Chapter 36: Management of Patients With Immune Deficiency Disorders Prep-U
A client who has been exposed to the human immunodeficiency virus (HIV) tests negative. Which explanation by the nurse would be most appropriate? "Your body may not have developed antibodies yet, so we need to follow up." "You might still go on to develop AIDS even with negative results." "You're one of the lucky ones who are immune to the virus." "Congratulations, a negative result means that you're not infected with the virus."
"Your body may not have developed antibodies yet, so we need to follow up." Explanation: A negative test result means that antibodies to HIV are not in the blood at this time. The person may not be infected or the person's body may not yet have produced antibodies. (The "window" period is 3 weeks to 6 months). The client needs follow-up testing and must continue to take precautions. The negative test result does not mean that the client is immune to HIV, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet.
The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed? "I will avoid letting my child drink any juice that has been sitting out for more than an hour." "I will let my neighbor have my pet iguana." "I will apply lotion following every bath to prevent dry skin." "I can take my child to the beach, as long as we play in the sand rather than swim in the water."
"I can take my child to the beach, as long as we play in the sand rather than swim in the water." Explanation: Parents should verbalize ways to plan for regular exercise and activity that does not pose a risk of infections. Immunocompromised clients should avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis.
When do most perinatal HIV infections occur? Through casual contact After exposure during delivery Through breastfeeding In utero
After exposure during delivery Explanation: Mother-to-child transmission of HIV-1 may occur in utero or through breastfeeding, but most perinatal infections are thought to occur after exposure during delivery.
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? Ribonucleic acid (RNA) Viral core Deoxyribonucleic acid (DNA) Glycoprotein envelope
Ribonucleic acid (RNA) Explanation: HIV is a retrovirus that carries its genetic material in the form of RNA rather than DNA. HIV consists of a viral core containing the viral RNA, surrounded by an envelope consisting of protruding glycoproteins.
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? Bathing or hygiene self-care deficit Risk for injury Complicated grieving Ineffective cerebral tissue perfusion
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 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 Aerosolized pentamidine Azithromycin Clindamycin
TMP-SMZ Explanation: TMP-SMZ is the treatment of choice for pneumocystis pneumonia. Alternative regimens may include dapsone and TMP, primaquine plus clindamycin, or atovaquone suspension. Aerosolized pentamidine is not used because of its limited efficacy and more frequent cases of relapse. Azithromycin or clarithromycin are the preferred prophylactic agents for Mycobacterium avium complex.
Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? Oral estrogen contraceptives The female condom A diaphragm An intrauterine device (IUD)
The female condom Explanation: The female condom, the first barrier method controlled by women, is the only proven, effective method to prevent the transmission of HIV and sexually transmitted infections (STI).
When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? Anxiety related to an inherited disorder Grieving related to the poor prognosis of the condition Impaired skin integrity related to persistent deep skin abscesses Risk for infection related to altered immune cell function
Risk for infection related to altered immune cell function Explanation: Although anxiety and impaired skin integrity may be appropriate, the priority nursing diagnosis for any immunodeficiency is the risk for infection. Although primary immunodeficiencies can be serious, they are rarely fatal. Therefore, the nursing diagnosis of grieving would be inappropriate.
What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? Antibiotics Bone marrow transplantation Removal of the thymus gland Radiation therapy
Bone marrow transplantation Explanation: Treatment options for SCID include stem cell and bone marrow transplantation.
Which condition is an early manifestation of HIV encephalopathy? Hyperreflexia Hallucinations Vacant stare Headache
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.
During a third-trimester transabdominal ultrasound, cardiac anomaly and facial abnormalities are noted in the fetus. Further testing reveals that the thymus gland has failed to develop normally, and the fetus is diagnosed with thymic hypoplasia. Based on this diagnosis, the nurse anticipates careful monitoring for which common manifestation during the first 24 hours of life? Thrombocytopenia Hypoglycemia Hypocalcemia Hyperkalemia
Hypocalcemia Explanation: The most frequent presenting sign in clients with thymic hypoplasia (DiGeorge syndrome) is hypocalcemia that is resistant to standard therapy. It usually occurs within the first 24 hours of life.
A client with ataxia-telangiectasia is admitted to the unit. The nurse caring for the client would expect to see what included in the treatment regimen? Factor VIII administration IV gamma globulin administration Platelet administration Thymus grafting
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 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? Latent infection Tertiary infection Primary infection Secondary infection
Primary infection Explanation: The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection, or stage 1. Initially, there is a period during which those who are HIV positive test negative on the HIV antibody blood test, although they are infected and highly infectious, because their viral loads are very high.
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." "My partner and I should avoid manual-anal intercourse." "I should use a new condom each time I have sex." "After having sex, I should hold onto the condom when pulling out."
"I will apply baby oil to lubricate the condom." Explanation: The client should use only water-soluble lubricant, such as K-Y jelly or glycerin. Baby oil can cause the condom to break. The client should use a new condom for each sexual activity and hold onto the condom so that it does not come off when pulling out. Manual-anal intercourse should be avoided.
The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 3 mL/min 6 mL/min 10 mL/min 1.5 mL/min
3 mL/min Explanation: The nurse should administer the IV infusion at a slow rate, not to exceed 3 mL/min, usually at 100-200 mL/h.
A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? AIDS CVID DAF SCID
AIDS Explanation: AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.
A nurse works in an employee health department of a hospital. She was asked to treat a staff nurse who was exposed to blood from a patient with an HIV infection. The nurse practitioner instituted a PEP protocol that includes which of the following actions? Select all that apply. Finish postexposure testing at 6 months. Continue HIV medications for 4 weeks postexposure. Initiate postexposure testing after 4 weeks. Start prophylaxis medications between 3 to 6 hours after exposure. Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level).
Continue HIV medications for 4 weeks postexposure. Initiate postexposure testing after 4 weeks. Finish postexposure testing at 6 months. Explanation: Refer to Box 37-4 in the text
Which microorganism is known to cause retinitis in people with HIV/AIDS? Cryptococcus neoformans Mycobacterium avium Cytomegalovirus Pneumocystis carinii
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 would a nurse be least likely to identify as a cause of secondary immunodeficiency? Burns Diabetes Genetics Chronic stress
Genetics Explanation: Genetics most likely would be a cause of primary immunodeficiency. Burns, chronic stress, and diabetes are associated causes of secondary immunodeficiency.
Which of the following is a lack of one or more of the five immunoglobulins? Hypogammaglobulinemia Telangiectasia Agammaglobulinemia Panhypoglobulinemia
Hypogammaglobulinemia Explanation: Hypogammaglobulinemia is a lack of one or more of the five immunoglobulins. Agammaglobulinemia is a disorder marked by an almost complete lack of immunoglobulins or antibodies. Panhypoglobulinemia is a general lack of immunoglobulins in the blood. Telangiectasia are vascular lesions caused by dilated blood vessels.
Phagocytic dysfunction is characterized by the following. Choose all that apply. Increased incidence of bacterial infections Rapid heartbeat Immunity to infection with herpes simplex Chronic eczematoid dermatitis Manifestation of underlying disease processes
Increased incidence of bacterial infections Chronic eczematoid dermatitis Explanation: In phagocytic cell disorders, incidence of bacterial and fungal infections is increased, resulting from organisms that are normally nonpathogenic. Clients experience recurrent cutaneous abscesses, chronic eczema, bronchitis, pneumonia, chronic otitis media, and sinusitis.
The nurse is aware that the most prevalent cause of immunodeficiency worldwide is Neutropenia Chronic diarrhea Malnutrition Hypocalcemia
Malnutrition Explanation: The most prevalent cause of immunodeficiency worldwide is severe malnutrition.
A client taking fosamprenavir reports "getting fat." What is the nurse's best action? Assess the client's diet. Have the client increase exercise. Teach the client about medication side effects. Arrange for a psychological counseling.
Teach the client about medication side effects. Explanation: The client needs to be aware of the potential for fat redistribution. Exercise, diet, and counseling will not change the outcome of this side effect.
Telangiectasia is the term that refers to Vascular lesions caused by dilated blood vessels Inability to understand the spoken word Difficulty swallowing Uncoordinated muscle movement
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.
The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? The client's CD4+ cell count has decreased due to the pneumocystis pneumonia. The client has advanced HIV infection. The client has converted from HIV infection to AIDS. The client has another infection present that is causing a decrease in the CD4+ cell count.
The client has converted from HIV infection to AIDS. Explanation: AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased CD4+ cell count from a normal level of 500 to 1000/mm³ and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The CD4+ cell count is not decreasing due to an infection.
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? Nystatin Amphotericin B Fluconazole Trimethoprim-sulfamethoxazole
Trimethoprim-sulfamethoxazole Explanation: To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.
A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? Encourage the client to drink more fluids. Administer fluids 100 mL/hour IV. Assess liver function tests. Assess blood urea nitrogen and creatinine.
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.
A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise? Increase intake of iron and zinc. Consume large, high-fat meals. Avoid fibrous foods, lactose, fat, and caffeine. Reduce food intake.
Avoid fibrous foods, lactose, fat, and caffeine. Explanation: Diarrhea may subside when the client avoids fibrous foods, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, and soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system
The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client probably has a case of the flu and you should give acetaminophen." "This is one of the side effects from antiretroviral therapy and will require changing the medication." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."
"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." Explanation: A fungal infection, Cryptococcus neoformans is another common opportunistic infection among clients with AIDS, and it causes neurologic disease. Cryptococcal meningitis is characterized by symptoms such as fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.
There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. "Your immune system was most likely affected by an underlying disease process." "Your condition will predispose you to frequent and recurring infections." "Your diagnosis was inherited." "You will now be more likely to develop cancer in the future."
"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.
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: Anorexia. Oral candida. Nausea and vomiting. Chronic diarrhea.
Chronic diarrhea. Explanation: Chronic diarrhea is believed related to the direct effect of HIV on cells lining the intestine. Although all gastrointestinal manifestations of AIDS can be debilitating, the most devastating is chronic diarrhea. It can cause profound weight loss and severe fluid and electrolyte imbalances.
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Liquids Sucrose Gluten Iron and zinc
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 is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately? Mouth sores Sneezing Constipation Tickle in the throat
Tickle in the throat Explanation: Continually assess the client for adverse reactions; be especially aware of complaints of a tickle or lump in the throat, which could be the precursor to laryngospasm that precedes bronchoconstriction.
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? Blood Semen Breast milk Urine
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? Viral load Enzyme immunoassay Western blotting Complete blood count
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: biopsy visual assessment. computed tomography. skin scraping.
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 term used to define the amount of virus in the body after the initial immune response subsides is primary infection stage. viral clearance rate. window period. viral set point.
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. During the primary infection period, the window period occurs because a person is infected with HIV but negative on the HIV antibody blood test. The period from infection with HIV to the development of antibodies to HIV is known as the primary infection stage. The amount of virus in circulation and the number of infected cells equals the rate of viral clearance.
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I can eat whatever I want as long as it's low in fat." "I won't go to see my sister while she has a cold." "I stopped smoking last year; this year I'll quit drinking alcohol." "I won't go to see my nephew right after he gets his vaccines."
"I can eat whatever I want as long as it's low in fat." Explanation: The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.
A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year? 1 mm3 to 10 mm3 10 mm3 to 20 mm3 50 mm3 to 150 mm3 20 mm3 to 45 mm3
50 mm3 to 150 mm3 Explanation: An adequate CD4 response for most patients on HAART is an increase in CD4 count in the range of 50 mm3 to 150 mm3 per year, generally with an accelerated response in the first 3 months.
A 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. Hunger Flank pain Fatigue Tightness in the chest Shaking chills
Flank pain Shaking chills 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.
When describing the effects of treatment for phagocytic cell disorders, which of the following would the nurse include as being the most successful? Use of granulocyte transfusions Hematopoietic stem cell transplantation Gene therapy Antibiotic therapy
Hematopoietic stem cell transplantation Explanation: Hematopoietic stem cell transplantation has proven to be a successful curative modality for phagocytic disorders. The effectiveness of antibiotic therapy is variable and depends on the factors associated with the infection, such as epidemiology, susceptibility, resistance, availability, and cost. Granulocyte infusions are seldom successful because of the short half-life of these cells. Gene therapy is promising but further study and improvements are needed.
A nurse is teaching a client with immunodeficiency about the signs and symptoms of infection to report. The nurse determines that the teaching was successful when the client makes which statement? "A fever over 101 degrees is the most common sign of infection." "I might notice a swollen lymph node or two, but this is normal." "A dry cough is just irritation, but one with mucous means an infection." "Any change, however subtle, might mean that I have an infection."
"Any change, however subtle, might mean that I have an infection." Explanation: For clients with immunodeficiencies, subtle changes may indicate an infection. Therefore, the client would contact the health care provider if symptoms develop that are not typical. Fever does not need to be over 101 degrees to indicate an infection. A cough, either dry or wet, or swollen lymph nodes suggest infection.
A nurse is developing a teaching plan for a client with an immunodeficiency. What would the nurse need to emphasize? Select all that apply. Signs and symptoms of bleeding Need to interrupt therapy for short periods Ways to manage stress Prophylactic medication regimens Maintenance of a well-balanced diet
Prophylactic medication regimens Ways to manage stress Maintenance of a well-balanced diet Explanation: Teaching for clients with immunodeficiency disorders should focus on the signs and symptoms that indicate infection, prophylactic medication regimens, the need for continued therapy without interruptions, ways to manage stress, and measures to ensure optimal nutritional status.
A client with HIV will be started on a medication regimen of three medications. What class of drugs will the nurse instruct the client about? Hydroxyurea Anticholinergics Disinhibitors Reverse transcriptase inhibitors
Reverse transcriptase inhibitors Explanation: Reverse transcriptase inhibitors are drugs that interfere with the virus' ability to make a genetic blueprint. A protease inhibitor is a drug that inhibits the ability of virus particles to leave the host cell. The integrase inhibitors are a class of drug that prevents the incorporation of viral DNA into the host cell's DNA. Hydroxyurea is a drug that is used as an adjunct therapy that tries to halt the progression of AIDS.
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? Sign a refusal of blood transfusion form so the client will not receive the transfusion. Ask people to donate blood. Use volume expanders in case blood is needed. Bank autologous blood.
Bank autologous blood. Explanation: Banking autologous blood that is self-donated is the safest option for the client. Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? Lack of social support Past substance abuse Depression Active substance abuse
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.
The nurse is caring for a client with an autoimmune disease. What is a characteristic of autoimmune disorders? Absence of a triggering event Profound fatigue with no identifiable cause Progressive tissue damage without any verifiable etiology Affects only older adults and infants less than 3 months
Progressive tissue damage without any verifiable etiology Explanation: Diseases are considered autoimmune disorders and are characterized by unrelenting, progressive tissue damage without any verifiable etiology. In many autoimmune disorders, there tends to be a triggering event, such as an infection, trauma, or introduction of a drug that integrates itself into the membranes of the host's cells. Although older adults face a greater risk of developing autoimmune disorders, persons belonging to any age-group can be affected. Chronic fatigue syndrome is primarily characterized by profound fatigue with no identifiable cause, and this is not a characteristic of autoimmune disorders.
A client is prescribed didanosine as part of a 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." "When you take this drug, eat a high-fat meal immediately afterwards." "It doesn't matter if you take this drug with or without food." "You should take the drug with an antacid."
"Be sure to take this drug about 1/2 hour before or 2 hours after you eat." Explanation: Didanosine (Videx) should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.
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? 18 weeks 6 weeks 12 weeks 24 weeks
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.
A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member 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? Candidiasis Distal sensory polyneuropathy (DSP) AIDS dementia complex (ADC) Cytomegalovirus (CMV)
AIDS dementia complex (ADC) Explanation: AIDS dementia complex, or ADC, is a neurologic condition that 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 has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? Bring the viral load to a virtually undetectable level Treat mycobacterium avium complex. Eliminate the risk of AIDS. Reverse the HIV+ status to a negative status.
Bring the viral load to a virtually undetectable level Explanation: The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.
More than 50% of individuals with this disease develop pernicious anemia: DiGeorge syndrome Common variable immunodeficiency (CVID) Nezelof syndrome Bruton disease
Common variable immunodeficiency (CVID) Explanation: More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.
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? Caring for a client who can kill other people Sharing the diagnosis with a support group Disclosure of the client's condition Caring for a client with an infectious terminal disease
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.
Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) Enzyme-linked immunosorbent assay (ELISA) Reverse transcriptase p24 antigen
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 client suspected of having human immunodeficiency virus (HIV) has blood drawn for a screening test. What is the first test generally run to see if a client is, indeed, HIV positive? Complete blood count (CBC) Western Blot Enzyme-linked immunosorbent assay (ELISA) Schick
Enzyme-linked immunosorbent assay (ELISA) Explanation: The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. If the ELISA is positive twice then the Western Blot test is run. A CBC and a Schick test are not screening tests for HIV.
A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV? Rashes on the face, trunk, palms, and soles Muscle and joint pain Gynecologic problems Weight loss
Gynecologic problems Explanation: In women with HIV, gynecologic problems, such as abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may be the focus of a majority of complaints. Acute retroviral syndrome (viremia) may be the chief complaint in one third to more than one half of those infected, not necessarily women. Its manifestations include rashes, muscle and joint pain, and weight loss.
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? means of transmission cure rate HIV-1 is more prevalent than HIV-2 subtypes the fact that it is a mutated virus originally thought to be bovine in nature
HIV-1 is more prevalent than HIV-2 subtypes Explanation: Two HIV subtypes have been identified: HIV-1 and HIV-2. HIV-1 mutates easily and frequently, producing multiple substrains that are identified by letters from A through O. HIV-2 is less transmittable, and the interval between initial infection with HIV-2 and development of AIDS is longer. HIV-1 is more prevalent in the United States and in the rest of the world. Western Africa is the primary site of infection with HIV-2. There is no cure for HIV/AIDS; hence, no cure rate. The virus is thought to be a mutation of a simian virus. Transmission of the virus is not a characteristic.
A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? Antibiotic therapy Anticoagulation Immunosuppressive agents Chest physiotherapy
Immunosuppressive agents Explanation: For a client undergoing a hematopoietic stem cell transplant, immunosuppression is started to ensure engraftment of depleted bone marrow. Antibiotic therapy may or may not be indicated. Chest physiotherapy would be appropriate for clients with ataxia-telangiectasis who have chronic lung disease. Anticoagulation would not be used.
A client 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? Mycobacterium avium complex (MAC) Community-acquired pneumonia Pneumocystis pneumonia Tuberculosis
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.
When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? The body has not produced antibodies to the AIDS virus. The client has not been infected with HIV. Antibodies to the AIDS virus are in the client's blood. The client is immune to the AIDS virus.
The body has not produced antibodies to the AIDS virus. Explanation: A negative test result indicates that antibodies to the AIDS virus 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 takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk client must be encouraged. The test result does not mean that the client is immune to the virus, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.
The nurse reviews laboratory results requested to track HIV. What laboratory test measures HIV RNA levels and is the best predictor of HIV disease progression? Western blot Enzyme immunoassay (EIA) Viral load CD4/CD8
Viral load Explanation: The viral load test quantifies the plasma HIV RNA levels and response to treatment of the HIV infection. It also confirms a positive EIA result and detects HIV in high-risk seronegative individuals before antibodies are measurable.
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: p24 antigen test for confirmation of diagnosis. polymerase chain reaction test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis. Western blot test for confirmation of diagnosis.
Western blot test for confirmation of diagnosis. Explanation: The enzyme-linked immunosorbent assay (ELISA) test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.
