Immune Deficiency Disorders

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

A) Bone marrow transplantation

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

A) Liquids

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) platelet administration C) IV gamma globulin administration D) Thymus grafting

C) IV gamma globulin administration

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? A) Tuberculosis of the skin B) Seborrheic dermatitis C) Kaposi's sarcoma D) Molluscum contagiosum

C) Kaposi's sarcoma

Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies: A) Develop as a result of treatment with antineoplastic agents. B) Occur most commonly in the aged population. C) Disappear with age. D) Develop early in life after protection from maternal antibodies decreases.

D) Develop early in life after protection from maternal antibodies decreases.

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

A) CD4+ counts

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? A) HIV-1 is more prevalent than HIV-2 subtypes. B) Means of transmission C) The fact that it is a mutated virus originally thought to be bovine in nature. D) Cure rate

A) HIV-1 is more prevalent than HIV-2 subtypes.

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? A) The client has converted from HIV infections to AIDS. B) The client's T4-cell count has decreased due to the Pneumocystis pneumonia. C) The client has another infection present that is causing a decrease in the T4-cell count. D) The client has advanced HIV infection.

A) The client has converted from HIV infections to AIDS.

Ataxia refers to: A) Uncoordinated muscle movement. B) Vascular lesions caused by dilated blood vessels. C) Inability to understand spoken words. D) Difficulty swallowing.

A) Uncoordinated muscle movement.

The nurse is administering an infusion of gamma-globulin to a patient in the hospital. When should the nurse discontinue the infusion? (Select all that apply.) A) When the patient begins to have shaking chills B) When the patient complains of tightness in the chest C) When the patient voids 30 mL an hour D) When the patient complains of flank pain E) When the patient complains of nausea

A) When the patient begins to have shaking chills B) When the patient complains of tightness in the chest D) When the patient complains of flank pain E) When the patient complains of nausea

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. A) Start prophylaxis medications between 3-6 hours after exposure B) Continue HIV medications for 4 weeks postexposure C) Finish postexposure testing at 6 months D) Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level) E) Initiate postexposure testing after 4 weeks

B) Continue HIV medications for 4 weeks postexposure C) Finish postexposure testing at 6 months E) Initiate postexposure testing after 4 weeks

Antiretroviral medications as post-exposure prophylaxis for healthcare workers are started within _____ hours of exposure _____.

72; to HIV

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? A) DAF B) AIDS C) SCID D) CVID

B) AIDS

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? A) Consume large, high-fat meals B) Avoid fibrous foods, lactose, fat, and caffeine C) Increase intake of iron and zinc D) Reduce food intake

B) Avoid fibrous foods, lactose, fat, and caffeine

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

B) Headache

Immune deficiency disorders may be caused by a defect in, or a deficiency of, phagocytic cells, B lymphocytes, T lymphocytes, or the _____ system.

Complement

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) "Your condition will prednisone you to frequent and recurring infections." B) "Your diagnosis was inherited." C) "You will now be more likely to develop cancer in the future." D) "Your immune system was most likely affected by an underlying disease process."

D) "Your immune system was most likely affected by an underlying disease process."

When do most perinatal HIV infections occur? A) Through casual contact B) Through breastfeeding C) In utero D) After exposure during delivery

D) After exposure during delivery

A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? A) Gastric ulcer B) Hyperthyroidism C) Sickle cell anemia D) Pernicious anemia

D) Pernicious anemia

T or F: Modes of transmission for HIV include blood, semen, saliva, and casual contact.

False

T or F: Many patients with PIDDs have comorbid autoimmune disorders, such as thyroid disease, rheumatoid arthritis, cytopenias, and inflammatory bowel disease.

True

T or F: Nurses need to be nonjudgmental in order to be effective in educating LGBT population about HIV/AIDS prevention methods.

True

T or F: Nursing management of patients with HIV include educating the patient to recognize the signs and symptoms of infection.

True

T or F: The majority of primary immune deficiency disorders are diagnosed during infancy.

True

Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? A) Rheumatoid arthritis B) Respiratory or urinary system infections C) Cardiac dysrhythmias and heart failure D) Depression, memory impairment, and coma

B) Respiratory or urinary system infections

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

B) Kaposi's sarcoma

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) Urine B) Semen C) Blood D) Breast milk E) Vaginal secretions

B) Semen C) Blood D) Breast milk E) Vaginal secretions

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? A) 3 mL/min B) 1.5 mL/min C) 6 mL/min D) 10 mL/min

A) 3 mL/min

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: A) Oral candida. B) Chronic diarrhea. C) Nausea and vomiting. D) Anorexia.

B) Chronic diarrhea.

_____ is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection.

HIV encephalopathy

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 then secondary immunodeficiencies.

B) Most cases are typically diagnosed in infancy.

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

B) Younger than 20

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis? A) Eczema B) Vascular lesions C) Thrush D) Thrombocytopenia

B) Vascular lesions

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

D) Enzyme-linked immunosorbent assay (ELISA)

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? A) "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." B) "The client probably has a case of the flu and you should give acetaminophen." C) "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider." D) "This is one of the side effects from antiretroviral therapy and will require changing the medication."

A) "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."

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: A) p24 antigen test for confirmation of diagnosis. B) T4-cell count for confirmation of diagnosis. C) Polymerase chain reaction test for confirmation of diagnosis. D) Western blot test for confirmation of diagnosis.

D) Western blot test for confirmation of diagnosis.

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. What would the nurse describe as the first step? A) Attachment B) Budding C) Uncoating D) Cleavage

A) Attachment

A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? A) Diarrhea B) Blindness C) Fatigue D) Hearing impairment

B) Blindness

A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? A) Eliminate the risk of AIDS B) Bring the viral load to a virtually undetectable level C) Reverse the HIV+ status to a negative status D) Treat mycobacterium avium complex

B) Bring the viral load to a virtually undetectable level

An infant that is 10 hours postdelivery is observed to have tetanic contractions. What symptom does the nurse recognize can indicate DiGeorge syndrome? A) Pernicious anemia B) Neutropenia C) Hypocalcemia D) Chronic diarrhea

C) Hypocalcemia

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) p24 antigen capture assay B) Nucleic acid sequence-based amplification C) Western blot assay D) OraSure test

C) Western blot assay

A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: A) Exposure to sunlight. B) Seafood. C) Applying skin moisturizers. D) Alcohol.

D) Alcohol.

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

D) Assess blood urea nitrogen and creatinine

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

C) Stool specimen for ova and parasites

A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV? A) Gynecologic problems B) Rashes on the face, trunk, palms, and soles C) Weight loss D) Muscle and joint pain

A) Gynecologic problems

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? A) Hypokalemia B) Hypernatremia C) Proteinuria D) Urine specific gravity of 1.010

A) Hypokalemia

A client on antiretroviral drug therapy is discussing with the nurse that sometimes he "forgets to take his meds for a few days." What should the nurse inform the client can occur when the medications are not taken as prescribed? A) The funding for the medications will cease if the client is not taking the meds correctly. B) The client will have to take higher doses of the antiviral medications. C) The client is risking the development of drug resistance and drug failure. D) The client will have to take the drugs intravenously to ensure compliance.

C) The client is risking the development of drug resistance and drug failure.

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) The use of condoms C) Side effects of drug therapy D) What vaccinations to have

C) Side effects of drug therapy

HIV is harbored within which type of cell? A) Erythrocyte B) Nerve C) Lymphocyte D) Platelet

C) Lymphocyte

A majority of clients with CVID develop which type of anemia? A) Hemolytic B) Macrolytic C) Pernicious D) Sickle cell

C) Pernicious

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? A) Mouth sores B) Sneezing C) Tickling in the throat D) Constipation

C) Tickling in the throat

A client receiving atazanavir requires what priority intervention? A) Increased fluids B) Renal function tests C) Diet modification D) Cardiac assessment

D) Cardiac assessment

A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment? A) Lymphedema of the lower extremities B) Severe joint pain C) Venous stasis and phlebitis formation D) Deep purple cutaneous lesions

D) Deep purple cutaneous lesions

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is: A) Neutropenia B) Hypocalcemia C) Chronic diarrhea D) Malnutrition

D) Malnutrition

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

D) Risk for injury

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? A) "I can take my child to the beach, as long as we play in the sand rather than swim in the water." B) "I will let my neighbor have my pet iguana." C) "I will apply lotion following every bath to prevent dry skin." D) "I will avoid letting my child drink any juice that has been sitting out for more than an hour."

A) "I can take my child to the beach, as long as we play in the sand rather than swim in the water."

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

A) 3 mL/min

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

A) Thrombocytopenia

A nurse is assessing a client with a primary immunodeficiency. Afterward the nurse documents that the client displayed ataxia. The nurse makes this documentation because the client has: A) Uncoordinated muscle movements. B) An inability to understand the spoken word. C) Difficulty swallowing. D) Vascular lesions caused by dilated blood vessels.

A) Uncoordinated muscle movements.

A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? A) Antibiotic therapy B) Immunosuppressive agents C) Anticoagulation D) Chest physiotherapy

B) Immunosuppressive agents

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? A) Tertiary infection B) Primary infection C) Secondary infection D) Latent infection

B) Primary infection

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

C) Viral load

A client who is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication will the client take for the treatment of this infection? A) Nystatin B) Amphotericin B C) Fluconazole D) Trimethoprim-sulfamethoxazole

D) Trimethoprim-sulfamethoxazole

Nursing management of a patient who requires immunosuppression must include use of _____ precautions when providing care to prevent infection.

Standard

A common complication of stage 3 HIV infection, _____, is defined as a loss of more than 10% of one's body weight over a 30 day timeframe.

Wasting syndrome

The nurse is working with a parent whose child has just been diagnosed with selective immunoglobulin A deficiency. The parent asks the nurse, "Does this mean that my child is going to die?" How should the nurse respond? A) "Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract." B) "Selective immunoglobulin A deficiency is the term used to describe the early stages of AIDS." C) "Your child may die without proper medication and treatment." D) "If left untreated, selective immunoglobulin A deficiency can cause uncontrolled muscle movements with progressive neurologic deterioration."

A) "Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract."

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

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

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? A) CBC B) Enzyme-linked immunosorbent assay (ELISA) C) Schick D) Western Blot

B) Enzyme-linked immunosorbent assay (ELISA)

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? A) Quit their jobs and get admitted to a hospital or a cancer treatment center B) Follow the same sexual precautions as someone who has been diagnosed with AIDS C) Limit interactions with people who are not HIV infected D) Limit interactions with people who are already HIV infected

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