NU371 PrepU: Management of patients with immune deficiency disorders

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

a) "The majority of primary immunodeficiencies are diagnosed in infancy." - The majority of primary immunodeficiencies are diagnosed in infancy, with a male-to-female ratio of 5 to 1.

A client is to receive intravenous immunoglobulin (IVIG). The infusion is started at 10 a.m. The nurse would be alert for signs and symptoms of an anaphylactic reaction during which time frame? a) 10:30 to 11:00 a.m. b) 11:00 to 11:30 a.m. c) 11:30 a.m. to 12:00 p.m. d) 12:30 p.m. to 1:30 p.m.

a) 10:30 to 11:00 a.m. - When administering IVIG, anaphylactic reactions typically occur 30 to 60 minutes after the start of the infusion. Therefore, the time frame would be 10:30 to 11:00 a.m.

A client is diagnosed with common variable immunodeficiency (CVID). What would the nurse identify as potential infections for this client? Select all that apply. a) Hemophilus influenzae b) Streptococcus pneumoniae c) Staphylococcus aureus d) Pneumocystis jiroveci pneumonia

a) Hemophilus influenzae b) Streptococcus pneumoniae c) Staphylococcus aureus - Clients with CVID are susceptible to infections with Hemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus. Opportunistic infections with Pneumocystis jiroveci pneumonia are seen only in clients with a concomitant deficiency in T-lymphocyte immunity.

A client with ataxia-telangiectasia is admitted to the unit. The nurse caring for the client would expect to see what included in the treatment regimen? a) IV gamma globulin administration b) Platelet administration c) Factor VIII administration d) Thymus grafting

a) IV gamma globulin administration - Treatment for ataxia-telangiectasia includes IV gamma globulin, antimicrobial therapy, and bone marrow transplantation. It does not include platelet administration, factor VIII administration, or thymus grafting.

What does the nurse understand will result if the patient has a deficiency in the normal level of complement? a) Increased susceptibility to infection b) Decrease in vascularity to the extremities c) Development of congestive heart failure d) Risk of stroke

a) Increased susceptibility to infection - The complement system is an integral part of the immune system, and deficiencies in normal levels of complement result in increased susceptibility to infectious diseases and immune-mediated disorders.

HIV is harbored within which type of cell? a) Lymphocyte b) Platelet c) Erythrocyte d) Nerve

a) Lymphocyte - Because HIV is harbored within lymphocytes, a type of white blood cell, any exposure to infected blood results in significant risk of infection. HIV infection is not harbored in platelets, erythrocytes, or nerve cells.

A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? a) TMP-SMZ b) Cephalexin c) Azithromycin d) Garamycin

a) TMP-SMZ - TMP-SMZ (Bactrim, Cotrim, Septra) is the treatment of choice for PCP; it is as effective as parenteral pentamidine isethionate (Pentacarinat) and more effective than other regimens.

When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? a) The body has not produced antibodies to the AIDS virus. b) The client has not been infected with HIV. c) The client is immune to the AIDS virus. d) Antibodies to the AIDS virus are in the client's blood.

a) The body has not produced antibodies to the AIDS virus. - A negative test result indicates that antibodies to the AIDS virus are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that, if infected, the body has not produced antibodies (which takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk client must be encouraged. The test result does not mean that the client is immune to the virus, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? a) Urine b) semen c) blood d) breast milk

a) Urine - HIV is transmitted in body fluids that contain free virions and infected CD4+ T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. Urine is not a body fluid responsible for HIV transmission.

Which allergic reaction is potentially life threatening? a) angioedema b) urticaria c) contact dermatitis d) None of the listed allergic reactions is potentially life threatening.

a) angioedema - Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens? a) back b) forearm c) upper arm d) chest

a) back - The scratch or prick test involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. The tester applies one allergen per scratch over the client's forearm, upper arm, or back. The back is more sensitive than the arms.

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

a) testing the client for the presence of HIV - Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may correlate with HIV infection. Wearing cotton underwear can help with the prevention of candidiasis but does not address the recurrent vaginal infection that may not be caused by a fungus. Abstaining from sexual intercourse does not address the recurrent vaginal infection. A medicated douche can alter the normal flora of the vaginal wall.

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? a) Sign a refusal of blood transfusion form so the client will not receive the transfusion. b) Bank autologous blood. c) Ask people to donate blood. d) Using volume expanders in case blood is needed.

b) Bank autologous blood. - Signing the refusal form does not give the client any information about the options that are available and place the client at risk. Banking autologous blood that is self-donated is the safest option for the client. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.

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? a) Anorexia b) Chronic diarrhea c) Nausea and vomiting d) Oral candida

b) Chronic diarrhea - Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of acquired immune deficiency syndrome (AIDS) can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

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? a) Imbalanced nutrition: more than body requirements b) Diarrhea c) Bowel incontinence d) Constipation

b) Diarrhea - Diarrhea is a problem in 50% to 90% of all AIDS patients. In patients with AIDS, the effects of diarrhea can be devastating in terms of profound weight loss, fluid and electrolyte imbalances, perianal skin excoriation, weakness, and the inability to perform self-care activities. Although the patient may experience bowel incontinence related to the diarrhea, the priority GI-related nursing diagnosis for more than 50% of patients with AIDS is diarrhea.

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

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

A nurse is preparing an in-service presentation about primary immunodeficiencies. When describing these conditions, what would the nurse need to integrate into the presentation? a) Overall, these conditions more commonly affect females. b) Most cases are typically diagnosed in infancy. c) The conditions appear to predominate in males after adolescence. d) Primary immunodeficiencies are more common than secondary immunodeficiencies

b) Most cases are typically diagnosed in infancy. - Most primary immunodeficiencies are diagnosed in infancy, with a male-to-female ratio of 5 to 1. A large fraction of primary immunodeficiencies are not diagnosed until adolescence or early adulthood when the gender distribution equalizes. Secondary immunodeficiencies are more common than primary immunodeficiencies.

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? a) ELISA b) Western Blot c) T4/T8 ratio d) Polymerase chain reaction

b) Western Blot - The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. A positive result on Western blot confirms the diagnosis; however, false-positive and false-negative results on both tests are possible. A polymerase chain reaction gives the viral load of the client. The T4/T8 ratio determines the status of T lymphocytes.

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? a) "I will let my neighbor have my pet iguana." b) "I will apply lotion following every bath to prevent dry skin." c) "I can take my child to the beach, as long as we play in the sand rather than swim in the water." d) "I will avoid letting my child drink any juice that has been sitting out for more than an hour."

c) "I can take my child to the beach, as long as we play in the sand rather than swim in the water." - Parents should verbalize ways to plan for regular exercise and activity that does not pose a risk of infections. Immunocompromised clients should avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis.

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

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

When do most perinatal HIV infections occur? a) Through breastfeeding b) In utero c) After exposure during delivery d) Through casual contact

c) After exposure during delivery - Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses, including the steps in the process of HIV entering the host cell. What would the nurse describe as the first step? a) Cleavage b) Budding c) Attachment d) Uncoating

c) Attachment - Once HIV enters the host cell, attachment occurs in which the glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors. This is followed by uncoating, in which HIV's viral core is emptied into the CD4+ T cell. Cleavage and budding occur as the last steps.

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

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

There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS? a) Sharing the diagnosis with a support group b) Caring for a client who can kill other people c) Disclosure of the client's condition d) Caring for a client with an infectious terminal disease

c) Disclosure of the client's condition - Despite HIV-specific confidentiality laws, clients infected with AIDS fear that disclosure of their condition will affect employment, health insurance coverage, and even housing. Since healthcare providers do not share a client's diagnosis with a support group, option A is incorrect. Caring for a client with an infectious terminal illness that can be transmitted to other people is a concern for healthcare providers but it is not an ethical issue.

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

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

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? a) Active substance abuse b) Depression c) Past substance abuse d) Lack of social support

c) Past substance abuse - Factors associated with nonadherence include active substance abuse, depression, and lack of social support, as well as neurocognitive impairment, low health literacy, stressful life events, high levels of alcohol consumption, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? a) The use of condoms b) What vaccinations to have c) Side effects of drug therapy d) The action of each antiretroviral drug

c) Side effects of drug therapy - Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

The nurse reviews laboratory results requested to track HIV. What laboratory test measures HIV RNA levels and is the best predictor of HIV disease progression? a) Enzyme immunoassay (EIA) b) Western blot c) Viral load d) CD4/CD8

c) Viral load - The viral load test quantifies the plasma HIV RNA levels and response to treatment of the HIV infection. It also confirms a positive EIA result and detects HIV in high-risk seronegative individuals before antibodies are measurable.

A client is given a dose of ketorolac, a nonsteroidal anti-inflammatory drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client's eyes, lips, and face begin to swell, and the nurse hears stridor. What priority measure should the nurse prepare to do? a) Intubate the client. b) Perform an electrocardiogram (ECG). c) Assess the client's vital signs. d) Administer epinephrine.

d) Administer epinephrine. - Anaphylaxis is a rapid and profound type I hypersensitivity response. A massive release of histamine causes vasodilation; increased capillary permeability; angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs); hypotension; and bronchoconstriction. A nurse must administer 0.2 mg of epinephrine subcutaneously to a client experiencing a severe allergic reaction. It is outside of the nurse's practice to intubate a client. Performing an ECG and assessing the vital signs delays the treatment of the client and can have negative outcomes.

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? a) Reverse the HIV+ status to a negative status. b) Treat mycobacterium avium complex. c) Eliminate the risk of AIDS. d) Bring the viral load to a virtually undetectable level

d) Bring the viral load to a virtually undetectable level - The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.

A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? a) MAC b) Wasting syndrome c) Kaposi's sarcoma d) Candidiasis

d) Candidiasis - Candidiasis, a fungal infection, occurs in almost all clients with AIDS and immune depression (Durham & Lashley, 2010). Oral candidiasis is characterized by creamy-white patches in the oral cavity and, if left untreated, can progress to involve the esophagus and stomach. Associated signs and symptoms include difficult and painful swallowing and retrosternal pain.

A client is diagnosed with common variable immunodeficiency (CVID). When assessing the client for possible infection, what would the nurse identify as a least likely cause? a) Hemophilus influenzae b) Streptococcus pneumonia c) Staphylococcus aureus d) Pneumocystis jiroveci pneumonia

d) Pneumocystis jiroveci pneumonia - Clients with CVID are susceptible to infections with Hemophilus influenzae, streptococcus pneumoniae, and staphylococcus aureus. Opportunistic infections with Pneumocystis jiroveci pneumonia are seen only in clients with a concomitant deficiency in T-lymphocyte immunity.

A male patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows antibodies to the AIDS virus are present in the blood, this indicates what? a) The patient is immune to HIV. b) AIDS is inactive in the body. c) The patient may have unprotected intercourse because he is not infected with HIV. d) The patient has been infected with HIV.

d) The patient has been infected with HIV. - Positive test results indicate that antibodies to the AIDS virus are present in the blood, HIV is probably active in the body, the patient does not necessarily have AIDS, the patient is not immune to AIDS, and the patient may not necessarily get AIDS in the future. The patient is not immune to HIV, and the patient may not have unprotected intercourse.