Nurs 107 Chapter 32 Management of Patients with Immune Deficiency Disorders
A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately? Mouth sores Tickle in the throat Constipation Sneezing
Tickle in the throat
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? Breast milk Semen Urine Blood
Urine
Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis? Eczema Thrush Vascular lesions Thrombocytopenia
Vascular lesions
What test will the nurse assess to determine the client's response to antiretroviral therapy? Western blotting Enzyme immunoassay Viral load Complete blood count
Viral load
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: Western blot test for confirmation of diagnosis. polymerase chain reaction test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis. p24 antigen test for confirmation of diagnosis.
Western blot test for confirmation of diagnosis
A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: seafood. exposure to sunlight. applying skin moisturizers. alcohol.
alcohol.
Kaposi sarcoma (KS) is diagnosed through skin scraping. biopsy. computed tomography. visual assessment.
biopsy.
Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies develop early in life after protection from maternal antibodies decreases. occur most commonly in the aged population. develop as a result of treatment with antineoplastic agents. disappear with age.
develop early in life after protection from maternal antibodies decreases.
The term used to define the amount of virus in the body after the initial immune response subsides is window period. primary infection stage. viral clearance rate. viral set point.
viral set point.
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. "Your diagnosis was inherited." "Your immune system was most likely affected by an underlying disease process." "You will now be more likely to develop cancer in the future." "Your condition will predispose you to frequent and recurring infections."
"Your immune system was most likely affected by an underlying disease process."
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? Antibodies to HIV are not present in his blood. He has not been infected with HIV. He is immune to HIV. Antibodies to HIV are present in his blood.
Antibodies to HIV are not present in his blood.
The nursing instructor is discussing hypersensitivity responses with a clinical group. What allergic reaction(s) would the nursing instructor talk about? Select all that apply. Atopic Immune complex Unmediated Typical Cytotoxic
Atopic Immune complex Cytotoxic
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? Factor VIII administration IV gamma globulin administration Thymus grafting Platelet administration
IV gamma globulin administration
A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? Chest physiotherapy Immunosuppressive agents Anticoagulation Antibiotic therapy
Immunosuppressive agents
A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.) Taking other medication Lack of social support Lives alone Active substance abuse Depression
Lack of social support Active substance abuse Depression
The nurse teaches the client that reducing the viral load will have what effect? Longer survival Shorter survival Shorter time to AIDS diagnosis Longer immunity
Longer survival
What severe complication does the nurse monitor for in a patient with ataxia-telangiectasia? Chronic lung disease Neurologic dysfunction Overwhelming infection Acute kidney injury
Overwhelming infection
A client with HIV will be started on a medication regimen of three medications. What class of drugs will the nurse instruct the client about? Anticholinergics Disinhibitors Hydroxyurea Reverse transcriptase inhibitors
Reverse transcriptase inhibitors
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? Risk for injury Complicated grieving Bathing or hygiene self-care deficit Ineffective cerebral tissue perfusion
Risk for injury
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? Stool specimen for ova and parasites Blood specimen for electrolyte studies Sputum specimen for acid fast bacillus Urine specimen for culture and sensitivity
Stool specimen for ova and parasites
Which medication classification is known to inhibit prostaglandin synthesis or release? Adrenal corticosteroids Antibiotics (in large doses) Nonsteroidal anti-inflammatory drugs (in large doses) Antineoplastic agents
Nonsteroidal anti-inflammatory drugs (in large doses)
Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? Active substance abuse Past substance abuse Depression Lack of social support
Past substance abuse
Which adverse effect should the nurse closely monitor in a client who takes immunosuppressive drugs? Respiratory or urinary system infections Depression, memory impairment, and coma Rheumatoid arthritis Heart failure, infusion reactions, and life-threatening infections
Respiratory or urinary system infections
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? More antiretroviral medication will be added every 2 to 3 months. Viral load and T4-cell counts will be performed every 2 to 3 months. The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. The Western blot test will be monitored every 6 months to see if the virus is still present.
Viral load and T4-cell counts will be performed every 2 to 3 months.
When preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home, the nurse should be sure to include which instruction? "Sterilize all plates and utensils in boiling water." "Put on disposable gloves before bathing." "Avoid eating foods from serving dishes shared by other family members." "Avoid sharing such articles as toothbrushes and razors."
"Avoid sharing such articles as toothbrushes and razors."
A client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate? "Congratulations, a negative result means that you're not infected with the virus." "Your body may not have developed antibodies yet, so we need to follow up." "You might still go on to develop AIDS even with negative results." "You're one of the lucky ones who are immune to the virus."
"Your body may not have developed antibodies yet, so we need to follow up."
Which is usually the most important consideration in the decision to initiate antiretroviral therapy? Western blotting assay HIV RNA CD4+ counts ELISA
CD4+ counts
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? Anorexia Oral candida Nausea and vomiting Chronic diarrhea
Chronic diarrhea
More than 50% of individuals with this disease develop pernicious anemia: Common variable immunodeficiency (CVID) Bruton disease DiGeorge syndrome Nezelof syndrome
Common variable immunodeficiency (CVID)
A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? Venous stasis and phlebitis formation Lymphedema of the lower extremities Severe joint pain Deep purple cutaneous lesions
Deep purple cutaneous lesions
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? Disclosure of the client's condition Sharing the diagnosis with a support group Caring for a client who can kill other people Caring for a client with an infectious terminal disease
Disclosure of the client's condition
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? Risk for infection related to the immune system dysfunction Disturbed body image related to loss of fat in the face and arms Risk for impaired liver function related to drug therapy effects Deficient knowledge related to the effects of the disease
Disturbed body image related to loss of fat in the face and arms
A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effect should the nurse closely monitor in the client? Electrolyte imbalances Peripheral neuropathy Hypotension Anemia
Electrolyte imbalances
Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) p24 antigen Enzyme immunoassay (EIA) Reverse transcriptase
Enzyme immunoassay (EIA)
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? Enzyme-linked immunosorbent assay Complete chemistry panel Plasmapheresis T-and C-cell assays
Enzyme-linked immunosorbent assay
Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) Reverse transcriptase p24 antigen Enzyme-linked immunosorbent assay (ELISA)
Enzyme-linked immunosorbent assay (ELISA)
Which of the following indicates that a client with HIV has developed AIDS? Severe fatigue at night Herpes simplex ulcer persisting for 2 months Weight loss of 10 lb over 3 months Pain on standing and walking
Herpes simplex ulcer persisting for 2 months
Which term means a lack of one or more of the five immunoglobulins? Hypogammaglobulinemia Panhypoglobulinemia Telangiectasia Agammaglobulinemia
Hypogammaglobulinemia
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? 24 weeks 6 weeks 18 weeks 12 weeks
6 weeks
Which client is more at risk of becoming infected with human immunodeficiency virus (HIV)? A woman who has never had intercourse A man who uses sildenafil before having intercourse A woman who has had deliveries after the age of 40 A person having casual intercourse with multiple partners
A person having casual intercourse with multiple partners
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? AIDS CVID DAF SCID
AIDS
When do most perinatal HIV infections occur? Through casual contact Through breastfeeding After exposure during delivery In utero
After exposure during delivery
HIV is harbored within which type of cell? Lymphocyte Platelet Erythrocyte Nerve
Lymphocyte
Which is a major manifestation of Wiskott-Aldrich syndrome? Thrombocytopenia Bacterial infection Ataxia Episodes of edema
Thrombocytopenia
Which substance may be used to lubricate a condom? Petroleum jelly K-Y jelly Skin lotion Baby oil
K-Y jelly
A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "You should take the drug with an antacid." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." "When you take this drug, eat a high-fat meal immediately afterwards." "It doesn't matter if you take this drug with or without food."
"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I won't go to see my sister while she has a cold." "I can eat whatever I want as long as it's low in fat." "I won't go to see my nephew right after he gets his vaccines." "I stopped smoking last year; this year I'll quit drinking alcohol."
"I can eat whatever I want as long as it's low in fat."
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? "The client probably has a case of the flu and you should give acetaminophen." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication."
"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."
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? candidiasis distal sensory polyneuropathy (DSP) AIDS dementia complex (ADC) cytomegalovirus (CMV)
AIDS dementia complex (ADC)
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? Assist with chest physiotherapy every 2 to 4 hours. Maintain the client in a supine or side-lying position. Encourage client to ambulate frequently in the halls. Limit fluid intake to 1 1/2 to 2 liters per day.
Assist with chest physiotherapy every 2 to 4 hours.
A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included? The client should be alert for joint aches. This medication is commonly used for many inflammatory reactions and is relatively safe. If the client experiences nausea, omit the dose. Be alert for signs and symptoms of infection and report them immediately to the physician.
Be alert for signs and symptoms of infection and report them immediately to the physician.
What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? Radiation therapy Bone marrow transplantation Removal of the thymus gland Antibiotics
Bone marrow transplantation
A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? Reverse the HIV+ status to a negative status. Eliminate the risk of AIDS. Treat mycobacterium avium complex. Bring the viral load to a virtually undetectable level
Bring the viral load to a virtually undetectable level
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? Seborrheic dermatitis Tuberculosis of the skin Kaposi's sarcoma Molluscum contagiosum
Kaposi's sarcoma
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? Overall, these conditions more commonly affect females. Primary immunodeficiencies are more common than secondary immunodeficiencies Most cases are typically diagnosed in infancy. The conditions appear to predominate in males after adolescence.
Most cases are typically diagnosed in infancy.
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." Which nursing action is the priority for this client? Recommend abstinence or safer-sex practices. Offer information on human immunodeficiency virus (HIV) testing. Refer the client to a support group with others experiencing the same symptoms. Provide a prescribed topical antifungal agent to treat the client's vaginal infection.
Offer information on human immunodeficiency virus (HIV) testing
client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? Sickle cell anemia Hyperthyroidism Pernicious anemia Gastric ulcer
Pernicious anemia
The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? Pneumocystis pneumonia Cytomegalovirus Legionnaire's disease Mycobacterium tuberculosis
Pneumocystis pneumonia
A client taking abacavir has developed fever and rash. What is the priority nursing action? Document the information. Administer lidocaine cream for the rash. Administer acetaminophen. Report to the health care provider.
Report to the health care provider.
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? Glycoprotein envelope Ribonucleic acid (RNA) Deoxyribonucleic acid (DNA) Viral core
Ribonucleic acid (RNA)
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? What vaccinations to have The action of each antiretroviral drug Side effects of drug therapy The use of condoms
Side effects of drug therapy
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? Trimethoprim-sulfamethoxazole Nystatin Amphotericin B Fluconazole
Trimethoprim-sulfamethoxazole