinical data, the patient might require either droplet or airborne precautions but this is not yet known. Standard precautions are not appropriate, because a nursing home patient may be at risk for a highly virulent respiratory infection such as methicillin-resistant staphylococcus aureus or tuberculosis. Contact precautions are used for draining wounds or contained infective substances. The term "universal precautions" is an outdated term for standard precautions.
The nurse assesses a patient who tests positive for human immunodeficiency virus (HIV). Which finding would the nurse identify as the highest priority for follow-up? 1 Anorexia 2 Insomnia 3 Mood swings 4 New or productive cough
4 The patient who tests positive for HIV should be informed to report a new or productive cough within 24 hours after symptoms begin. After evaluation of the cough, follow-up care for anorexia, insomnia, and mood swings is secondary.
The nurse should assess a patient with acquired immunodeficiency syndrome (AIDS) for which most common symptoms? 1 Tremors and bradykinesia 2 Hematuria and abdominal pain 3 Persistent vomiting and headache 4 Low-grade fever and persistent diarrhea
4 The symptoms of acquired immunodeficiency syndrome (AIDS) are variable, but low-grade fever and persistent diarrhea are common. Tremors and bradykinesia, hematuria and abdominal pain, and persistent vomiting and headache are not specifically associated with AIDS.
A patient has been prescribed antiretroviral therapy (ART), and the nurse is monitoring the assessment of growth of HIV in the concentrations of prescribed antiretroviral drugs. The nurse anticipates that what test will be advised for the patient? 1 Genotype assay 2 Phenotype assay 3 Enzyme immunoassay 4 Immunofluorescence assay
A phenotype assay involves the assessment of growth of HIV in various concentrations of antiretroviral drugs. It helps determine the correct dosage of ART for the patient. A genotype test assesses the drug-resistant mutations in protease and reverse transcriptase genes. The enzyme immunoassay and immunofluorescence assay are used to detect serum antibodies that bind to HIV antigens.
The nurse assesses a patient with recently diagnosed acquired immunodeficiency syndrome (AIDS). When obtaining a health history from the patient, what statement does the nurse determine most correlates with this diagnosis? 1 "I am feeling fatigue in the evening." 2 "I am sleeping six to eight hours per night." 3 "I have had a steady weight loss over the past several months." 4 "I have been having feelings of helplessness and hopelessness."
A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss.
A patient with human immunodeficiency virus (HIV) comes into the clinic with a temperature of 102oF. Which statement would be of most concern to the nurse? 1 "I vomited once this morning." 2 "I woke up this morning with a mild headache." 3 "I have a rash that appeared on my stomach this morning." 4 "I started coughing up some clear mucous when I woke up this morning."
Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours.
A patient is diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse monitor for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex
Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS, because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with HIV due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus, and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence.
The nurse was stuck accidently with a needle used on a patient with human immunodeficiency virus (HIV). After reporting this, what is a priority action by the nurse? 1 A negative evaluation by the manager 2 Applying personal protective equipment 3 Start on combination antiretroviral therapy 4 Begin counseling to report blood exposures
Correct3 Start on combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first.
The nurse is reviewing the pathophysiology of human immunodeficiency virus (HIV) infection. Which of these statements about HIV infection is true? 1 HIV is able to replicate outside a living cell. 2 The virus replicates going from DNA to RNA. Correct3 The immune system is impaired from CD4+ T cell destruction. 4 Infection of monocytes occur, but antibodies quickly destroy these cells.
Correct3 The immune system is impaired from CD4+ T cell destruction. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells (also known as T helper cells or CD4+ T lymphocytes). HIV cannot replicate unless it is inside a living cell. HIV replicates in a "backward" manner (going from RNA to DNA). Antibodies do not destroy the infected monocytes.
The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). The patient asks what would determine the actual development of acquired immunodeficiency syndrome (AIDS). The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? 1 Presence of HIV antibodies 2 CD4 +T cell count below 200/µL 3 Presence of oral hairy leukoplakia 4 White blood cell (WBC) count below 5000/µL
Diagnostic criteria for AIDS include a CD4 +T cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or oral hairy leukoplakia or WBC count below 5000/µL may be found in patients with HIV disease, but do not define the advancement of HIV infection to AIDS.
A patient has been diagnosed with Burkitt's lymphoma. When the nurse educates the patient regarding the disease, what virus should the patient be informed caused it? 1 Echoviruses 2 Epstein-Barr 3 Rotaviruses 4 West Nile virus
Epstein-Barr virus causes mononucleosis and Burkitt's lymphoma. Echoviruses cause upper-respiratory tract infection, gastroenteritis, and aseptic meningitis. Rotaviruses cause gastroenteritis. The West Nile virus causes flu-like symptoms, meningitis, and encephalitis.
A patient who participates in high-risk activities has undergone an enzyme immunoassay (EIA) test for human immunodeficiency virus (HIV) infection. The nurse reviews the patient's lab results and notes a positive EIA result. What is likely to be included in the patient's plan of care? Select all that apply. 1 Repeat the EIA test. 2 Confirm with a Western blot test. 3 Confirm with an immunofluorescence assay. 4 Confirm with a rapid screening test for antigens. 5 Inform the patient that the patient is HIV-antibody positive.
If the patient tests positive with the enzyme immunoassay (EIA) test, which is highly sensitive, the test has to be repeated. If the repeat test is positive, the patient should be subjected to a confirmatory Western blot or immunofluorescence assay. Rapid screening tests are helpful for detecting antibodies, not antigens. The patient should be informed that he is positive for HIV antibody only if the confirmatory Western blot or immunofluorescence assay is positive.
During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidioides immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans
Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus and the presence of thrush indicate Candida albicans. Infection by Coccidioides immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans.
A patient with a bacterial infection is prescribed penicillin G. After reviewing the patient's laboratory report, the nurse anticipates a need for a medication change to either ceftriaxone or cefotaxime. Which microorganism did the nurse likely find in the report? 1 Enterococcus faecalis 2 Staphylococcus aureus 3 Staphylococcus epidermidis 4 Streptococcus pneumoniae
Penicillin G is a beta-lactam antibiotic that kills bacteria by blocking the cell wall production and the cross-linking enzyme transpeptidase. Streptococcus pneumoniae is a gram-positive bacterium and is resistant to penicillin G. Ceftriaxone or cefotaxime can be used to treat infections caused by Streptococcus pneumoniae, because these medications act by inhibiting the bacterial cell wall synthesis. Enterococcus faecalis is a gram-positive bacterium that is sensitive to penicillin G or ampicillin. Staphylococcus aureus is a gram-positive coccal bacterium that is sensitive to vancomycin. Ceftriaxone and cefotaxime are not effective in killing Staphylococcus epidermidis; this gram-positive bacterium is sensitive to vancomycin.
A patient with human immunodeficiency virus (HIV) taking antiretroviral therapy reports they are starting to feel like they did before starting the therapy. What test should the nurse prepare the patient for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test
The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection.