Ch 36 Management of PT with Immune Def.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

The nurse is instructing a male client about safer sexual behaviors. Which client statement indicates a need for additional instruction?

"I will apply baby oil to lubricate the condom."

The nurse is discussing sexual activity with a patient recently diagnosed with HIV. The patient states, "As long as I have sex with another person who is already infected, I will be okay." What is the best response by the nurse?

"You should avoid having unprotected sex with a person who is HIV positive because you can increase the severity of the infection in both you and your partner."

Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________.

1 hour; 72 hours; 4 weeks

A patient is infected with HIV after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection?

3 to 12 weeks

A patient is on ART 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?

50 mm3 to 150 mm3

Which category of HIV disease correlates with asymptomatic AIDS?

A

When do most perinatal HIV infections occur?

After exposure during delivery

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client?

Anemia and granulocytopenia

A patient receiving antiretroviral therapy is complaining of "not urinating enough." What is the nurse's best action?

Assess BUN and creatinine.

A nurse is preparing an in-service presentation about human immunodeficiency virus (HIV) for a group of new graduate nurses. As part of the presentation, the nurse is planning to describe the events that occur once HIV enters the host cell. Which of the following would the nurse describe as the first step?

Attachment

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

Avoid Fibrous foods, lactose, fat, and caffeine.

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?

Bank autologous blood.

Diagnosis of Kaposi's sarcoma (KS) is made by which of the following?

Biopsy

Which of the following are modes of transmission for HIV? Select all that apply.

Blood Seminal fluid Vaginal secretions Amniotic fluid

Which of the following is usually the most important consideration in decisions to initiate antiretroviral therapy?

CD4 counts

Which of the following tests determines initiation of antiretroviral treatment?

CD4/CD8 ratio

The nurse is collecting objective data for a client with AIDS at the clinic. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does the nurse understand this finding indicates?

Candidiasis

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:

Chronic diarrhea

Which of the following microorganisms is known to cause retinitis in people with HIV/AIDS?

Cytomegalovirus

During assessment of a patient with Kaposi's sarcoma, the nurse knows to look for the initial sign of:

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

A client suspected of having HIV has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive?

ELISA

Which blood test confirms the presence of antibodies to HIV?

Enzyme-linked immunosorbent assay (ELISA)

Which of the following is the first barrier method that can be controlled by the woman?

Female condom

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?

Follow the same sexual precautions as someone who has been diagnosed with AIDS.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by ____.

HIV-1 is more prevalent than HIV-2 subtypes

Which of the following is an early manifestation of HIV encephalopathy?

Headache

Which of the following indicates that a client with HIV has developed AIDS?

Herpes simplex ulcer persisting for 2 months

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean that

His body has not produced antibodies to the AIDS virus.

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?

Hypokalemia

The nurse teaches the patient that lowering his or her viral load will have what effect?

Longer survival time

HIV is harbored within which type of cell?

Lymphocyte

Which of the following nursing actions is essential before an EIA test is performed?

Obtaining a general consent for medical care from the patient

Which assessment finding is not likely to cause noncompliance with antiretroviral treatment?

Past substance abuse

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay with positive results twice. What is the next step for the nurse to explain to the patient for confirmation of the diagnosis?

Perform a Western blot test for confirmation of diagnosis.

A patient with HIV develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this patient?

Pneumocystis pneumonia

The nurse completes a history and physical assessment on a patient with AIDS who was admitted to the hospital with respiratory complications. The nurse knows to assess for the most common infection in persons with AIDS (80% occurrence). This is:

Pneumocystis pneumonia

The nurse is administering an injection to a client with AIDS and, when finished, attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse?

Report the incident to the supervisor

A client with HIV will be started on a medication regimen of three medications. Which medication will be given that will interfere with the virus's ability to make a genetic blueprint. What drug will the nurse instruct the client about?

Reverse transcriptase inhibitors

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 containing the genetic viral material?

Ribonucleic acid (RNA)

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission?

Semen

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply.

Semen Breast milk Blood Vaginal secretions

A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions?

Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens.

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

A client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care?

TMP-SMZ

A client diagnosed with HIV asks the nurse how the doctor can know what their viral load is. What should the nurse respond?

The doctor can have a polymerase chain reaction test run.

Which of the following statements reflects the treatment of HIV infection?

Treatment of HIV infection for an individual patient is based on the clinical condition of the patient, CD4 T cell count level, and HIV RNA (viral load).

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 (Bactrim, Septra)

An older adult widowed woman informs the nurse that she notices vaginal dryness now that she has become sexually active again. She is not using barrier protection because it makes the dryness worse. What education should the nurse provide to the patient?

Vaginal dryness is common in postmenopausal women, and there are creams that can be used, but she should use a latex condom.

The nurse practitioner reviews laboratory results requested to track HIV. Which of the following is a laboratory test that measures HIV RNA levels and is the best predictor of HIV disease progression?

Viral load

extra info

Viral load quantifies HIV RNA in the plasma. It monitors efficacy of antiretroviral treatment through virological suppression

In a client infected with human immunodeficiency virus (HIV), CD4+ levels are measured to determine the:

extent of immune system damage.

The nurse is teaching a client with HIV how to use a male condom. The client demonstrates understanding of the information when he states which of the following? Select all that apply.

"I need to hold the condom by the tip to squeeze out the air before putting it on." "I should avoid using baby oil or petroleum jelly with a condom." "I should unroll the condom all the way over my erect penis."

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe?

4 weeks

A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when he schedules a return visit for viral load testing at which time?

6 weeks

A client with AIDS is brought to the clinic by his family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

AIDS dementia complex (ADC)

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.

A client taking abacavir (ABC) has developed fever and rash. What is the priority nursing action?

Call the health care provider to report.

Which tests tell the physician what the viral load is in a client with HIV/AIDS? Select all that apply.

polymerase chain reaction p24 antigen test

Other than abstinence, what is the only proven method of decreasing the risk for sexual transmission of HIV infection?

Consistent and correct use of condoms

A client with AIDS is brought to the clinic by their family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

HIV encephalopathy

Which of the following is the most common HIV-related malignancy?

Kaposi's sarcoma

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

You are caring for a client who has a diagnosis of 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

Side effects of drug therapy

A patient taking amprenavir (APV, Agenerase) complains of "getting fat." What is the nurse's best action?

Teach the patient about medication side effects.

The client comes to the clinic to obtain the results from the test to determine if he is infected with HIV. The physician informs the client that he has a CD4 cell count of 300 cells/mm3 and a high viral load. What does the nurse anticipate the physician will discuss with the client?

The initiation of antiretroviral therapy

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

CDC category A: HIV asymptomatic

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?

Disturbed body image related to loss of fat in the face and arms

The nurse advises a patient who has received a negative test result from his HIV antibody test that he:

May be infected but antibodies are not currently present.

A client with suspected HIV has had two positive enzyme-linked immunosorbent assay tests. What diagnostic test would be run next?

Western Blot

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.

A client is admitted with a tentative diagnosis of acquired immunodeficiency syndrome (AIDS). He undergoes biopsies of facial lesions. The preliminary report indicates Kaposi's sarcoma. Which action by the nurse is most appropriate?

Explore the client's feelings about his facial disfigurement.

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?

Inform the patient that it would be beneficial to test for HIV.

Nursing students are reviewing information about the different manifestations associated with AIDS. The students demonstrate understanding of these manifestations when they identify which of the following as the most common HIV-related malignancy?

Kaposi's sarcoma

A nurse is preparing to administer an antiretroviral medication to a client who is positive for HIV. The nurse identifies the drug as a nucleoside reverse transcriptase inhibitor (NRTI). Which drug might this be?

Lamivudine (Epivir)

Which of the following options should the nurse encourage to replace fluid and electrolyte losses in a patient with AIDS?

Lipids

Students are reviewing information from the Centers for Disease Control and Prevention (CDC) for a class presentation about preventing the transmission of HIV transmission. Which of the following would the students be least likely to include in their presentation?

Nonlatex lambskin condoms are highly effective in preventing HIV infection.

A client with AIDS is exhibiting shortness of breath, cough, and fever. The nurse most likely would suspect infection with which of the following?

Pneumocystis jiroveci

A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in?

Primary infection

What intervention is appropriate before the patient starts on efavirenz (EFV, Sustiva) therapy?

Testing for Stevens-Johnson syndrome potential

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often."What should the nurse consult with the physician regarding?

Testing the client for the presence of HIV

A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care?

The client can state that he is at home

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?

The client has converted from HIV infection to AIDS.

A client with human immunodeficiency virus undergoes intradermal anergy testing using Candida and mumps antigen. During the 3 days following the tests, there is no induration or evidence of reaction at the intradermal injection sites. The most accurate conclusion the nurse can make is:

The client is immunodeficient and won't have a skin response.

The nurse receives a phone call at the clinic from the family of a patient with AIDS. They state that the patient started "acting funny" after complaining of 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 patient may have cryptococcal meningitis and will need to be evaluated by the physician."

A client who is HIV positive has been prescribed antiretroviral drugs. The nurse explains the action of each antiretroviral drug and develops a schedule for the client's self-administration, including strong emphasis about rigidly adhering to the dosage, time and frequency of the administration of the drugs. Why is it important to adhere to the schedule of drug dosing developed for this client?

To avoid resistance to the drugs

The term used to define the balance between the amount of HIV in the body and the immune response is

Viral set point

Which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm?

Primary infection (acute HIV infection or acute HIV syndrome)