MRSA, HIV, Lupus

Symptoms of impaired immune system

lymphadenopathy fever night sweats cough skin lesions diarrhea Common symptoms of an impaired immune systems include fever, cough, weakness, nausea/vomiting, diarrhea, dysphagia, forgetfulness, skin lesions, dyspnea, headache, vision changes, pain, night sweats, and lymphadenopathy.

The client tells the nurse, "Who cares if I have methicillin-resistant Staphylococcus aureus (MRSA)? Just give me some antibiotics and everything will be okay." What is the nurse's best response to this client statement? "The correct antibiotic therapy will clear up this infection, so there is no need to worry." "Antibiotics can be given, but it is equally important to make sure that no complications arise due to the presence of MRSA." "Using antibiotics more frequently will only lead to further antibiotic resistance." "As long as you are asymptomatic, you don't need any antibiotic therapy."

"Antibiotics can be given, but it is equally important to make sure that no complications arise due to the presence of MRSA."

Which statements from a patient diagnosed with human immunodeficiency virus indicate understanding of the virus? Select all that apply. "Because I am at a higher risk for opportunistic infection and malignancies, I should have annual routine screenings." "I should avoid raw or undercooked foods such as sushi or rare meat to decrease the risk for diarrheal illnesses." "I don't need to take any extra precautions to clean up blood spills in my own home." "My partner will empty our cat's litter box so that I am not exposed to toxoplasmosis." "Condoms are not necessary if I am in a monogamous relationship and I take my medication."

"Because I am at a higher risk for opportunistic infection and malignancies, I should have annual routine screenings." "I should avoid raw or undercooked foods such as sushi or rare meat to decrease the risk for diarrheal illnesses." "My partner will empty our cat's litter box so that I am not exposed to toxoplasmosis."

Which client is mostly likely to have lupus? 18-year-old Caucasian female who wears glasses for correction of farsightedness 80-year-old Hispanic female who has just been diagnosed with type 2 diabetes 32-year-old African-American female who is a gravida 2 para 2 40-year-old Caucasian male who has a history of hypertension that is well controlled with medication therapy

32-year-old African-American female who is a gravida 2 para 2

What is the length of progression untreated HIV to acquired immune deficiency syndrome (AIDS)? A few days to a year A year to around 5 years A few years to longer than a decade Several decades

A few years to longer than a decade

A client with lupus is receiving hydroxychloroquine as part of her therapeutic regimen. Based on this finding, the nurse would anticipate assessing: Body mass index Blood pressure Baseline eye exam Mental status

Baseline eye exam

Which antibody is considered to be highly specific for lupus? Anti-ds DNA ANA Anti-RNP Antiphospholipid

ANA

At which stage will the client's immune system become symptomatic and unable to fight the progression of the virus? Seroconversion Asymptomatic chronic infection Symptomatic chronic infection Acquired immune deficiency syndrome

Acquired immune deficiency syndrome

After several days of intravenous treatment, Mr. Nguyen is asking when he will no longer need to be on contact precautions. What statement by the nurse is correct? After 10 days of IV vancomycin administration After three or more surveillance tests show clearance Until discharge For the rest of his life

After three or more surveillance tests show clearance Discontinuation of contact precautions for MRSA clients may occur when clearance of the organism has been documented with three or more surveillance tests. Retesting patients to document clearance is commonly done 3 to 4 months after the last positive test result. However, some institutions consider MRSA-colonized patients to be colonized indefinitely.

Janet has been scheduled for a knee replacement. What is the most likely reason for this surgery? Ground level fall (GLF) with negative imaging study Avascular necrosis Osteoporosis of the spine Hypertension

Avascular necrosis Clients who are diagnosed with lupus may require surgical intervention and/or joint replacement due to avascular necrosis, or death of bone tissue.

Janet tells the nurse that she has reoccurring migraine headaches. Which additional teaching should the nurse provide? Avoid the use of NSAIDS Avoid oral contraceptives Increase fluid intake to protect your kidneys Monitor your urine output much more closely

Avoid oral contraceptives Oral contraceptives should be avoided in SLE patients who have migraine headaches, Raynaud's phenomenon, a history of phlebitis, or antiphospholipid antibodies. SLE clients have an increased risk of hypercoagulability, which may be heightened by the use of oral contraceptives.

The nurse is caring for a client newly diagnosed with human immunodeficiency virus who is concerned about the risk of transmitting the virus to others. What information about virus transmission should the nurse include in the teaching session? Select all that apply. Avoid the use of alcohol and drugs that can impair your judgment. Do not share towels or underclothing. Clean blood spills with bleach solution. Use condoms with every sexual encounter. Avoid kissing or sharing drinks with others.

Avoid the use of alcohol and drugs that can impair your judgment. Clean blood spills with bleach solution. Use condoms with every sexual encounter.

Hydroxychloroquine has been prescribed for Janet. Which safety measures should be incorporated into the plan of care? Select all that apply. Weekly funduscopic exam to denote retinal changes Baseline eye exam prior to initiating therapy Calculation of renal clearance rate Biannual eye exam while the client is taking hydroxychloroquine Skeletal survey to denote potential arthritic changes in joints

Baseline eye exam prior to initiating therapy Biannual eye exam while the client is taking hydroxychloroquine Safety management for hydroxychloroquine therapy requires a baseline eye exam with follow up annual or biannual eye exams to ascertain presence of retinal changes. Retinal toxicity can occur with long-term usage of this drug.

Can you differentiate assessment data for immunodeficiency disorders? For each disorder, drag and drop the clinical manifestations associated with the specific disorder to the box. Asymptomatic Chronic infection

CD4+ count near normal Drop in viral load During the asymptomatic chronic infection stage, the body's immune system is able to maintain control over the invading virus by increasing the CD4+ count as the viral load drops to a set point. Total elimination of the virus is not possible, but the patient is asymptomatic. It is important to recognize that the virus can still be transmitted during the phase.

Which findings alert the nurse to the possibility of a hospitalized client developing hospital-acquired methicillin-resistant Staphylococcus aureus? Select all that apply. Client has intravenous line. Client has frequently used antibiotic therapy. Client is on a full-liquid diet. Client just had a pacemaker placed. Client is allergic to sulfa.

Client has intravenous line. Client has frequently used antibiotic therapy. Client just had a pacemaker placed.

In reviewing a client's hospital chart, the nurse notes that in addition to multiple comorbidities, the client has been diagnosed with hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA). Based on this finding the nurse determines that: A shortened hospital stay will be anticipated. The clinical diagnosis of HA-MRSA will have no direct effect on client's outcome. It is likely that the client will require blood transfusions for stabilization. Client is at risk for increased morbidity and mortality as a result of HA-MRSA diagnosis.

Client is at risk for increased morbidity and mortality as a result of HA-MRSA diagnosis.

Test results confirm that Mr. Nguyen is positive for MRSA. Based on this result, the nurse should institute which type of precaution? Contact precaution Bloodborne precaution Placement in a private room with an antechamber washroom Placement in a laminar flow room

Contact precaution Use of contact precaution is the mainstay for clients who are positive for MRSA. Bloodborne precaution is not needed since MRSA is typically located in the nares. Although a private room is preferred, a client who has MRSA can be placed with another client who has the same infection. A laminar flow room is appropriate for a client who has tuberculosis or another serious airborne infectious disease.

What benefits does hydroxychloroquine have for treatment of symptoms of lupus? It provides an additive protective benefit against malaria. It promotes weight gain to maintain adequate nutritional stores. It improves red blood count to prevent anemia from developing. It impairs complement-dependent antigen-antibody reactions.

It impairs complement-dependent antigen-antibody reactions.

Janet has been treated for lupus for several years. Which clinical finding is a priority concern on a follow-up visit? Decreased white blood cells, platelets, and red blood cells Temperature of 99.8° Fahrenheit and complaints of chills and increased fatigue Fasting blood sugar result of 85 mg/dL Nonproductive cough for two days

Decreased white blood cells, platelets, and red blood cells. Clinical signs of pancytopenia (decreased blood counts across all cells lines) indicates immunosuppression and would require intervention. Fasting blood sugar result is within normal range. Nonproductive cough for 2 days and slight temperature elevation along with complaints of chills and increased fatigue should be monitored but are not a priority concern in view of clinical immunosuppression.

Mr. Nguyen progresses through hospitalization and following the surgical revision, the surgical site becomes positive for MRSA. Based on this new finding, the provider initiated intravenous therapy of vancomycin. Mr. Nguyen has been on this therapy for 5 days. Which assessment data should the nurse evaluate before hanging the next scheduled dose of therapy? Select all that apply. Client's current weight Documentation of peak level prior to start of scheduled dose Determination of trough level prior to start of scheduled dose Patency of intravenous access site Hydration status

Documentation of peak level prior to start of scheduled dose Determination of trough level prior to start of scheduled dose Patency of intravenous access site Hydration status Vancomycin is the most commonly initiated IV therapy for MRSA. When hanging ongoing vancomycin therapy, it is important to know the trough level prior to initiation of dosing. If the trough level is too high, then the dosage may be adjusted or held to prevent potential nephrotoxicity. A peak level is the drug's highest serum level and would not be obtained prior to the start of the scheduled dose. Although the client's weight is an important baseline factor for dosing, it is not necessary to include the client's current weight. It is important to note that the intravenous site can be accessed since the medication is an irritant. The client's hydration status is not pertinent.

What is the key to prolonging life with HIV and AIDS? Select all that apply. Prevent of the spread of the virus to others Eradicate the virus in the body Slow the replication of the virus Early identification of infection

Early identification of infection

Janet is concerned that her kidneys are not functioning as well as they should. Which labs indicate she is experiencing a decreased renal function? Select all that apply. Elevated BUN level Elevated CRP Elevated ESR Elevated creatinine level Elevated urine protein

Elevated BUN level Elevated creatinine level Elevated urine protein. Elevated BUN and creatinine along with the presence of proteinuria may indicate decreased renal function and is one of the clinical criteria for SLE. An elevated CRP and/or ESR indicates inflammation and may require intervention, but are not specific to kidney function.

The nurse is providing care to a patient whose CD4+ count is below 200 cells/µL. Which illnesses and opportunistic infections should the nurse assess for when providing patient care? Select all that apply. Esophageal candidiasis Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Progressive multifocal leukoencephalopathy Urinary tract infection

Esophageal candidiasis Pneumocystis (carinii) jiroveci pneumonia Mycobacterium avium complex Progressive multifocal leukoencephalopathy

Which clinical manifestation may occur during the acute viral infection stage of human immunodeficiency virus infection? Weight loss Oral thrush Flu-like symptoms Night sweats and cough

Flu-like symptoms

What nursing action is considered to be a best-practice in stopping the spread of methicillin-resistant Staphylococcus aureus in the clinical setting? Vital sign assessment Changing the client's water pitcher Hand hygiene Changing the first post-operative dressing using sterile technique

Hand hygiene

Mr. Nguyen is an older adult admitted to the hospital from a long-term care facility for treatment of a hip fracture that occurred during a fall. Upon admitting the client to the surgical unit, the nurse obtains assessment data based on a provided client history.Which factors, if noted in Mr. Nguyen's history, would increase the risk of him having methicillin-resistant Staphylococcus aureus (MRSA)? Select all that apply. History of type 2 diabetes, controlled with medication He is a widower Resides in a long-term care facility Surgery required to correct the hip fracture Client is male

History of type 2 diabetes, controlled with medication Resides in a long-term care facility Surgery required to correct the hip fracture Risk factors for MRSA include history of type 2 diabetes, residence in a long-term care environment where clients have frequent contact with multiple people, and invasive medical or surgical procedures

Janet is experiencing increased joint pain. Based on this information, what therapy may be considered to decrease pain and inflammation? High dose glucocorticoids Topical glucocorticoids Biologic response modifier Immunosuppressive agent

Immunosuppressive agent Immunosuppressive agents such as methotrexate are the first-line therapy for treatment of joint pain and synovitis. A low-dose glucocorticoid may also be considered.

Which medication would the nurse anticipate to be ordered for a client who was admitted with synovitis from an exacerbation of lupus? Antibiotics to treat infection Acetaminophen for pain relief Immunosuppressive agents to modify immune response Total parenteral nutrition for nutritional support

Immunosuppressive agents to modify immune response

Mr. Nguyen is going to be medicated for MRSA. Based on the information provided, which pharmacological statement is accurate about MTSA treatments? It is not necessary to obtain a peak level for vancomycin as the dosage indicated for this type of therapy is at the lower therapeutic range. While the client is taking linezolid, he should refrain from using sugar substitutes. There is an increased likelihood for the client to experience constipation while being treated with clindamycin.] Initiation of a decolonization process using mupirocin ointment in both nares should be instituted.

Initiation of a decolonization process using mupirocin ointment in both nares should be instituted. Decolonization treatment for MRSA is provided intranasally with mupirocin ointment. When using vancomycin as a therapy treatment, use of peak/trough level monitoring is required to verify that dosages are both safe and therapeutic. Patients taking linezolid should avoid foods with high tyramine contents, not sugar substitutes. The client taking clindamycin is at risk for diarrhea and C-diff infection.

The nurse observes a student in Mr. Nguyen's room. Which situations requires correction by the nurse? Select all that apply. Isolation gown and gloves are removed as the student enters the hallway. Hand hygiene performed before the isolation gown and gloves are applied. Isolation gown is secured at the waist only. Hand hygiene performed after the student leaves the room. Student checks Mr. Nguyens identification band before giving a medication.

Isolation gown and gloves are removed as the student enters the hallway. Isolation gown is secured at the waist only. Hand hygiene performed after the student leaves the room.

A 48-year-old female client with long-standing lupus is being admitted for surgery. Which type of surgery might be indicated based on this established clinical diagnosis? Total abdominal hysterectomy due to fibroids Knee replacement from joint destruction Cataract removal Incision and drainage of rectal abscess

Knee replacement from joint destruction

The nurse is providing medication teaching for a patient who is positive for human immunodeficiency virus and has been prescribed tenofovir. Which adverse reactions to the drug should the nurse include in the session? Select all that apply. Severe rash Yellow sclera Elevated glucose Lactic acidosis Decreased bone density

Lactic acidosis Decreased bone density

The nurse is reviewing the CD4+ count for several patients who have tested positive for human immunodeficiency virus (HIV). Which patient is classified as HIV, stage 3? At least 500 cells/µL 300 cells/µL 450 cells/µL Less than 200 cells/µL

Less than 200 cells/µL

According to the American College of Rheumatology, which finding would be considered to establish a clinical diagnosis of lupus? Meeting all 7 established criteria Meeting 4 out of the 11 established criteria Meeting 2 out of the 8 established criteria Meeting all 10 established criteria

Meeting 4 out of the 11 established criteria

When considering the epidemiological presence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which statement is most accurate? All clients who test positive for CA-MRSA are symptomatic. The most likely location for detection of CA-MRSA is in the peripheral joints of the lower extremities. MRSA is found in bodies of stagnant water. Most CA-MRSA infections are of the skin and soft tissue.

Most CA-MRSA infections are of the skin and soft tissue.

The nurse is assessing a patient who is positive for human immunodeficiency virus and has been experiencing night sweats. Which is the probable cause of the clinical manifestation? Anemia Mycobacterial infection Candidiasis Tuberculosis

Mycobacterial infection

Janet is a 28-year-old female who has received a clinical diagnosis of lupus from her primary care physician following confirmation of diagnostic testing. After learning of the diagnosis, she returns to the office for initial health promotion measures. Which of Janet's behaviors requires that the nurse provide further instruction to prevent flare-ups of lupus symptoms? Select all that apply: Not covering up while in the sun Eating a balanced diet to avoid illness Avoidance of dusty work areas Drinking eight glasses of water each day Limiting exercise and activity

Not covering up while in the sun Limiting exercise and activity Additional stress due to increased workload will contribute to the fatigue often associated with lupus. Clients with this disease should consume a well-balanced diet and participate in regular exercise to maintain joint health. Exposure to dusty area can increase flares. Exposure to sunlight can cause a flare and should be avoided.

AIDS

Pneumocystis (carinii) jiroveci pneumonia CD4+ count is less than 200 cells/uL Esophageal candidiasis Mycobacterium avium complex toxoplasmosis As the body weakens, the HIV virus will progress to AIDS. AIDS is defined by two things. The patient may have a CD4+ count is less than 200 cells/µL or present with an AIDS-defining illnesses or opportunistic infections. AIDS-defining illnesses include: Pneumocystis (carinii) jiroveci pneumonia, Mycobacterium avium complex, toxoplasmosis, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. The patient may also develop pain while swallowing due to esophageal candidiasis.

A client who has a clinical diagnosis of lupus has an increased chance of acquiring which complication? Chronic obstructive pulmonary disease Renal damage Pulmonary edema Migraine headaches

Renal damage

Janet has been taking NSAID therapy for several months and is concerned about possible complications. What is important for the nurse to educate her about? Increased metabolism leading to hyperthermia Dyspnea leading to respiratory distress Renal impairment due to decreased renal blood flow Blurred vision

Renal impairment due to decreased renal blood flow Use of NSAID therapy can lead to renal impairment as a result of inhibition of prostaglandins responsible for preserving blood flow.

Based on your admission assessment, the nurse identifies that Mr. Nguyen should be screened for MRSA. Which method would the nurse use to obtain a specimen, and from which anatomical location would the specimen be obtained to show colonization? Intradermal injection; inner aspect of arm Sterile swab; anterior nares Blood specimen; venous access Imaging study; chest x-ray

Sterile swab; anterior nares The most common location to obtain a specimen for MRSA colonization is the anterior nares. Use of a sterile swab is the preferred collection method. Intradermal injection on the inner aspect of the arm would be used to administer a PPD to determine whether an individual had tuberculosis. A blood sample could be used to ascertain serum glucose level or other specific testing parameters. Examination of the urethral meatus would be needed if one was trying to determine the presence of genitourinary infection. An imaging study, specifically a chest x-ray, would reveal information relative to the respiratory and cardiac systems.

While the nursing staff is waiting for test results, which method would be instituted as part of a prevention strategy? Initiation of reverse isolation Two shower applications of Kwell shampoo Use of Personal Protective Equipment (PPE) throughout the course of hospitalization Strict handwashing utilized in all client care interactions

Strict handwashing utilized in all client care interactions While waiting for the test results, the nursing staff should always maintain strict handwashing techniques as the best prevention strategy. There is no need for reverse isolation as there is no current evidence of immunosuppression. There is no confirmed reason at present to anticipate that the use of PPE will be warranted during the client's hospitalization.

The nurse is teaching for a client with lupus about immunizations, as she is planning a trip overseas. What recommendation should the nurse make? The client should not receive any live vaccines. There are no contraindications to vaccinations. Immunizations should be administered orally rather than by injection. Immunizations are not needed for overseas travel.

The client should not receive any live vaccines.

When considering the epidemiology of lupus, which statements are accurate? Select all that apply. Clients with lupus who have a higher socioeconomic status are more likely to have poor disease control. The majority of clients diagnosed with lupus are between 16 and 55 years old. Male clients with lupus are more likely to have renal disease than female clients with lupus. People who have relatives with lupus are at higher risk of developing the disease. There is no genetic association noted with the occurrence of this disease.

The majority of clients diagnosed with lupus are between 16 and 55 years old. Male clients with lupus are more likely to have renal disease than female clients with lupus. People who have relatives with lupus are at higher risk of developing the disease.

Which statement indicates that the nurse understands pharmacological treatment of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA)? Ampicillin is the most likely drug that the physician will order. Alternative therapies should be used for clients who have allergies to penicillin as this is the drug of choice for MRSA. Vancomycin therapy will be initiated via parenteral route. Serum blood work evaluating the client's uric acid level will be required during the course of therapy.

Vancomycin therapy will be initiated via parenteral route.

Symptomatic Chronic HIV Infection

frequent respiratory infections skin problems lymphadenopathy The symptomatic chronic HIV infection phase is when the body begins to lose its fight against the virus. During this phase, the CD4+ count will fall and the viral load begins to take over, making it more difficult for the person to fight off infections. Symptoms begin to develop, such as frequent respiratory infections, enlarged lymph nodes, and skin rashes and disorders. Once a person with HIV becomes symptomatic, the average time to the development of AIDS is 2 years.

Can you differentiate assessment data for immunodeficiency disorders? For each disorder, drag and drop the clinical manifestations associated with the specific disorder to the box. Acute Viral Infection and Seroconversion

swollen lymph nodes rapid viral load increase generalized aches and pains low-grade fever During the acute viral infection and seroconversion, the CD4+ lymphocyte count rapidly decreases and the viral load rapidly increases as the HIV virus spreads. The individual may experience flu-like symptoms during this time including low-grade fever, generalized aches and pains, swollen lymph nodes, and generally feeling ill. After several weeks, the person's immune system develops antibodies to HIV, seroconversion occurs, and the person tests positive for HIV.