1210 Exam 2 Immunity

The nurse is teaching a patient with a latex allergy about preventing and treating allergic reactions. Which statement, if made by the patient, indicates a need for further teaching? "My dentist should be told about my latex allergy." "I should avoid foods such as bananas, avocados, and kiwi." "I will use vinyl gloves for activities such as housekeeping." "Because my reactions are not severe, I will not need an EpiPen."

"Because my reactions are not severe, I will not need an EpiPen."

The nurse is teaching a patient with a new diagnosis of systemic lupus erythematosus (SLE) about her disease. The nurse recognizes that the patient understands the information when making which statement? "I need to avoid getting infections because they will increase the immune response in my body, which can make my SLE worse." "I need to be sure to take all the available immunizations to keep me from getting sick." "Because of my SLE, my immune system is already diminished, so I need to avoid people with the flu." "As long as I take all my prescribed medications, I won't have to make any lifestyle changes as a result of my SLE."

"I need to avoid getting infections because they will increase the immune response in my body, which can make my SLE worse."

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? "My drug dosages will be lower because the medications enhance each other." "Taking more than one medication will put me at risk for developing allergies." "I will be more prone to malignancies because I will be taking more than one drug." "The lower doses of my medications can prevent rejection and minimize the side effects."

"The lower doses of my medications can prevent rejection and minimize the side effects."

The patient with cellulitis has a prescription to receive cefotetan 1.5 g intravenous piggyback (IVPB) q12h. The reconstituted vial contains 3000 mg per 20 mL. The nurse should draw up milliliters to add to the IVPB solution? Record your answer using a whole number.

10 mL 1.5 gram equals 1500 mg. Using ratio and proportion, multiply 3000 by x and multiply 1500 × 20 to yield 3000x = 30000. Divide 30,000 by 3000 to yield 10 mL.

Which patient is at risk for developing graft-versus-host disease (GVHD)? A 65-yr-old man who received an autologous blood transfusion A 40-yr-old man who received a kidney transplant from a living donor A 65-yr-old woman who received a pancreas and kidney from a deceased donor A 40-yr-old woman who received a bone marrow transplant from a close relative

A 40-yr-old woman who received a bone marrow transplant from a close relative

A patient presents to the clinic with observable edema and erythema of the left forearm. A brief history reveals no exposure to potential irritating agents. On palpation, the nurse finds the area very warm and tender. What is the most likely cause of the patient's symptoms? An allergic reaction A complement cascade IgE reactions Clonal diversity

A complement cascade

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A new onset of polycythemia Presence of mononucleosis-like symptoms A sharp decrease in the patient's CD4+ count A sudden increase in the patient's WBC count

A sharp decrease in the patient's CD4+ count

A healthy older adult patient requests a "flu shot" during an office visit. When assessing the patient, what other vaccinations should the nurse ask the patient about receiving (select all that apply.)? Shingles Pneumonia Meningococcal Haemophilus influenzae type b (Hib) Measles, mumps, and rubella (MMR)

A, B

When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods (select all that apply.)? Grapes Oranges Bananas Potatoes Tomatoes

A, C, D, E

A patient who has been taking efavirenz (Sustiva) reports a sore throat, fever, and blisters. What is the nurse's best action? a. Hold the dose and notify the prescriber. b. Document the report as the only action. c. Remind the patient that these are symptoms of opportunistic infection. d. Reassure the patient that these are common and expected side effects of the drug.

ANS: A Efavirenz is a nonnucleotide analogue reverse transcriptase inhibitor (NNRTI). A sore throat, fever, different types of rashes, blisters, or multiple bruises are all signs of serious adverse effects of drugs from this class. The drug should be stopped and the prescriber contacted.

A patient who is taking zidovudine (Retrovir) reports diarrhea. Which dietary change does the nurse suggest for this patient? a. "Avoid fatty and fried foods." b. "Increase your intake of fiber." c. "Take an antacid 30 minutes before each meal." d. "Restrict your intake of fluids to 1 L per day."

ANS: A Fatty foods tend to reduce intestinal absorption and make drug-induced diarrhea worse. Although fiber can prevent some types of diarrhea, it is of no benefit for diarrhea associated with antiviral drug therapy.

What is the most important precaution the nurse must teach a patient who is prescribed any antiviral drug? a. "Take the drug exactly as prescribed and for as long as prescribed." b. "Never take any antibacterial drugs while you are on antiviral therapy." c. "Drink at least 3 L of water daily for the entire time you are taking this drug." d. "Avoid unnecessary exposure to this drug by stopping it when you have no symptoms for 24 hours."

ANS: A For effective antiviral therapy the patient must take the drug long enough to ensure suppression of viral reproduction. If the patient stops taking the drug as soon as he or she feels better, symptoms of infection may recur and resistant viruses may develop.

A patient who is taking interferon is also prescribed ribavirin (Virazole). Which laboratory blood test result for this patient does the nurse report immediately to the prescriber? a. Red blood cells (RBCs) 2.2 million/mm3 b. White blood cells (WBCs) 6000/mm3 c. Sodium 134 mEq/L d. International normalized ratio (INR) 1.6

ANS: A One of the many serious adverse effects of ribavirin is suppression of bone marrow cell division, leading to fewer RBCs and anemia. This patient's RBC level is only about half of normal.

Which statement about human immune deficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is true? a. Everyone with AIDS has HIV infection but not everyone with HIV infection has AIDS. b. Everyone with HIV infection eventually dies of it because the disease cannot be cured. c. With successful antiretroviral therapy, HIV-infected patients become HIV-antibody negative. d. When HIV disease becomes AIDS, the infection is in the blood and treatment must be given intravenously.

ANS: A People infected with HIV develop antibodies to the virus and become HIV positive. Not everyone who is HIV positive will progress with the disease and develop AIDS, the most severe form of the disease.

26. A pediatric patient is prescribed nelfinavir (Viracept) 450 mg orally. The available drug is 50 mg/scoop. How many level scoops does the nurse measure into the patient's pudding to administer the correct dose? a. 9 b. 6 c. 3 d. 2

ANS: A Want 450 mg in X scoops/Have 50 mg in 1 scoop. 450/50 = 9 scoops.

Which patient outcomes are major goals of antiretroviral therapy? (Select all that apply.) a. Prevention of opportunistic infections b. Conversion to an HIV-negative antibody status c. Reduction of the number of viral particles in the patient's blood d. Increase in CD4+ cells e. Decrease in CD8+ cells f. Prevention of disease spread

ANS: A, C, D, F The human immunodeficiency virus (HIV) retrovirus selectively infects the helper/inducer T cells, known as CD4+ cells, which coordinate the patient's immune response. When these cells are destroyed, the person has little protection from opportunistic infection. Successful antiretroviral therapy reduces the number of viral particles in the blood and increases the CD4+ cell numbers in the blood. These actions reduce the risk for opportunistic infection and reduce the likelihood of HIV disease spread by the patient. Antiretroviral therapy does not affect the number of CD8+ cells and does not change the patient's antibody status.

How are retroviruses different from common viruses? a. Retroviruses respond to antibacterial drugs but common viruses do not. b. Retroviruses have a greater efficiency of infection than common viruses. c. Common viral infections can be cured while retroviral infections can only be controlled. d. Common viruses can infect anyone whereas retroviruses can only cause infection in an immunosuppressed host.

ANS: B A retrovirus is a special virus that always uses RNA as its genetic material, and carries with it the enzymes reverse transcriptase, integrase, and protease, which allow a much higher efficiency of cellular infection than common viruses. This means that disease may result even when low levels of retroviruses enter the body.

A patient is prescribed intravenous (IV) acyclovir (Zovirax). Which question is most important for the nurse to ask before giving the first dose of this drug? a. "Do you have a hearing problem or any trouble with your ears?" b. "Do you take medications for seizures?" c. "Are you allergic to sulfa drugs?" d. "Have you ever had asthma?"

ANS: B Acyclovir reduces the effectiveness of phenytoin, a drug that is used to prevent seizures. The prescriber may need to adjust the phenytoin dosage while the patient is on antiviral therapy.

A patient taking highly active antiretroviral therapy (HAART) for a year has the following blood laboratory test values. Which value does the nurse report to the prescriber immediately? a. White blood cell count 3500 cells/mm3 b. Lactate dehydrogenase 990 IU/L c. Sodium 132 mEq/L d. Hematocrit 32%

ANS: B All of these blood values are abnormal; however, only the lactate dehydrogenase level is very high (four times normal). This value indicates liver impairment. Nearly all antiretroviral drugs can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.

Which precaution is most important for the nurse to teach a patient who is prescribed enfuvirtide (Fuzeon)? a. "After the drug is mixed, store it away from light." b. "Use sterile technique to draw up and inject the drug." c. "Do not take this drug if there is any possibility that you are pregnant." d. "Mix the drug with tap water, then rinse the drug's original container and add that fluid to the drug mixture."

ANS: B Enfuvirtide is given twice daily by subcutaneous injection. The patient self-injects this drug at home and must use sterile technique. Injection site infections are common.

A patient who has been taking indinavir (Crixivan) for a year has just been told that the organism is now resistant to this drug. The patient expresses worry to the nurse that this means the disease will now progress to acquired immunodeficiency syndrome (AIDS) and death will soon follow. What is the nurse's best response? a. "Your health care provider can change this drug to the intravenous form, which prevents viral replication even in HIV that has developed drug resistance." b. "Although the HIV is now resistant to this drug, other antiretroviral drugs are likely to be effective in controlling your disease." c. "The HIV easily becomes drug resistant. That is why the drug combinations are switched so often." d. "That is a possibility because these drugs do not kill the virus. It is best to be prepared."

ANS: B Human immunodeficiency virus (HIV) can develop drug resistance relatively quickly, especially to protease inhibitors. This does not mean that the organism is resistant to all antiretroviral drugs and that the disease will then progress to AIDS. By changing the combination of drugs frequently, even an organism that has developed resistance to one antiretroviral drug can still have its replication suppressed and the disease can be controlled. Simply telling the patient that HIV easily becomes drug resistant may be a true statement, but it does not address the patient's concerns about the disease's progression.

Which health problem must the nurse be specifically alert for in pregnant women who are prescribed any nucleoside analogue reverse transcriptase inhibitor (NRTI)? a. Headache b. Lactic acidosis c. Diabetes mellitus d. Nausea and vomiting

ANS: B NRTIs increase the risk for lactic acidosis in pregnant women. This problem is not a common occurrence for other patients. Lactic acidosis is the buildup of lactic acid in muscle and other tissues when not enough oxygen is present to allow metabolism to occur normally. Signs and symptoms of lactic acidosis are muscle aches, tiredness and difficulty remaining awake, abdominal pain, hypotension, and a slow, irregular heartbeat.

A patient prescribed raltegravir (Isentress) reports all of the following problems or changes since starting this drug. Which problem or change does the nurse report to the prescriber? a. Abdominal cramps and bloating b. Muscle aches and weakness c. Urinating more at night d. Loss of taste for sweets

ANS: B This drug can cause the adverse reaction of rhabdomyolysis, which is destruction of skeletal muscle. The symptoms of this problem are muscle aches and weakness. When a patient develops this problem, the drug should be stopped.

How are viral infections different from bacterial infections? a. Bacterial infections can be spread from one person to another, whereas viral infections cannot be spread directly. b. Bacterial infections can be cured by treatment with some anti-infective drugs, whereas viral infections are not cured by anti-infective therapy. c. Viruses only cause disease in a person who is immunocompromised, whereas bacteria can cause disease even among immunocompetent people. d. Viruses are the less mature form of a bacterium, so there is essentially no difference between viral infections and bacterial infections.

ANS: B Viral infections are not "cured" but are self-limiting, meaning that in a person with a healthy immune system, the illness only lasts for a limited time. If the person's immune system is working properly, the body fights off the infection by itself. If the person's immune system is weak or if the body has other health problems, the person may die of the effects of the disease.

Which precaution about zanamivir (Relenza) therapy does the nurse teach a patient who also uses a bronchodilator for asthma control? a. "Drink at least 3 L of water daily while using this drug." b. "Use the bronchodilator 15 minutes before taking the zanamivir." c. "Avoid taking the zanamivir within 2 hours of using the bronchodilator." d. "Take your pulse daily while on this drug because when taken with a bronchodilator heart rhythm problems are common."

ANS: B Zanamivir is an inhalation drug. When a patient also takes a bronchodilator for asthma, chronic obstructive pulmonary disease, or any other airway problem, the manufacturer recommends using the bronchodilator at least 5 minutes before zanamivir to ensure a wider airway and improved inhalation of the antiviral drug.

A 2-year-old patient with respiratory syncytial virus is prescribed aerosolized ribavirin (Virazole). Which visitor does the nurse ensure is not in the patient's room during the aerosol treatments? a. 10-year-old brother b. 81-year-old grandmother c. 32-year-old pregnant mother d. 36-year-old father who has diabetes

ANS: C A major adverse effect of ribavirin is that it is a teratogen, an agent that can cause birth defects. Ribavirin is pregnancy category X. It should not be given to pregnant or breastfeeding women, and it should not be handled or inhaled by anyone who is pregnant.

A patient who has been prescribed amantadine (Symmetrel) has all of the following health problems. For which problem does the nurse contact the prescriber before giving the first dose? a. Asthma b. Influenza c. Glaucoma d. Diabetes mellitus

ANS: C Amantadine has central nervous system side effects and can worsen glaucoma. Although the drug may still be given to a person who has glaucoma, more frequent checking of intraocular pressure or adjustment in glaucoma drugs may be needed.

A patient prescribed highly active antiretroviral therapy (HAART) is flying to a wedding and will be gone 1 day. The patient asks about skipping prescribed drug doses that day in order to avoid having to show them all at the airport. What is the nurse's best response? a. "Yes, just one day off your drugs will not make any difference." b. "Yes, as long as you avoid direct contact with anyone who is ill." c. "No, even one day off the drugs can help the virus become drug resistant." d. "No, even one day off the drugs increases the chance that you can spread the disease."

ANS: C An important issue with HAART is the development of drug-resistant mutations in the human immunodeficiency virus organism. When resistance develops, viral replication is no longer suppressed by the drugs. Several factors contribute to the development of drug resistance to HAART, with the most important being missed doses of drugs. When doses are missed, the blood concentrations become lower than what is needed to inhibit viral replication, allowing the virus to replicate and produce new viruses that are resistant to the drugs being used.

A human immunodeficiency virus (HIV)-positive patient taking highly active antiretroviral therapy informs the nurse she is now pregnant. What advice regarding drug therapy does the nurse give this patient? a. "Stop taking these drugs for your entire pregnancy." b. "Stop taking these drugs for the first trimester and start again for the second and third trimesters." c. "Continue to take these drugs throughout your pregnancy exactly as they have been prescribed." d. "It will be necessary to double your dosages of these drugs to ensure your unborn baby is adequately protected."

ANS: C Antiretroviral drugs for HAART are recommended to be taken by pregnant women who are known to be HIV positive because the virus can cross the placenta and infect the fetus. These drugs, when taken as prescribed, can reduce the chances of fetal infection from about 30% to about 8%. Dosages are based on the woman's viral load, not on weight or pregnancy status.

What is the purpose of antiviral drug therapy? a. To make the patient immune to infection by viruses b. To reduce infection by killing the virus causing disease c. To reduce illness duration by controlling viral reproduction d. To prevent opportunistic infections in immunosuppressed patients

ANS: C Antiviral drugs are only virustatic and reduce the number of viruses by preventing them from reproducing and growing. They are not virucidal and cannot kill the virus. By keeping the number of viruses low, antiviral drugs allow the body's natural defenses to destroy, eliminate, or inactivate them.

Which precaution is most important for the nurse to teach an older patient who is prescribed atazanavir (Reyataz)? a. "Be sure to take this drug at least 1 hour before or 4 hours after taking an antacid." b. "Weigh yourself daily and notify your prescriber if you gain more than 2 pounds in 1 week." c. "Check your pulse for a full minute daily and notify your prescriber if it becomes irregular or slow." d. "Check your calves daily for swelling or redness. If these symptoms appear, go to the emergency department immediately."

ANS: C Atazanavir can impair electrical conduction in the heart and lead to heart block, especially in older adults or people who have an abnormally slow heart rate.

Which food, drink, or herbal supplement does the nurse warn a patient who is prescribed nevirapine (Viramune) to avoid? a. Caffeinated beverages b. Grapefruit juice c. St. John's wort d. Dairy products

ANS: C Nevirapine is a nonnucleoside analogue reverse transcriptase inhibitor (NNRTI). The effectiveness of drugs from this class is greatly reduced by the herbal supplement St. John's wort.

Which precaution is most important for the nurse to teach older adults who are prescribed maraviroc (Selzentry)? a. "If an injection site infection occurs, do not reuse that site until the skin has healed completely." b. "Take the drug with food or milk to reduce the likelihood of GI side effects." c. "Change positions slowly when moving from a sitting to a standing position." d. "Store the drug at room temperature."

ANS: C Orthostatic hypotension is more likely to develop in older adults taking maraviroc, increasing the risk for falls. Patients need to change positions slowly and use handrails when going up or down steps.

How do protease inhibitor (PI) drugs prevent viral replication? a. They are counterfeit bases that prevent reverse transcriptase from synthesizing the DNA needed for viral replication. b. They inactivate the enzyme that allows the viral genetic material to be integrated into the human host's cellular DNA. c. They prevent the production of proteins needed for viral particles to leave the cell and infect other cells. d. They prevent initial infection by blocking the receptor the virus uses to enter target cells.

ANS: C Protease inhibitors prevent viral replication and release of viral particles. Human immunodeficiency virus produces its proteins, including those needed to move viral particles out of the host cell, in one long (human immunodeficiency virus [HIV]) strand. For the proteins to be active, this large protein must be broken down into separate smaller proteins through the action of the viral enzyme HIV protease. Protease inhibitors, when taken into an HIV-infected cell, make the protease enzyme work on the drug rather than on the initial large protein. Thus active proteins are not produced and viral particles cannot leave the cell to infect other cells.

A patient has human immunodeficiency virus (HIV) disease and is taking a "cocktail" consisting of protease inhibitors, nucleoside analogue reverse transcriptase inhibitors, and nonnucleoside analogue reverse-transcriptase inhibitors. Which statement made by the patient indicates that more teaching about the drug therapy is needed? a. "Using three drugs at the same time enhances suppression of viral replication." b. "There is no problem using these drugs during the last trimester of my pregnancy." c. "Because this drug combination kills HIV, I do not need to worry about transmitting the virus." d. "If the virus becomes resistant to this cocktail, another combination of drugs may be required to reduce my viral load."

ANS: C Protease inhibitors suppress viral replication and release. They do not kill the virus, and currently no therapy for HIV infection kills the virus. The patient needs to understand that even on antiretroviral therapy, the disease can be spread through exchange of body fluids and precautions still must be taken.

A child is prescribed emtricitabine (Emtriva) 120 mg orally. The drug on hand is emtricitabine suspension 10 mg/mL. How many mL does the nurse prepare? a. 2 b. 6 c. 12 d. 20

ANS: C Want 120 mg in X mL/Have 10 mg in 1 mL. 120/10 = 12 mL = 120 mg.

A patient is prescribed to begin highly active antiretroviral therapy (HAART). What is the most important question the nurse asks this patient before beginning therapy? a. "Do you have any symptoms now of active infection?" b. "Is there any possibility that you are pregnant?" c. "Are you currently sexually active?" d. "What other drugs do you take?"

ANS: D Before giving an antiretroviral drug, always obtain a list of all other drugs the patient also takes, because antiretroviral drugs interact with many other drugs. Check with the pharmacist for possible interactions and the need to consult the prescriber about dosage or changing the patient's other drugs.

Which test results indicate to the nurse that a patient's antiretroviral therapy is effective? a. White blood cell count 5000 cells/mm3 b. Blood urea nitrogen level 15 mg/dL c. Blood positive for human immunodeficiency virus (HIV) antibodies d. CD4+ to CD8+ ratio increased

ANS: D HIV selectively infects and causes the destruction of CD4 cells (T-helper cells). An increase in ratio of this population of cells compared with CD8+ cells in a patient with HIV disease indicates the drug regimen is effective in suppressing viral replication.

A 40-year-old patient infected with human immunodeficiency virus (HIV) asks the nurse why the new drug maraviroc (Selzentry) is not being prescribed for her. What is the nurse's best response? a. "This drug is very expensive and your insurance may not cover it." b. "This drug can cause birth defects and should not be prescribed for anyone who is pregnant or might become pregnant." c. "This drug is very toxic to the heart and lungs. It is prescribed only for patients who are young and have no other health problems." d. "This drug is not effective against all HIV subtypes and the HIV causing your infection does not have the target for this drug."

ANS: D Maraviroc prevents cellular infection by blocking the CCR5 receptor on CD4+ T-cells. Because this drug is not effective against all HIV subtypes, the patient must first be tested to ensure that his or her HIV infection is likely to respond to this therapy. When the HIV subtype does not use the CCR5 receptor, the drug is not prescribed for that patient.

A patient who has been taking lamivudine (Epivir) for 6 months reports reduced sensation in the fingers and toes. What is the nurse's best action? a. Document the report as the only action. b. Hold the dose and notify the prescriber. c. Remind the patient to continue the drug as usual and take a multiple vitamin daily. d. Reassure the patient that this is an expected drug side effect and to use injury precautions.

ANS: D Peripheral neuropathy with loss of sensation in the extremities is a common and expected side effect of therapy. Drug therapy is not stopped for this effect. The patient needs to implement precautions to prevent injury from not having full sensation for touch, temperature, and pressure.

What is the most important precaution for the nurse to teach a patient who is prescribed oral valacyclovir (Valtrex)? a. "Avoid coffee and other caffeinated beverages." b. "Wear long sleeves and a hat when going outdoors." c. "Take this drug 1 hour before or 4 hours after eating a full meal." d. "Drink at least 3 L of water daily for the entire time you are taking this drug."

ANS: D Valacyclovir consists of a type of chemical that can easily turn into crystals. Crystals that form and clump in the kidneys can cause kidney failure or kidney stones. Drinking at least 3 L of fluids daily while taking this drug can prevent crystallization in the kidneys.

The nurse teaches the staff ensuring that standard precautions should be used when providing care for which type of patient? All patients regardless of diagnosis Pediatric and gerontologic patients Patients who are immunocompromised Patients with a history of infectious diseases

All patients regardless of diagnosis

The nurse is assessing an older adult patient. What type of age related disorders should the nurse assess for related to the increased immunologic response? Autoimmune response Cell-mediated immunity Hypersensitivity response Humoral immune response

Autoimmune response

A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What should the nurse include when teaching about preexposure prophylaxis (select all that apply.)? Take fluconazole (Diflucan). Take amphotericin B (Fungizone). Use condoms for risk-reducing sexual relations. Take emtricitabine and tenofovir (Truvada) regularly. Have regular HIV testing for herself and her husband.

C, D, E

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on the palms and soles, jaundice, and diarrhea. What does the nurse determine these clinical manifestations are indicating? The patient is experiencing a type I allergic reaction. An atopic reaction is causing the patient's symptoms. The patient is experiencing rejection of the bone marrow. Cells in the transplanted bone marrow are attacking the host tissue.

Cells in the transplanted bone marrow are attacking the host tissue.

A nurse was accidently stuck with a needle used on a patient who is infected with human immunodeficiency virus (HIV). After reporting the incident, what care should this nurse first receive? Personal protective equipment Combination antiretroviral therapy Counseling to report blood exposures A negative evaluation by the manager

Combination antiretroviral therapy

A patient with pneumococcal pneumonia is prescribed ceftriaxone for 10 days. During a follow-up visit, the patient reports to the nurse, "I stopped the medication after taking it for five days because I felt better." What is the best nursing response? 1 Explain the importance of completing the planned medication therapy. 2 Suggest that the patient give the leftover medications to the pharmacy. 3 Instruct the patient to obtain a refill to continue the medication for another week. 4 Instruct the patient to save the remaining medication in case the symptoms reoccur.

Correct 1 Antibiotics should always be taken until the completion of planned therapy even if the symptoms subside. Skipping the medications or not completing the therapy may result in developing resistance to the organism. Antibiotics should not be used for more than the planned therapy. Organisms may develop resistance to antibiotics if used for a longer duration. Antibiotics will lose their effectiveness when stored for a longer time, and they can even be fatal. The nurse will not instruct the patient to save the remaining medication for future use. The patient should not give it back to the pharmacy, because this medication may not be appropriate for others and may contain inadequate doses that do not provide full treatment.

Which patient factor has contributed to the development of antibiotic-resistant superinfections? 1 Skipping doses of antibiotics 2 Finishing the full course of antibiotics 3 Compliance regarding dosing intervals 4 Adherence to prescribed course of treatment

Correct 1 Patient factors that have led to the development of antibiotic-resistant organisms include skipping doses of medications and not finishing the full course of antibiotics. Adherence to a prescribed course of treatment and compliance regarding dosing intervals (taking medication on time as prescribed) lead to the intended eradication of infectious organisms.

A patient with human immunodeficiency virus (HIV) taking antiretroviral therapy reports they are starting to feel like they did before starting the therapy. What test should the nurse prepare the patient for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test

Correct 1 The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection.

A patient with human immunodeficiency virus (HIV) is educated about health promotion activities. What should the nurse inform the patient the importance of these activities is? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities

Correct 1 These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.

A patient diagnosed with acquired immunodeficiency syndrome (AIDS) comes to the clinic to find out which tests would determine the prognosis of the syndrome. What information will the nurse provide? Select all that apply. 1 Prognosis can be assessed by viral load. 2 Prognosis can be assessed by CD4 +T-cell count. 3 Prognosis can be assessed by red blood cell count. 4 Prognosis can be assessed by testing for hepatitis B virus (HBV). 5 Prognosis can be assessed by immunoglobulin M (IgM) antibody levels.

Correct 1, 2'The progression HIV infection is monitored by two important laboratory assessments: CD4+T-cell counts and viral load. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4 +T-cell count is done to monitor the progression of HIV infection and response to treatment. The normal range for CD4 +T cells is 800 to 1200 cells/μL. The red blood cell count indicates presence or absence of anemia. The tests for HBV and HCV indicate the infection with respective hepatitis virus. IgM antibody levels are nonspecific and do not indicate the progress of AIDS.

A patient who participates in high-risk activities has undergone an enzyme immunoassay (EIA) test for human immunodeficiency virus (HIV) infection. The nurse reviews the patient's lab results and notes a positive EIA result. What is likely to be included in the patient's plan of care? Select all that apply. 1 Repeat the EIA test. Correct 2 Confirm with a Western blot test. Correct 3 Confirm with an immunofluorescence assay. 4 Confirm with a rapid screening test for antigens. 5 Inform the patient that the patient is HIV-antibody positive.

Correct 1, 2, 3 If the patient tests positive with the enzyme immunoassay (EIA) test, which is highly sensitive, the test has to be repeated. If the repeat test is positive, the patient should be subjected to a confirmatory Western blot or immunofluorescence assay. Rapid screening tests are helpful for detecting antibodies, not antigens. The patient should be informed that he is positive for HIV antibody only if the confirmatory Western blot or immunofluorescence assay is positive.

The nurse knows that more patients are developing antibiotic-resistant infections requiring inpatient care. What actions may have contributed to the development of antibiotic-resistant infections? Select all that apply. 1 Prescribing antibiotics for viral infections 2 Performing cultures prior to initiating antibiotic therapy 3 Prescribing inadequate drug regimens to treat infections 4 Prescribing antibiotics based on need rather than patient insistence 5 Prescribing broad-spectrum antibiotics when only first-line antibiotics are needed

Correct 1, 3, 5 Health care providers (HCPs) have contributed to the development of antibiotic-resistant infections by prescribing broad-spectrum antibiotics when first-line medications should be used. HCPs that prescribe inadequate drug regimens depending on the bacteria involved also lead to development of antibiotic-resistance. Antibiotics should be used to treat infections caused by bacteria only since they are ineffective for viral infections. Performing cultures prior to initiating antibiotic therapy helps HCPs identify the bacteria and prescribe the appropriate first-line medication. Prescribing antibiotics based on need is an effective strategy for treating patients while also preventing the rise of antibiotic-resistant infections.

A nurse educator is teaching a group of nurses how to prevent health care-associated infections (HAI) in hospitals. Which bacteria are common culprits for the spread of health care-associated infections? Select all that apply. 1 Escherichia coli 2 Salmonella typhi 3 Clostridium botulinum 4 Staphylococcus aureus 5 Enterobacter aerogenes

Correct 1, 4, 5 Escherichia coli, Staphylococcus aureus, and Enterobacter aerogenes are the common culprits for health care-associated infections (HAI). These infections are acquired as a result of exposure to the microorganisms in a hospital setting. Surgical and immunocompromised patients are at increased risk of acquiring HAI. Salmonella typhi, which causes typhoid fever, and Clostridium botulinum, which causes food poisoning, are less common infections in hospitals.

In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? Select all that apply. 1 Platelets 2 T lymphocytes 3 B lymphocytes 4 Red blood cells 5 Immunoglobulins

Correct 2, 3 In the early stages of HIV infection, B cells and T cells protect the body from infections. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T-cells. Platelets do not take part in providing immunity to the human body. They are required for clotting mechanism. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

A patient is diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse monitor for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex

Correct 2, 4, 5 Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS, because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with HIV due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus, and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence.

A primary health care provider advises against prescribing an antibiotic to a patient with a severe cold, sore throat, and running nose. The patient tells the nurse, "I really want an antibiotic to make this cold go away." What is the best response by the nurse? 1 "An antibiotic is ineffective against a cold or flu." 2 "Use the rest of a previous prescribed antibiotic from home." 3 "I will ask the health care provider to prescribe a low-dose antibiotic." 4 Communicate the patient request and ask the primary health care provider to prescribe an antibiotic

Correct1 A cold, sore throat, and running nose are symptoms of cold and flu (a viral infection), and antibiotics are ineffective in treating viral infections. The nurse should inform the patient about the use of antibiotics, not tell the patient to use the rest of a previous prescribed antibiotic from home. The nurse should not give antibiotics to the patient, because frequent use of antibiotics causes resistance. The nurse should not ask the primary health care provider to prescribe antibiotics. Test-Taking Tip: A cold, sore throat, and running nose indicate a viral infection. Antibiotics are ineffective against viruses. Use this tip in answering this question.

During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidioides immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans

Correct1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus and the presence of thrush indicate Candida albicans. Infection by Coccidioides immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans.

A patient has been prescribed antiretroviral therapy (ART), and the nurse is monitoring the assessment of growth of HIV in the concentrations of prescribed antiretroviral drugs. The nurse anticipates that what test will be advised for the patient? 1 Genotype assay 2 Phenotype assay 3 Enzyme immunoassay 4 Immunofluorescence assay

Correct2 A phenotype assay involves the assessment of growth of HIV in various concentrations of antiretroviral drugs. It helps determine the correct dosage of ART for the patient. A genotype test assesses the drug-resistant mutations in protease and reverse transcriptase genes. The enzyme immunoassay and immunofluorescence assay are used to detect serum antibodies that bind to HIV antigens.

The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). The patient asks what would determine the actual development of acquired immunodeficiency syndrome (AIDS). The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? 1 Presence of HIV antibodies 2 CD4 +T cell count below 200/µL 3 Presence of oral hairy leukoplakia 4 White blood cell (WBC) count below 5000/µL

Correct2 Diagnostic criteria for AIDS include a CD4 +T cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or oral hairy leukoplakia or WBC count below 5000/µL may be found in patients with HIV disease, but do not define the advancement of HIV infection to AIDS.

The nurse is caring for a patient who is human immunodeficiency virus (HIV)-positive. The nurse is educating the patient about CD4 T cells. Which statement will be a part of the nurse's teaching? 1 "HIV produces CD4 cells to cause your infections." 2 "HIV will destroy your CD4 cells and overwhelm your body." 3 "Your immune system is healthy as long as you have CD4 cells." 4 "Immune problems occur when your CD4 level is greater than 500 CD4 T cells/uL."

Correct2 HIV cripples the immune system by destroying CD4 cells and overwhelming the body. The human body produces CD4 cells to fight the HIV virus. An immune system is considered healthy as long as CD4 levels remain above 500 CD4 T cells/uL, not for as long as the human body has CD4 cells. Immune problems occur when CD4 levels are less than 500 CD4 T cells/uL.

The nurse is caring for a group of assigned patients on the acute care unit. Which nursing action is a priority for preventing healthcare-associated infections (HAIs)? 1 Avoid direct contact with patients. 2 Wash hands before and after patient care. 3 Wear sterile gloves when working with patients. 4 Treat all patients as if they are infected with mycobacterium tuberculosis.

Correct2 Standard precautions should be instituted for all patients in the healthcare setting. These precautions include washing hands before and after patient care with soap and water or an alcohol-based rub. Wearing sterile gloves when working with patients is not always appropriate. Direct contact with patients is an aspect needed to deliver quality patient care. Precautions for care of patients with mycobacterium tuberculosis infection requires airborne precautions. Airborne precautions are instituted for patients with highly communicable respiratory diseases spread through the air over short distances.

A patient is being placed on efavirenz with a once-a-day dose. Which instructions should the nurse give to help the patient cope with the side effects? 1 Use electronic reminders, timers, and beepers. 2 Take the dose at bedtime before going to sleep. 3 Have tests regularly to assess viral load in the body. 4 Inform the health care provider about other drugs being taken.

Correct2 The antiretroviral drug efavirenz is associated with side effects like dizziness and confusion. Therefore the nurse should teach the patient to take the drug dose at bedtime to cope better with the side effects. Electronic reminders, timers, and beepers are used to increase adherence to drug regimens. Informing the health care providers about concurrent medicines is important to decrease adverse drug interactions, but may not help in coping with side effects of the drug. Regular testing should be done to assess the viral load on the body and, in turn, indicate the efficacy of the drug therapy.

A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the patient reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."

Correct2 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4 + T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection, nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle.

A patient has been diagnosed with human immunodeficiency virus (HIV). The patient does not want to take more than one antiretroviral drug. What explanation can the nurse give to the patient regarding the importance of combination antiretroviral therapy? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs

Correct2 The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

The nurse is providing education to parents to prepare their children for school. Which infection is preventable with vaccines? 1 Avian flu 2 Poliomyelitis 3 West Nile virus 4 Human immunodeficiency virus (HIV)

Correct2 The polio vaccine prevents the outbreak of the infection. There are currently no vaccines available to prevent the avian flu, HIV, or West Nile virus.

The nurse is preparing to disconnect IV fluid tubing from the access port so the patient can ambulate to the bathroom. What will the nurse wear to prevent the spread of pathogens? 1 A cap 2 Gloves 3 Shoe covers 4 An isolation gown

Correct2 When disconnecting IV fluid tubing, the nurse may come in contact with blood. Therefore personal protective equipment such as gloves should be used. This also helps the nurse avoid an infection by not touching contaminated items or surfaces. Caps, gowns, and boots are not required when removing IV tubing

Which is a microorganism capable of causing disease? 1 Lipase 2 Antigen 3 Pathogen 4 Microorganism

Correct3 A pathogen is a microorganism, such as a bacteria or virus, capable of causing disease. A pathogen can invade the body, multiply, produce disease, and cause harm to the host. An organism that can only be seen with a microscope is termed a microorganism. An antigen is a toxin or foreign substance that enters the body and initiates the immune response. Lipase is a pancreatic enzyme.

The nurse assesses a patient with recently diagnosed acquired immunodeficiency syndrome (AIDS). When obtaining a health history from the patient, what statement does the nurse determine most correlates with this diagnosis? 1 "I am feeling fatigue in the evening." 2 "I am sleeping six to eight hours per night." 3 "I have had a steady weight loss over the past several months." 4 "I have been having feelings of helplessness and hopelessness."

Correct3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss.

A patient with human immunodeficiency virus (HIV) comes into the clinic with a temperature of 102oF. Which statement would be of most concern to the nurse? 1 "I vomited once this morning." 2 "I woke up this morning with a mild headache." 3 "I have a rash that appeared on my stomach this morning." 4 "I started coughing up some clear mucous when I woke up this morning."

Correct3 Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.

A nurse is caring for older adults in a long-term care facility. For which early manifestation should the nurse monitor to detect infection in older adults? 1 High fever 2 Pain in the legs 3 Cognitive changes 4 Altered laboratory values

Correct3 In older adults, infections usually have atypical manifestations such as cognitive and behavioral changes. Unlike young adults, older adults have lower core temperatures and decreased immune responses; therefore, they may not have fever as a hallmark sign of infection. Pain, fever, and altered laboratory changes may occur in due course of the disease.

Zoonosis is the spread of disease from animals to humans. Which is a clinical example of a zoonosis infection? 1 Acute meningitis 2 Tuberculosis bacterium (TB) 3 Severe acute respiratory syndrome (SARS) 4 Methicillin-resistant staphylococcus aureus (MRSA)

Correct3 SARS is an example of a zoonosis infection. In 2003, China experienced an outbreak of SARS linked to the civet cat, a small carnivorous mammal found throughout Asia and Africa. TB is an infection that spreads through the air from person to person. Acute meningitis is a bacterial infection spread from person to person via respiratory and throat secretions. MRSA is an antibiotic-resistant infection spread from person to person via droplets or contact with contaminated objects.

An HIV patient is on long-term antiretroviral therapy (ART). Of what side effects of the antiretroviral therapy should the nurse instruct the patient to be aware? 1 Nausea 2 Vomiting 3 Diarrhea 4 Lipodystrophy

Correct4 HIV-infected patients on antiretroviral therapy may develop a metabolic disorder called lipodystrophy, which is the deposition of fat in the abdomen, upper back, and breasts. There may simultaneously be a loss of fat in the arms, legs, and face. Nausea, vomiting, and diarrhea are short-term side effects of ART and tend to subside with regular use.

A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? Cough, diarrhea, headaches, blurred vision, muscle fatigue Night sweats, fatigue, fever, and persistent generalized lymphadenopathy Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? "The baby will probably be infected with HIV." "Only an abortion will keep your baby from having HIV." "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

(ART) for a patient with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications are effective? Increased viral load Decreased neutrophil count Increased CD4+ T cell count Decreased white blood cell count

Increased CD4+ T cell count

The nurse is caring for a patient experiencing an immune response. She assesses the patient for development of a hyperimmune response while knowing that cytotoxic T cells are responsible for which action? May kill healthy cells along with foreign antigens. Are the most prevalent type of T lymphocyte. Can suppress the immune response. Diminish dendritic cell function.

May kill healthy cells along with foreign antigens.

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, what is the nurse's priority action? Monitor the patient's fluid balance. Assess the patient's need for analgesia. Monitor for signs and symptoms of an adverse reaction. Assess the patient for changes in level of consciousness.

Monitor for signs and symptoms of an adverse reaction.

The patient with an allergy to bee stings was just stung by a bee. After administering oxygen, removing the stinger, and administering epinephrine, the nurse notices the patient is hypotensive. What should be the nurse's first action? Administer IV diphenhydramine. Administer nitroprusside as soon as possible. Anticipate tracheostomy with laryngeal edema. Place the patient recumbent and elevate the legs.

Place the patient recumbent and elevate the legs.

A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? There is currently no need for those older vaccines. There is a reemergence of some of the infections, such as pertussis. There is no longer an immunization available for some of those diseases. The only way to protect your child is to have the federally required vaccines.

There is a reemergence of some of the infections, such as pertussis.