NU371 Week 2 PrepU: Management of Patients With Immune Deficiency Disorders (Chapter 36)

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

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

Which allergic reaction is potentially life threatening? o angioedema o urticaria o contact dermatitis o None of the listed allergic reactions is potentially life threatening.

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

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

o Liquids · The nurse should encourage clients with AIDS to consume liquids in order to help replace fluid and electrolyte losses. Gluten and sucrose may increase the complication of malabsorption. Large doses of iron and zinc should be avoided because they can impair immune function.

A nurse knows that more than 50% of clients with CVID develop the following disorder. o Hypocalcemia o Pernicious anemia o Neutropenia o Chronic diarrhea

o Pernicious anemia · More than 50% of clients with CVID develop pernicious anemia. Although chronic diarrhea may occur in clients with CVID, it does not happen in 50% of them. Hypocalcemia and neutropenia are not concerns for clients with CVID.

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint? o Weight loss o Gynecologic problems o Muscle and joint pain o Rashes on the face, trunk, palms, and soles

o Gynecologic problems · In women with HIV, gynecologic problems, such as abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may be the focus of a majority of complaints. Acute retroviral syndrome (viremia) may be the chief complaint in one third to more than one half of those infected, not necessarily women. Its manifestations include rashes, muscle and joint pain, and weight loss.

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? o Molluscum contagiosum o Tuberculosis of the skin o Kaposi's sarcoma o Seborrheic dermatitis

o Kaposi's sarcoma · Kaposi's sarcoma, the most common HIV-related malignancy, is a disease that involves the endothelial layer of blood and lymphatic vessels. Cutaneous signs may be the first manifestation of HIV; they can appear anywhere on the body and are usually brownish pink to deep purple. They may be flat or raised and surrounded by ecchymoses (hemorrhagic patches) and edema (Fig. 37-3).

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? o Urine o Semen o Blood o Breast milk

o 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.

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

o develop early in life after protection from maternal antibodies decreases. · These disorders may involve one or more components of the immune system. Primary immunodeficiencies are seen primarily in infants and young children. Primary immunodeficiencies are rare disorders with genetic origins. Without treatment, infants and children with these disorders seldom survive to adulthood.

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

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

o "We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." · Treatment options for SCID include stem cell and bone marrow transplantation. Hematopoietic stem cell transplantation is the definitive therapy for SCID; the best outcome is achieved if the disease is recognized and treated early in life. The ideal donor is a human leukocyte antigen-identical sibling.

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

o 3 mL/min · The nurse should administer the IV infusion at a slow rate, not to exceed 3 mL/min, usually at 100-200 mL/h.

When do most perinatal HIV infections occur? o Through breastfeeding o After exposure during delivery o Through casual contact o In utero

o 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.

What intervention is a priority when treating a client with HIV/AIDS? o Monitoring skin integrity o Monitoring psychological status o Assessing fluid and electrolyte balance o Assessing neurologic status

o Assessing fluid and electrolyte balance · Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.

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

o Assessing the client for signs and symptoms of infection · Normal neutrophil levels range from 3,000 to 7,000 mm3. Levels rise in response to infection, so the nurse should monitor the client closely for signs and symptoms of infection. Increased neutrophil levels do not normally affect coagulation or energy levels.

More than 50% of individuals with this disease develop pernicious anemia: o Bruton disease o Common variable immunodeficiency (CVID) o DiGeorge syndrome o Nezelof syndrome

o Common variable immunodeficiency (CVID) · More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.

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

o 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 client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate? o "Congratulations, a negative result means that you're not infected with the virus." o "You're one of the lucky ones who are immune to the virus." o "You might still go on to develop AIDS even with negative results." o "Your body may not have developed antibodies yet, so we need to follow up."

o "Your body may not have developed antibodies yet, so we need to follow up." · A negative test result means that antibodies to HIV are not in the blood at this time. The person may not be infected or the person's body may not yet have produced antibodies. (The "window" period is 3 weeks to 6 months). The client needs follow-up testing and must continue to take precautions. The negative test result does not mean that the client is immune to HIV, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet.

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? o IV gamma globulin administration o Platelet administration o Factor VIII administration o Thymus grafting

o 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.

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

o Respiratory or urinary system infections · Secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. Abnormalities of the immune system affect both natural and acquired immunity. Because immunodeficiencies result in a compromised immune system and pose a high risk for infection, careful assessment of the client's immune status is essential. The nurse assesses and monitors the client for signs and symptoms of infection.

A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis? o Urine specimen for culture and sensitivity o Blood specimen for electrolyte studies o Stool specimen for ova and parasites o Sputum specimen for acid fast bacillus

o Stool specimen for ova and parasites · A stool specimen for ova and parasites will give a definitive diagnosis. The organism is spread by the fecal-oral route from contaminated water, food, or human or animal waste. Those infected can lose from 10 to 20 L of fluid per day. Losing this magnitude of fluid quickly leads to dehydration and electrolyte imbalances.

A 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? o Cleavage o Budding o Attachment o Uncoating

o 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.

Which condition is an early manifestation of HIV encephalopathy? o Headache o Hallucinations o Hyperreflexia o Vacant stare

o Headache · Early manifestations of HIV encephalopathy include headache, memory deficits, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. Later stages include hyperreflexia, a vacant stare, and hallucinations.

When a nurse infuses gamma globulin intravenously, the rate should not exceed o 3 mL/min o 6 mL/min o 10 mL/min o 1.5 mL/min

o 3 mL/min · The intravenous infusion should be administered at a slow rate, not to exceed 3 mL/min.

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? o Thyroid o Thymus o Pituitary o Adrenal

o Thymus · T-cell deficiency occurs when the thymus gland fails to develop normally during embryogenesis.

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? o Enzyme immunoassay (EIA) o Western blot o Viral load o CD4/CD8

o 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.

What test will the nurse assess to determine the client's response to antiretroviral therapy? o Western blotting o Viral load o Enzyme immunoassay o Complete blood count

o Viral load · Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART. The other tests are not used in this way.

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? o ELISA o Western Blot o T4/T8 ratio o Polymerase chain reaction

o 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.

A nurse is assessing a client with a primary immunodeficiency. Afterward the nurse documents that the client displayed ataxia. The nurse makes this documentation because the client has o vascular lesions caused by dilated blood vessels. o an inability to understand the spoken word. o uncoordinated muscle movements. o difficulty swallowing.

o uncoordinated muscle movements. · Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination).

Which assessment finding(s) are likely to cause noncompliance with antiretroviral treatment? Select all that apply. o Active substance abuse o Depression o Past substance abuse o Lack of social support

o Active substance abuse o Depression o Lack of social support · Psychosocial barriers such as depression and other mental illnesses, neurocognitive impairment, low health literacy, low levels of social support, stressful life events, high levels of alcohol consumption and active substance use, homelessness, poverty, nondisclosure of HIV serostatus, denial, stigma, and inconsistent access to medications affect adherence to ART. Past substance abuse has not been implicated as a factor for noncompliance with antiretroviral treatment.

A client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive? o Western Blot o Schick o Enzyme-linked immunosorbent assay (ELISA) o Complete blood count (CBC)

o Enzyme-linked immunosorbent assay (ELISA) · The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. If the ELISA is positive twice then the Western Blot test is run. A CBC and a Schick test are not screening tests for HIV.

Phagocytic dysfunction is characterized by the following. Choose all that apply. o Increased incidence of bacterial infections o Immunity to infection with herpes simplex o Chronic eczematoid dermatitis o Manifestation of underlying disease processes o Rapid heartbeat

o Increased incidence of bacterial infections o Chronic eczematoid dermatitis · In phagocytic cell disorders, incidence of bacterial and fungal infections is increased, resulting from organisms that are normally nonpathogenic. Clients experience recurrent cutaneous abscesses, chronic eczema, bronchitis, pneumonia, chronic otitis media, and sinusitis.

Which substance may be used to lubricate a condom? o Skin lotion o Baby oil o K-Y jelly o Petroleum jelly

o K-Y jelly · K-Y jelly is water-based and will provide lubrication while not damaging the condom. The oils in skin lotion and petroleum jelly, and baby oil, will cause a latex condom to break.

A protease inhibitor, an antiretroviral agent that can be taken without regard to meals is: o Viracept. o Lexiva. o Kaletra. o Norvir.

o Lexiva. · The advantage and appeal of Lexiva is its ability to be taken without food. However, it does have gastrointestinal side effects, and it causes a skin rash in 19% of patients.

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

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

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

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

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? o type I o type II o type III o type IV

o type I · There are four types of hypersensitivity responses, three of which are immediate. This is an example of Type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies.

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

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

A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? o 10 mm3 to 20 mm3 o 20 mm3 to 45 mm3 o 1 mm3 to 10 mm3 o 50 mm3 to 150 mm3

o 50 mm3 to 150 mm3 · An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.

A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? o Assess liver function tests. o Administer fluids 100 mL/hour IV. o Assess blood urea nitrogen and creatinine. o Encourage the client to drink more fluids.

o Assess blood urea nitrogen and creatinine. · Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urea nitrogen and creatinine for clients who have decreased urination is appropriate. The other answers will not assist the nurse in determining the client's problem, which should be assessed before intervention are administered.

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? o testing the client for the presence of HIV o instructing the client to wear cotton underwear o having the client abstain from sexual activity for 6 weeks while the medication is working o using a medicated douche in order to keep the vaginal pH normal

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

o "I can eat whatever I want as long as it's low in fat." · The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

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

o "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.

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

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

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

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

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

o 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 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? o Anorexia o Chronic diarrhea o Nausea and vomiting o Oral candida

o 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? o Imbalanced nutrition: more than body requirements o Diarrhea o Bowel incontinence o Constipation

o 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.

During a third-trimester transabdominal ultrasound, cardiac anomaly and facial abnormalities are noted in the fetus. Further testing reveals that the thymus gland has failed to develop normally, and the fetus is diagnosed with thymic hypoplasia. Based on this diagnosis, the nurse anticipates careful monitoring for which common manifestation during the first 24 hours of life? o Hypoglycemia o Hypocalcemia o Hyperkalemia o Thrombocytopenia

o Hypocalcemia · The most frequent presenting sign in clients with thymic hypoplasia (DiGeorge syndrome) is hypocalcemia that is resistant to standard therapy. It usually occurs within the first 24 hours of life.

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

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

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? o The use of condoms o What vaccinations to have o Side effects of drug therapy o The action of each antiretroviral drug

o 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.

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? o Polymerase chain reaction o Western Blot o ELISA o T4/T8 ratio

o 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 practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: o Anorexia. o Chronic diarrhea. o Nausea and vomiting. o Oral candida.

o Chronic diarrhea. · Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.

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

o 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.

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is o Malnutrition o Neutropenia o Hypocalcemia o Chronic diarrhea

o Malnutrition · The most prevalent cause of immunodeficiency worldwide is severe malnutrition.

The nurse is instructing a male client about safer sexual behaviors. Which client statement indicates a need for additional instruction? o "I will apply baby oil to lubricate the condom." o "I should use a new condom each time I have sex." o "My partner and I should avoid manual-anal intercourse." o "After having sex, I should hold onto the condom when pulling out."

o "I will apply baby oil to lubricate the condom." · The client should use only water-soluble lubricant, such as K-Y jelly or glycerin. Baby oil can cause the condom to break. The client should use a new condom for each sexual activity and hold onto the condom so that it does not come off when pulling out. Manual-anal intercourse should be avoided.

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

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

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? o distal sensory polyneuropathy (DSP) o candidiasis o AIDS dementia complex (ADC) o cytomegalovirus (CMV)

o AIDS dementia complex (ADC) · ADC, a neurologic condition, causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

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? o Intubate the client. o Perform an electrocardiogram (ECG). o Assess the client's vital signs. o Administer epinephrine.

o 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.

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

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

The nurse is interviewing a client being admitted to the hospital and inquires about any allergies the client has. The client states he is allergic to aspirin and penicillin. What intervention should the nurse provide immediately to prevent complications related to allergies? o Apply an allergy bracelet and flag the chart. o Tape an EpiPen to the head of the bed. o Inform the client not to take any medications with those substances in them. o Call the physician.

o Apply an allergy bracelet and flag the chart. · The nurse asks each client about the existence of any allergies. If any are reported, the nurse flags the medical record and applies a wristband with the appropriate information. Throughout the client's care, the nurse observes for signs of an allergic reaction, especially when administering medication, applying substances such as tape or adhesive patches to the skin. Medication should never be left in the client's room. The responsibility for medications with the identified allergens lies with the healthcare personnel in the acute care facility. The physician does not need to be called if the chart is flagged.

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

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

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? o MAC o Wasting syndrome o Kaposi's sarcoma o Candidiasis

o 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 to self-administer intravenous immunoglobulin (IVIG) in the home. What is the client's first action? o Prepare the IVIG solution. o Check the IV device patency. o Take the premedication. o Check his or her temperature.

o Check the IV device patency. · When administering intravenous immunoglobulin in the home, it is imperative to ensure that the IV access device is patent. This should be done first because if the device is not patent, it would be useless to prepare the solution, administer the premedication, or check vital signs. Unless the device is patent, the medication could not be given.

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

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

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

o Disturbed body image related to loss of fat in the face and arms · The client is experiencing lipoatrophy, which results in a localized loss of subcutaneous fat in the face (manifested as sinking of the cheeks, eyes, and temples), arms, legs, and buttocks. These changes as well as his statement about the side effects of the drug being worse than the disease indicate that he is concerned about how he appears to others. Therefore, the nursing diagnosis of disturbed body image would be the priority. Deficient knowledge, risk for infection, and risk for impaired liver function may be applicable; however, they are not concerns at this time.

A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be alright to relieve the nasal congestion he is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid complications? o Report white patches in the mouth because the medication can cause a fungal infection. o Do not overuse the medication as rebound congestion can occur. o Taper the dose when discontinuing the medication. o Do not operate machinery or drive while using the medication.

o Do not overuse the medication as rebound congestion can occur. · Overusing oxymetazoline nasal spray can cause rebound congestion. The medication does not cause fungal infection. Corticosteroids should be tapered, but it is not necessary to taper oxymetazoline. Oxymetazoline does not cause sleepiness so the client can operate machinery or drive.

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

o Enzyme immunoassay (EIA) · EIA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA.

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? o Enzyme-linked immunosorbent assay o T-and C-cell assays o Plasmapheresis o Complete chemistry panel

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

A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms? Select all that apply. o Fatigue o Flank pain o Tightness in the chest o Shaking chills o Hunger

o Fatigue o Flank pain o Tightness in the chest · Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.

A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms? Select all that apply. o Flank pain o Shaking chills o Tightness in the chest o Hunger o Fatigue

o Flank pain o Shaking chills o Tightness in the chest · Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.

A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? o Limit interactions with people who are not HIV infected. o Limit interactions with people who are already HIV infected. o Follow the same sexual precautions as someone who has been diagnosed with AIDS. o Quit their job and get admitted to a hospital or a cancer treatment center.

o Follow the same sexual precautions as someone who has been diagnosed with AIDS. · The healthcare worker will be tested for HIV at regular intervals and treated with antiretrovirals depending on the results of the tests or the potential for infection. While awaiting the results, the healthcare worker should follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker should not limit interactions with either non-HIV-infected or HIV-infected people. In addition, the healthcare worker should not quit and be admitted to a hospital for treatment. Treatment, if required, can begin if the result of the test is positive.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? o For their immunosuppressant effects o To decrease the body's risk of infection o So the client has strong drug therapy o Because an autoimmune disease is a neoplastic disease

o For their immunosuppressant effects · Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? o To decrease the body's risk of infection o Because an autoimmune disease is a neoplastic disease o So the client has strong drug therapy o For their immunosuppressant effects

o For their immunosuppressant effects · Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

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

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

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

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

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? o Urine specific gravity of 1.010 o Hypernatremia o Hypokalemia o Proteinuria

o Hypokalemia · Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

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

o Inform the patient that it would be beneficial to test for HIV. · HIV screening is recommended for all persons who seek evaluation and treatment for STIs. HIV testing must be voluntary and free of coercion. Patients must not be tested without their knowledge. HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health care settings. Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient.

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

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

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? o Overall, these conditions more commonly affect females. o Most cases are typically diagnosed in infancy. o The conditions appear to predominate in males after adolescence. o Primary immunodeficiencies are more common than secondary immunodeficiencies

o 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 nurse knows that more than 50% of clients with CVID develop the following disorder. o Pernicious anemia o Neutropenia o Hypocalcemia o Chronic diarrhea

o Pernicious anemia · More than 50% of clients with CVID develop pernicious anemia. Although chronic diarrhea may occur in clients with CVID, it does not happen in 50% of them. Hypocalcemia and neutropenia are not concerns for clients with CVID.

A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms? Select all that apply. o Fatigue o Flank pain o Tightness in the chest o Shaking chills o Hunger

o Shaking chills o Flank pain o Tightness in the chest · Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.

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

o Standard Precautions should be applied to patients regardless of diagnosis or presumed infectious status. · Standard Precautions incorporate the major features of Universal Precautions (designed to reduce the risk of transmission of bloodborne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances); they are applied to all patients in health care facilities regardless of their diagnosis or presumed infectious status.

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

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

A parent brings a young child to the clinic for an evaluation of an infection. The parent states, "my child has been taking antibiotics now for more than 2 months and still doesn't seem any better." During the history and physical examination, what would alert the nurse to suspect a primary immunodeficiency? o History of fungal diaper rash o Weight within age-appropriate parameters o Ten ear infections in the past year o Superficial wound on the child's left leg

o Ten ear infections in the past year · The parent has already reported one of the warning signs associated with primary immunodeficiencies--the use of antibiotics for 2 or more months with little effect. Another warning sign is eight or more new ear infections within 1 year. Therefore, the report of 10 ear infections in the past year would increase the nurse's suspicion. Recurrent, deep skin, or organ abscesses, failure of an infant to gain weight or grow normally, and persistent thrush (yeast infection) in the mouth or elsewhere on the skin after age 1 year would be additional warning signs. A superficial wound on the leg, age-appropriate weight, and a history of a fungal diaper rash would not be considered warning signs.

A nurse is reviewing the causes of genetic diseases with parents of an infant born with severe combined immunodeficiency disease (SCID). Which would be inaccurate information pertaining to SCID? o The incidence is unknown. o This illness occurs in all racial groups and both genders. o This is one of the most common causes of primary immunodeficiencies. o The inheritance of SCID can be autosomal dominant.

o The inheritance of SCID can be autosomal dominant. · SCID is rare in most population groups, but is one of the most common causes of primary immunodeficiencies. Inheritance of this disorder can be X linked, autosomal recessive, or sporadic. The exact incidence of SCID is unknown; it is recognized as a rare disease in most population groups, with an incidence of about 1 case in 1,000,000. This illness occurs in all racial groups and both genders.

A client is scheduled to have a prick test to determine what specific allergens are creating problems for the client. What should the nurse inform the client is involved with the testing? o A concentrated form of the substance is applied to the skin and covered with an occlusive dressing for 48 hours and then examined. o A dilute solution of an antigen is injected intradermal and observed for a wheal. o The skin will be scratched, and applying a small amount of the liquid test antigen to the scratch, usually on the back. o The client will taste several different possible antigens and observe for wheals.

o The skin will be scratched, and applying a small amount of the liquid test antigen to the scratch, usually on the 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 arm. Results of the test are identifiable in as little as 20 minutes. If a raised wheal with localized erythema appears, the tester measures its length and width and width in millimeters. The client does not taste in any of the skin tests. The other two options are distractors.

Which is a major manifestation of Wiskott-Aldrich syndrome? o Ataxia o Bacterial infection o Thrombocytopenia o Episodes of edema

o Thrombocytopenia · Major symptoms of Wiskott-Aldrich syndrome include thrombocytopenia, infections, and malignancies. Ataxia occurs with ataxia-telangiectasia. Episodes of edema in various body parts occur with angioneurotic edema. Bacterial infection occurs with hyperimmunoglobulinemia E syndrome.

A client that is HIV+ has been diagnosed with Pneumocystispneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? o Trimethoprim-sulfamethoxazole o Nystatin o Amphotericin B o Fluconazole

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

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis? o Thrombocytopenia o Vascular lesions o Thrush o Eczema

o Vascular lesions · Ataxia-telangiectasis is characterized by loss of muscle coordination and vascular lesions. Thrombocytopenia and eczema are associated with Wiskott-Aldrich syndrome. Thrush is a manifestation associated with severe combined immunodeficiency (SCID).

Telangiectasia is the term that refers to o Vascular lesions caused by dilated blood vessels o Inability to understand the spoken word o Uncoordinated muscle movement o Difficulty swallowing

o Vascular lesions caused by dilated blood vessels · Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia-telangiectasia is an autosomal-recessive disorder affecting both T-cell and B-cell immunity. Receptive aphasia is an inability to understand the spoken word. Dysphagia refers to difficulty swallowing.

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

o biopsy. · KS is diagnosed through biopsy of the suspected lesions. Visual assessment will not confirm a diagnosis. A computed tomography scan will not assist in determining skin cell changes. Skin scraping is a procedure to collect cells, not to evaluate cells.