Chapter 32: Management of Patients with Immune Deficiency Disorders

Which substance may be used to lubricate a condom? A) Skin lotion B) Petroleum jelly C) K-Y jelly D) Baby oil

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

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? A) CD4+ counts B) HIV RNA C) Western blotting assay D) ELISA

A) CD4+ counts Explanation: The most important consideration in decisions to initiate antiretroviral therapy is CD4+ counts.

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

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

A 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? A) 6 weeks B) 12 weeks C) 24 weeks D) 18 weeks

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

In a client infected with human immunodeficiency virus (HIV), CD4+ levels are measured to determine the: A) extent of immune system damage. B) level of the viral load. C) presence of opportunistic infections. D) resistance to antigens.

A) extent of immune system damage. Explanation: CD4+ levels in the blood of an individual with HIV infection determine the extent of damage to the individual's immune system. The test indicates the individual's risk of an opportunistic infection but doesn't identify specific infections. Viral loads and resistance to specific antigens are determined using other diagnostic tests.

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. A) breast milk B) semen C) urine D) vaginal secretions E) blood

A) breast milk B) semen D) vaginal secretions E) blood Explanation: There are only four known body fluids through which HIV is transmitted: blood, semen, vaginal secretions, and breast milk. HIV may be present in saliva, tears, and conjunctival secretions, but transmission of HIV through these fluids has not been implicated. HIV is not found in urine, stool, vomit, or sweat.

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? A) Cytomegalovirus B) Mycobacterium tuberculosis C) Pneumocystis pneumonia D) Legionnaire's disease

C) Pneumocystis pneumonia Explanation: Pneumocystic pneumonia (PCP) is one of the first and most common opportunistic infections associated with AIDS. It may be present despite the absence of crackles. If untreated, PCP progresses to cause significant pulmonary impairment and respiratory failure.

The majority of patient with primary immunodeficiency are in which age group? A) Younger than 20 B) 41 to 50 C) 51 to 60 D) 20 to 40

A) Younger than 20 Explanation: About 80% of the patients with primary immunodeficiency are younger than age 20 years.

Which condition is an early manifestation of HIV encephalopathy? A) Vacant stare B) Headache C) Hyperreflexia D) Hallucinations

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

A home care nurse is visiting a client with acquired immune deficiency syndrome (AIDS) at home. During the visit, the nurse observes the caregiver providing care. What action by the caregiver would alert the nurse to the need for additional teaching? A) Caregiver disposes of syringe and needle in a metal coffee can with lid. B) Caregiver uses a dilute bleach solution to clean up a urine spill. C) Caregiver cleans the client's anal area without wearing gloves D) Caregiver washes hands before and after providing care to the client.

C) Caregiver cleans the client's anal area without wearing gloves Explanation: To prevent the risk of HIV transmission, standard precautions should be used. Cleaning the client's anal area without wearing gloves indicates that the nurse needs to reinstruct the caregiver in measures related to standard precautions. Handwashing before and after client care, disposing of sharps in a puncture-resistant container, and cleaning up spills with a dilute bleach solution are appropriate measures.

Which blood test confirms the presence of antibodies to HIV? A) p24 antigen B) Reverse transcriptase C) Enzyme-linked immunosorbent assay (ELISA) D) Erythrocyte sedimentation rate (ESR)

C) Enzyme-linked immunosorbent assay (ELISA) Explanation: ELISA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. The p24 antigen test is a blood test that measures viral core protein. Reverse transcriptase is not a blood test. Rather, it is an enzyme that transforms single-stranded RNA into double-stranded DNA.

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

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

A 16-year-old has come to the clinic and asks to talk to a nurse. The teen states that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do to keep from getting HIV. What would be the nurse's best response? A) "There are new ways of protecting yourself from HIV that are being discovered every day." B) "Only the correct use of a female condom protects against the transmission of HIV." C) "There's no way to be sure you won't get HIV except to use condoms correctly." D) "Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV."

D) "Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV." Explanation: Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.

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

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

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

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

A client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care? A) Preparation for a thymus graft B) Preparation for bone marrow transplantation C) Administration of antifungal agents D) Administration of granulocyte colony-stimulating factors

B) Preparation for bone marrow transplantation Explanation: For a client with severe combined immunodeficiency (SCID), the nurse would include in the plan of care preparing the client for a bone transplant. Antifungal agents are used to treat chronic mucocutaneous candidiasis. Granulocyte-stimulating factors would be used to treat immunodeficiency related to phagocytic dysfunction. A thymus graft would be used to treat DiGeorge syndrome.

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? A) Oral candida B) Anorexia C) Chronic diarrhea D) Nausea and vomiting

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

Telangiectasia is the term that refers to: A) Inability to understand the spoken word B) Difficulty swallowing C) Vascular lesions caused by dilated blood vessels D) Uncoordinated muscle movement

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

A hospital client is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Send the client to the x-ray department, and have the staff in the department wear masks. B) Ensure that the radiology department has been disinfected prior to the test. C) Have the client wear a mask to the x-ray department. D) Arrange for a portable x-ray machine to be used.

D) Arrange for a portable x-ray machine to be used. Explanation: A client who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the client's room. This confers more protection than disinfecting the radiology department or using masks.

A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? A) Semen B) Blood C) Breast milk D) Urine

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

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

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

Kaposi sarcoma (KS) is diagnosed through: A) skin scraping. B) biopsy. C) visual assessment. D) computed tomography.

B) biopsy. Explanation: KS is diagnosed by biopsy of the suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count.

The balance between the amount of HIV in the body and the immune response is the: A) window period. B) viral set point. C) anergy. D) viral load test.

B) viral set point. Explanation: The amount of virus in the body after the initial immune response subsides is referred to as the viral set point, which results in an equilibrium between HIV levels and the immune response that may be elicited. A viral load test measures the quantity of HIV RNA in the blood. The window period is the time from infection with HIV until seroconversion detected on HIV antibody test. Anergy is the loss or weakening of the body's immunity to an irritating agent or antigen.

When a nurse infuses gamma globulin intravenously, the rate should not exceed: A) 3 mL/min B) 1.5 mL/min C) 6 mL/min D) 10 mL/min

A) 3 mL/min Explanation: The intravenous infusion should be administered at a slow rate, not to exceed 3 mL/min.

A client received 2 units of packed red blood cells while in the hospital with rectal bleeding. Three days after discharge, the client experienced an allergic response and began to itch and break out with hives. What type of reaction does the nurse understand could be occurring? A) Delayed hypersensitivity response B) An immediate hypersensitivity response C) Sensitization D) Anaphylactic reaction

A) Delayed hypersensitivity response Explanation: A delayed hypersensitivity response may develop over several hours or days, or it may reach maximum severity after repeated exposure. Examples of a delayed hypersensitivity response include a blood transfusion reaction that occurs days to weeks after blood administration, rejection of transplanted tissues, and reaction to a tuberculin skin test. Anaphylaxis is a rapid and profound type I hypersensitivity response. Sensitization is the process by which cellular and chemical events occur after a second or subsequent exposure to an allergen. An immediate hypersensitivity response is due to antibodies interacting with allergens and occurs rapidly.

Which of the following are antidepressants used in the treatment of AIDS? Select all that apply. A) Norpramin B) Megace C) Tofranil D) Prozac E) Mycelex

A) Norpramin C) Tofranil D) Prozac Explanation: Antidepressants such as Tofranil, Norpramin, and Prozac may be used, because these medications also alleviate the fatigue and lethargy that are associated with depression. Megace is an appetite stimulant. Mycelex is used for esophageal or oral candidiasis.

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? A) Past substance abuse B) Active substance abuse C) Lack of social support D) Depression

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

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

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

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

A) Shaking chills B) Flank pain D) Tightness in the chest Explanation: Adverse reactions can include reports of flank and back pain, shaking chills, dyspnea, and tightness in the chest, as well as headache, fever, and local reaction at the infusion site.

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: A) alcohol. B) exposure to sunlight. C) applying skin moisturizers. D) seafood.

A) alcohol. Explanation: The nurse should advise a client taking antihistamines not to take it with alcohol or other central nervous system depressants because additive sedative effects can occur.

Which tests tell the physician what the viral load is in a client with HIV/AIDS? Select all that apply. A) p24 antigen test B) polymerase chain reaction C) ELISA test D) T4/T8 ratio E) Western blot

A) p24 antigen test B) polymerase chain reaction Explanation: It is now possible to measure a person's viral load, the number of viral particles in the blood. The p24 antigen test and polymerase chain reaction test measure viral loads. The ELISA is a screening test for HIV. The Western blot is a diagnostic test for HIV. The T4/T8 ratio determines the status of T lymphocytes.

The lower the client's viral load, A) the longer the survival time. B) the longer the time immunity. C) the shorter the time to AIDS diagnosis. D) the shorter the survival time.

A) the longer the survival time. Explanation: The lower the client's viral load, the longer the time to AIDS diagnosis and the longer the survival time. The key goal of antiretroviral therapy is to achieve and maintain durable viral suppression.

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

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

Which of the following is the first barrier method that can be controlled by the woman? A) Diaphragm B) Birth control pills C) IUD D) Female condom

D) Female condom Explanation: The female condom has the distinction of being the first barrier method that can be controlled by the woman. The IUD may increase the risk for HIV transmission through an inflammatory foreign body response. The female condom is as effective in preventing pregnancy as other barrier methods, such as the diaphragm and the male condom. Birth control pills are not a barrier method.

A client taking antiretroviral therapy (ART) for stage 1 of HIV wants new medications because the CD4+ level is not much higher one year after initiation of therapy. The nurse knows that which response will be correct when educating the client about their disease? A) "The viral load results can show improvement." B) "This means that medication doses have been skipped." C) "You are entering another stage of the illness." D) "It's possible that other medication would be more effective."

A) "The viral load results can show improvement." Explanation: Laboratory tests evaluate whether ART is effective for a specific patient. An adequate CD4+ response for most clients on ART is an increase in CD4+ count in the range of 50 to 150 mm3 per year, generally with an accelerated response in the first 3 months. Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART. A slowing of the CD4+ level does not indicate that the client is entering another stage of the illness. It also does not mean that the client is missing doses of the medication. There is no reason to question the medications being used to treat the client.

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? A) AIDS dementia complex (ADC) B) distal sensory polyneuropathy (DSP) C) cytomegalovirus (CMV) D) candidiasis

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

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

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

Which of the following are common sites of visceral involvement of Kaposi's sarcoma? Select all that apply. A) Lymph nodes B) Gastrointestinal tract C) Heart D) Lungs E) Brain

A) Lymph nodes B) Gastrointestinal tract D) Lungs Explanation: The most common sites of visceral involvement are the lymph nodes, the gastrointestinal tract, and the lungs. Involvement of internal organs may eventually lead to organ failure, hemorrhage, infection, and death. The brain and the heart are not common sites.

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior? A) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. B) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle. C) The nurse performs hand hygiene with a waterless antiseptic agent after removing a pair of soiled gloves. D) The nurse wears face protection, gloves, and a gown when irrigating a wound.

A) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. Explanation: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same client. Each of the other listed actions adheres to standard precautions.

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

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

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

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

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

B) Bone marrow transplantation Explanation: Treatment options for SCID include stem cell and bone marrow transplantation.

Which microorganism is known to cause retinitis in people with HIV/AIDS? A) Mycobacterium avium B) Cytomegalovirus C) Cryptococcus neoformans D) Pneumocystis carinii

B) Cytomegalovirus Explanation: Cytomegalovirus is a species-specific herpes virus. C. neoformans is a fungus that causes an opportunistic infection in clients with HIV/AIDS. M. avium is an acid-fast bacillus that commonly causes a respiratory illness. P. carinii is an organism that is thought to be protozoan, but believed to be a fungus based on its structure.

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

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

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

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

A 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? A) Provide a prescribed topical antifungal agent to treat the client's vaginal infection. B) Offer information on human immunodeficiency virus (HIV) testing. C) Recommend abstinence or safer-sex practices. D) Refer the client to a support group with others experiencing the same symptoms.

B) Offer information on human immunodeficiency virus (HIV) testing. Explanation: In women, gynecologic problems may be the focus of the chief complaint for clients who are HIV positive but not yet diagnosed. Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may also correlate with HIV infection. Based on this information, the priority nursing action is to offer information on HIV testing to the client. Although recommending abstinence or safer-sex practices, providing a prescribed topical antifungal agent to treat the client's vaginal infection, and referring to a support group may be appropriate, the priority is to determine the source of the client's symptoms.

A client with acquired immune deficiency syndrome (AIDS) is exhibiting shortness of breath, cough, and fever. What type of infection will the nurse most likely suspect? A) Legionella B) Pneumocystis jiroveci C) Mycobacterium avium complex D) Cytomegalovirus

B) Pneumocystis jiroveci Explanation: Although mycobacterium, legionella, and cytomegalovirus may cause the signs and symptoms described, the most common infection in people with AIDS is pneumocystis pneumonia caused by pneumocystis jiroveci. It is the most common opportunistic infection associated with AIDS.

A client with AIDS has developed cytomegalovirus (CMV) retinitis and is receiving treatment with foscarnet. The nurse would monitor for which possible adverse drug effects? Select all that apply. A) Neutropenia B) Seizures C) Hypercalcemia D) Hyperphosphatemia E) Hypomagnesemia

B) Seizures D) Hyperphosphatemia E) Hypomagnesemia Explanation: Adverse reactions associated with foscarnet include nephrotoxicity, including acute renal failure, and electrolyte imbalances such as hypocalcemia, hyperphosphatemia, and hypomagnesemia, which can be life-threatening. Seizures also may occur. Neutropenia is an adverse effect associated with ganciclovir.

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

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

The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what? A) Uncoordinated muscle movement B) Vascular lesions caused by dilated blood vessels C) Peripheral edema D) A condition marked by development of urticaria

B) Vascular lesions caused by dilated blood vessels Explanation: Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia refers to uncoordinated muscle movement and is a clinical manifestation of combined B-cell and T-cell deficiencies. Telangiectasia is not peripheral edema, vascular lesions, or urticaria.

A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate? A) "Your child does not have AIDS but this condition puts your child at risk for it later in life." B) "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." C) "Although AIDS is an immune deficiency, your child's condition is different from AIDS." D) "We need to do some more testing before we will know if your child's condition is AIDS."

C) "Although AIDS is an immune deficiency, your child's condition is different from AIDS." Explanation: Primary immune deficiencies should be not be confused with AIDS. They are not the same condition. In addition, a primary immune disorder does not increase the child's risk for developing AIDS later in life. Primary immune deficiency diseases are serious, but they are rarely fatal and can be controlled. Testing will reveal the evidence of a primary immune disease, not AIDS. AIDS is classified as a secondary immunodeficiency.

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

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

The nurse 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? A) Limit fluid intake to 1 1/2 to 2 liters per day. B) Encourage client to ambulate frequently in the halls. C) Assist with chest physiotherapy every 2 to 4 hours. D) Maintain the client in a supine or side-lying position.

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

Which of the following is the most common HIV-related malignancy? A) Pancreatic carcinoma B) B-cell lymphoma C) Kaposi's sarcoma D) Cervical carcinoma

C) Kaposi's sarcoma Explanation: Kaposi's sarcoma is the most common HIV-related malignancy and involves the endothelial layer of blood and lymphatic vessels. Kaposi's sarcoma, certain types of B-cell lymphomas, and invasive cervical carcinoma are included in the CDC classification of AIDS-related malignancies.

A client taking abacavir has developed fever and rash. What is the priority nursing action? A) Administer lidocaine cream for the rash. B) Document the information. C) Report to the health care provider. D) Administer acetaminophen.

C) Report to the health care provider. Explanation: Fever and a rash could be indicative of a hypersensitivity reaction. Hypersensitivity reactions are also known as anaphylactic reactions and often involve skin rashes, fever, and bronchopulmonary issues such as bronchial constriction. The health care provider should be notified immediately and the medication stopped. Interventions need to be taken to assure that the client's airway is not compromised. Administering acetaminophen and documentation and treating the rash are not the priority and would be completed after the client is stabilized.

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? A) Blood specimen for electrolyte studies B) Sputum specimen for acid fast bacillus C) Stool specimen for ova and parasites D) Urine specimen for culture and sensitivity

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

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior? A) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle. B) The nurse performs hand hygiene with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. D) The nurse wears face protection, gloves, and a gown when irrigating a wound.

C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. Explanation: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same client. Each of the other listed actions adheres to standard precautions.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate? A) The intrauterine device is recommended for a client with HIV. B) If the client and her sexual partners are HIV-positive, unprotected sex is permitted. C) Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended to prevent HIV transmission. D) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.

D) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. Explanation: A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. The nurse should caution the client not to have unprotected sex because continued exposure to HIV in a seropositive client may hasten the course of the disease or result in infection with another strain of HIV. Hormonal contraceptives, implants, and injections offer no protection against HIV transmission. The intrauterine device isn't recommended for a client with HIV because it may increase her susceptibility to pelvic inflammatory disease.

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

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

A client 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? A) Deficient knowledge related to the effects of the disease B) Risk for impaired liver function related to drug therapy effects C) Risk for infection related to the immune system dysfunction D) Disturbed body image related to loss of fat in the face and arms

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

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? A) Gluten B) Iron and zinc C) Sucrose D) Liquids

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

A client with human immunodeficiency virus (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 client? A) Tuberculosis B) Community-acquired pneumonia C) Mycobacterium avium complex (MAC) D) Pneumocystis pneumonia

D) Pneumocystis pneumonia Explanation: The most common life-threatening infection in those living with acquired immune deficiency syndrome (AIDS) is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly P. carinii) (Durham & Lashley, 2010). Without prophylactic therapy, most people infected with HIV will develop PCP. The clinical presentation of PCP in HIV infection is generally less acute than in people who are immunosuppressed as a result of other conditions. Clients with HIV infection initially develop nonspecific signs and symptoms, such as nonproductive cough, fever, chills, shortness of breath, dyspnea, and occasionally chest pain. Arterial oxygen concentrations in clients who are breathing room air may be mildly decreased, indicating minimal hypoxemia.

Which is a major manifestation of Wiskott-Aldrich syndrome? A) Ataxia B) Episodes of edema C) Bacterial infection D) Thrombocytopenia

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

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? A) Nucleic acid sequence-based amplification B) p24 antigen capture assay C) OraSure test D) Western blot assay

D) Western blot assay Explanation: A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. The OraSure test uses saliva to perform an EIA test. The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load and evaluate response to treatment. However, the reverse transcriptase-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based tests have replaced the p24 antigen test. The RT-PCR tests may be used to confirm a positive EIA result.