PrepU Chapter 36: Immunodeficiency

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 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.

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

-semen -breast milk -blood -vaginal secretions 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 is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse? -The client has converted from HIV infection to AIDS. -The client has advanced HIV infection. -The client's T4-cell count has decreased due to the Pneumocystis pneumonia. -The client has another infection present that is causing a decrease in the T4-cell count.

-The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 200/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 T4-cell count is not decreasing due to an infection.

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? -"Your child does not have AIDS but this condition puts your child at risk for it later in life." -"Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." -"Although AIDS is an immune deficiency, your child's condition is different from AIDS." -"We need to do some more testing before we will know if your child's condition is AIDS."

-"Although AIDS is an immune deficiency, your child's condition is different from AIDS." 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 seconary immunodeficiency.

A patient in the clinic states, "My boyfriend told me he went to the clinic and was treated for gonorrhea." While testing for the sexually transmitted infection (STI), what else should be done for this patient? -Test for HIV without informing the patient. -Test for HIV, requiring the patient to sign a permit. -Inform the patient that it would be beneficial to test for HIV. -Administer treatment for the STI and discharge the patient.

-Inform the patient that it would be beneficial to test for HIV. HIV screening is recommended for all persons who seek evaluation and treatment for STIs. HIV testing must be voluntary and free of coercion. Patients must not be tested without their knowledge. HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health care settings. Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient.

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) -Pneumocystis pneumonia -Tuberculosis -Community-acquired pneumonia

-Pneumocystis pneumonia 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.

The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? -The client has converted from HIV infection to AIDS. -The client has advanced HIV infection. -The client's T4-cell count has decreased due to the pneumocystis pneumonia. -The client has another infection present that is causing a decrease in the T4-cell count

-The client has converted from HIV infection to AIDS. AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/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 T4-cell count is not decreasing due to an infection.

A client with chronic mucocutaneous candidiasis, an autosomal recessive disorder, asks the nurse, "Will my children have this disease?" Which response by the nurse is appropriate? -"Only your male children are at risk for developing this disease." -"Your female children will be carriers for the disease, but only male children will develop the disease." -"All of your children will be carriers of the recessive gene but may not develop the disease." -"All of your children will develop the disease."

-"All of your children will be carriers of the recessive gene but may not develop the disease." Chronic mucocutaneous candidiasis is a rare T-cell disorder, which is thought to be an autosomal recessive disorder that affects both males and females. In pedigrees, an autosomal recessive disorder is revealed by the appearance of the phenotype in the male and female progeny of unaffected individuals. Parents must both be heterozygotes, C/c. (That is, both must have a c allele in order to contribute one to create a homozygote affected child with a cc phenotype displaying the disease.) A child born with Cc will be phenotypically normal but carry the recessive trait.

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 -DAF -CVID -SCID

-AIDS 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 panhypoglobulinemia (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 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? -distal sensory polyneuropathy (DSP) -candidiasis -AIDS dementia complex (ADC) -cytomegalovirus (CMV)

-AIDS dementia complex (ADC) 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.

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

-Antibodies to HIV are not present in his blood. 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.

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? -Avoid fibrous foods, lactose, fat, and caffeine. -Consume large, high-fat meals. -Reduce food intake. -Increase intake of iron and zinc.

-Avoid fibrous foods, lactose, fat, and caffeine. 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.

A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included? -If the client experiences nausea, omit the dose. -The client should be alert for joint aches. -This medication is commonly used for many inflammatory reactions and is relatively safe. -Be alert for signs and symptoms of infection and report them immediately to the physician

-Be alert for signs and symptoms of infection and report them immediately to the physician Instruct the client about signs and symptoms of and the increased risk for infection. Instruct the client to report signs and symptoms of infection immediately to the physician. Early treatment promotes a shorter duration of illness and reduced complication. Tell the client to avoid high-risk activities, such as being in crowds, during periods of immunosuppression. The client should not omit a dose if nausea is experienced;he may take the medication with food. There are many side effects and required laboratory work to detect the side effects from immunosuppressive therapy. Joint aches are vague symptoms and are not a priority for reporting purposes.

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

-Bone marrow transplantation Treatment options for SCID include stem cell and bone marrow transplantation.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? -CD4+ counts -HIV RNA -Western blotting assay -ELISA

-CD4+ counts The most important consideration in decisions to initiate antiretroviral therapy is CD4+ counts.

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? -Western Blot -Schick -Enzyme-linked immunosorbent assay (ELISA) -Complete blood count (CBC)

-Enzyme-linked immunosorbent assay (ELISA) 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.

Which of the following is the first barrier method that can be controlled by the woman? -Female condom -IUD -Diaphragm -Birth control pills

-Female condom 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 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? -Gastric ulcer -Pernicious anemia -Hyperthyroidism -Sickle cell anemia

-Pernicious anemia More than 50% of clients with CVID develop pernicious anemia. Lymphoid hyperplasia of the small intestine and spleen and gastric atrophy, which is detected by biopsy of the stomach, are common findings. Gastrointestinal malabsorption may occur.

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? -The use of condoms -What vaccinations to have -Side effects of drug therapy -The action of each antiretroviral drug

-Side effects of drug therapy 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.

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

-Urine 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.

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

-Vascular lesions Ataxia-telangiectasis is characterized by loss of muscle coordination and vascular lesions. Thrombocytopenia and eczema are associated wtih Wiskott-Aldrich syndrome. Thrush is a manifestation associated with severe combined immunodeficiency (SCID).

The balance between the amount of HIV in the body and the immune response is the: -Viral set point -Viral load test -Window period -Anergy

-Viral set point The balance between the amount of HIV in the body and the immune response is the viral set point. 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.

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next? -ELISA -Western Blot -T4/T8 ratio -Polymerase chain reaction

-Western Blot 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. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. A positive result on Western blot confirms the diagnosis; however, false-positive and false-negative results on both tests are possible. A polymerase chain reaction gives the viral load of the client. The T4/T8 ratio determines the status of T lymphocytes.

Kaposi sarcoma (KS) is diagnosed through -skin scraping. -biopsy. -visual assessment. -computed tomography.

-biopsy. KS is diagnosed through biopsy of the suspected lesions. Visual assessment will not confirm a diagnosis. A computed tomography scan will not assist in determining skin cell changes. Skin scraping is a procedure to collect cells, not to evaluate cells.

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 -Prophylactic medication regimens -Need to interrupt therapy for short periods -Ways to manage stress -Maintenance of a well-balanced diet

-Prophylactic medication regimens -Ways to manage stress -Maintenance of a well-balanced diet 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 secondary immunodeficiency is characterized by the following. Choose all that apply. -It usually occurs as a result of underlying disease processes. -It frequently is caused by certain autoimmune disorders. -It may be caused by certain viruses. -IgA deficiency is present in 40% of individuals. -It is less common than primary immunodeficiency.

-It usually occurs as a result of underlying disease processes. -It frequently is caused by certain autoimmune disorders. -It may be caused by certain viruses. Secondary immunodeficiencies are more common than primary immunodeficiencies and frequently result from underlying disease processes or their treatment. Common causes of secondary immunodeficiencies include chronic stress, burns, uremia, diabetes mellitus, certain autoimmune disorders, certain viruses, exposure to immunotoxic medications and chemicals, and self-administration of recreational drugs and alcohol.

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? -Overall, these conditions more commonly affect females. -Most cases are typically diagnosed in infancy. -The conditions appear to predominate in males after adolescence. -Primary immunodeficiencies are more common than secondary immunodeficiencies

-Most cases are typically diagnosed in infancy. 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 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? -Anorexia -Chronic diarrhea -Nausea and vomiting -Oral candida

-Chronic diarrhea 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.

A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for? -T-and C-cell assays -Complete chemistry panel -Enzyme-linked immunosorbent assay -Plasmapherisis

-Enzyme-linked immunosorbent assay T-cell and B-cell assays (or counts) and the enzyme-linked immunosorbent assay may be performed. A C-cell assay and plasmapherisis are distractors for this question. A complete chemistry panel is not a diagnostic test for an immune system disorder.

The nurse is preparing a teaching plan for a client with an immunodeficiency. What aspect would the nurse emphasize as most important? -Frequent and thorough handwashing -Identifying the signs and symptoms of infection -Adherence to prophylactic medication administration -Incorporation of treatment regimens into daily patterns

-Frequent and thorough handwashing Although identifying the signs and symptoms of infection, adherence to medication prophylaxis, and incorporation of treatment regimens into daily patterns are important, the most important aspect is frequent and thorough handwashing to prevent infection. If infection is prevented, signs and symptoms will not develop and medications would not necessarily be needed.

The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? -Obtain counseling. -Call the lab to draw the nurse's blood. -Fill out a risk management report. -Report the incident to the supervisor.

-Report the incident to the supervisor. Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.

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." -"I should use a new condom each time I have sex." -"My partner and I should avoid manual-anal intercourse." -"After having sex, I should hold onto the condom when pulling out."

-"I will apply baby oil to lubricate the condom." 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 teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed? -"I will wash my hands whenever I get home from work." -"I will make sure to have my own toothbrush and tube of toothpaste at home." -"I will avoid contact with people who are sick or who have recently been vaccinated." -"I will be sure to eat lots of fresh fruits and vegetables every day."

-"I will be sure to eat lots of fresh fruits and vegetables every day." The client should avoid eating raw fruits and vegetables. All foods should be cooked thoroughly and all leftover food should be refrigerated immediately to prevent infection.

The nurse is aware that the most prevalent cause of immunodeficiency worldwide is -Malnutrition -Neutropenia -Hypocalcemia -Chronic diarrhea

-Malnutrition The most prevalent cause of immunodeficiency worldwide is severe malnutrition.

The majority of patient with primary immunodeficiency are in which age group? -Younger than 20 -20 to 40 -41 to 50 -51 to 60

-Younger than 20 About 80% of the patients with primary immunodeficiency are younger than age 20 years.

A female client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wartlike lesions on my vagina. This is happening quite often." What should the nurse consult with the physician regarding? -testing the client for the presence of HIV -instructing the client to wear cotton underwear -having the client abstain from sexual activity for 6 weeks while the medication is working -using a medicated douche in order to keep the vaginal pH normal

-testing the client for the presence of HIV Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may correlate with HIV infection. Wearing cotton underwear can help with the prevention of candidiasis but does not address the recurrent vaginal infection that may not be caused by a fungus. Abstaining from sexual intercourse does not address the recurrent vaginal infection. A medicated douche can alter the normal flora of the vaginal wall.

A nurse is collecting objective data for a client with AIDS. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does this finding indicate? -Kaposi's sarcoma -candidiasis -hairy leukoplakia -coccidiomycosis

-candidiasis Candidiasis is a yeast infection caused by the Candida albicans microorganisms. It may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in folds of the skin. It is often called thrush when located in the mouth. Inspection of the mouth, throat, or vagina reveals areas of white plaque that may bleed when mobilized with a cotton-tipped swab. Kaposi's sarcoma is a purple lesion and is an opportunistic cancer. Hairy leukoplakia is also an indication of oral cancer. Coccidiomycosis causes diarrhea in the immunosuppressed client.

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? -Caregiver washes hands before and after providing care to the client. -Caregiver cleans the client's anal area without wearing gloves -Cargiver disposes of syringe and needle in a metal coffee can with lid. -Caregiver uses a dilute bleach solution to clean up a urine spill.

-Caregiver cleans the client's anal area without wearing gloves 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.

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

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? -"We can ask our family members to donate blood for stem cell harvesting." -"The only treatment option is thymus gland transplantation." -"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." -"Hematopoietic stem cell transplantation cannot be performed until the age of 5 years."

-"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." 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.

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? -means of transmission -HIV-1 is more prevalent than HIV-2 subtypes -the fact that it is a mutated virus originally thought to be bovine in nature -cure rate

-HIV-1 is more prevalent than HIV-2 subtypes 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 who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? -Urine specific gravity of 1.010 -Hypernatremia -Hypokalemia -Proteinuria

-Hypokalemia Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea. A urine specific gravity of 1.010 would indicate dilute urine. The client with severe diarrhea most likely would be dehydrated, leading to a high urine specific gravity. Proteinuria may suggest renal dysfunction and would not be associated with severe diarrhea unless the client was developing renal failure.

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? -IV gamma globulin administration -Platelet administration -Factor VIII administration -Thymus grafting

-IV gamma globulin administration 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.

Which substance may be used to lubricate a condom? -Skin lotion -Baby oil -K-Y jelly -Petroleum jelly

-K-Y jelly 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.

When reviewing the laboratory test results of a client with X-linked agammaglobulinemia, which of the following would be most likely? Select all that apply. -Low levels of IgM -Hypocalcemia -Leukopenia -Absent B cells -Pernicious anemia

-Low levels of IgM X-linked agammaglobulinemia, a type of B-cell deficiency, is characterized by low or absent B cells in the peripheral blood and low or absent levels of IgG, IgM, IgA, IgD, and IgE. Hypocalcemia is associated with T-cell deficiencies. Leukopenia is associated with deficiencies of the complement system. Pernicious anemia is associated with common variable immunodeficiency (CVID), a second type of B-cell deficiency.

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

-Primary infection 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.

A client with HIV will be started on a medication regimen of three medications. What drug will the nurse instruct the client about? -Protease inhibitor -Integrase inhibitors -Reverse transcriptase inhibitors -Hydroxyurea

-Reverse transcriptase inhibitors 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.

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

-Assist with chest physiotherapy every 2 to 4 hours. 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.

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? -Cleavage -Budding -Attachment -Uncoating

-Attachment 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 with severe combined immunodeficiency disease is receiving immunosuppression therapy to ensure engraftment of depleted bone marrow during transplantation procedures. What is the priority nursing care for this client? -Continuous monitoring of cardiac status -Meticulous infection control precautions -Daily weight measurements and strict monitoring of intake and output -Daily oral assessment and oral care every 4 hours

-Meticulous infection control precautions Nursing care must be meticulous. Appropriate infection control precautions and thorough hand hygiene are essential. Institutional policies and procedures related to protective care must be followed scrupulously until definitive evidence demonstrates that precautions are unnecessary. Continual monitoring of the patient's condition is critical, so early signs of impending infection may be detected and treated before they seriously compromise the patient's status. It also is imperative that nurses appropriately apply standard precautions (previously known as universal precautions), which have become one of the first-line tools for decreasing transmission of disease.

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

-Respiratory or urinary system infections Secondary immunodeficiencies occur as a result of underlying disease processes or the treatment of these disorders, including administration of immunosuppressive agents. Abnormalities of the immune system affect both natural and acquired immunity. Because immunodeficiencies result in a compromised immune system and pose a high risk for infection, careful assessment of the client's immune status is essential. The nurse assesses and monitors the client for signs and symptoms of infection.

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 -Ineffective cerebral tissue perfusion -Complicated grieving -Risk for injury

-Risk for injury 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 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. -Bank autologous blood. -Ask people to donate blood. -Using volume expanders in case blood is needed.

-Bank autologous blood. Signing the refusal form does not give the client any information about the options that are available and place the client at risk. Banking autologous blood that is self-donated is the safest option for the client. 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.

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

-Hypocalcemia Thymic hypoplasia, also known as DiGeorge syndrome, is associated with recurrent infections, hypoparathyroidism, hypocalcemia, tetany, convulsions, congenital heart disease, possible renal abnormalities, and abnormal facies.

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

-Deep purple cutaneous lesions Localized cutaneous lesions may be the first manifestation of this HIV-related malignancy, which appears in 90% of clients as immune function deteriorates. Other symptoms develop over time as the lesions increase in size and spread to other locations.

A client taking fosamprenavir reports "getting fat." What is the nurse's best action? -Have the client increase exercise. -Assess the client's diet. -Teach the client about medication side effects. -Arrange for a psychological counseling.

-Teach the client about medication side effects. 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.

When a nurse infuses gamma globulin intravenously, the rate should not exceed -1.5 mL/min -3 mL/min -6 mL/min -10 mL/min

-3 mL/min The intravenous infusion should be administered at a slow rate, not to exceed 3 mL/min.

When do most perinatal HIV infections occur? -Through breastfeeding -In utero -After exposure during delivery -Through casual contact

-After exposure during delivery 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 containing the genetic viral material? -Deoxyribonucleic acid (DNA) -Ribonucleic acid (RNA) -Viral core -Glycoprotein envelope

-Ribonucleic acid (RNA) 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 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 blood urea nitrogen and creatinine. -Assess liver function tests.

-Assess blood urea nitrogen and creatinine. Adverse effects associated with antiretroviral therapy include potential nephrotoxicity. Assessing blood urean 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.

Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? -Oral estrogen contraceptives -An intrauterine device (IUD) -A diaphragm -The female condom

-The female condom 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).

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

-Trimethoprim-sulfamethoxazole To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.

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% occurence) in persons with AIDS? -Cytomegalovirus -Legionnaire's disease -Mycobacterium tuberculosis -Pneumocystis pneumonia

-Pneumocystis pneumonia 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.

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

-Preparation for bone marrow transplantation 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.

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? -Peripheral edema -Uncoordinated muscle movement -Vascular lesions caused by dilated blood vessels -A condition marked by development of urticaria

-Vascular lesions caused by dilated blood vessels 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.

Telangiectasia is the term that refers to -Vascular lesions caused by dilated blood vessels -Inability to understand the spoken word -Uncoordinated muscle movement -Difficulty swallowing

-Vascular lesions caused by dilated blood vessels 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.

Which diagnostic test measures HIV RNA in the plasma? -Viral load -Enzyme immunoassay -Enzyme-linked immunoassay -Western blotting assay

-Viral load A viral load test measures the quantity of HIV RNA in the blood. Enzyme immunoassay (EIA) is a blood test that can determine the presence of antibodies to HIV in the blood or saliva; it is also referred to as an enzyme-linked immunosorbant assay (ELISA). A Western blotting assay is a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test.

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

-alcohol. 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.

Kaposi sarcoma (KS) is diagnosed through -skin scraping. -biopsy. -visual assessment. -computed tomography.

-biopsy. 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.

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. -Flank pain -Shaking chills -Tightness in the chest -Hunger -Fatigue

-Flank pain -Shaking chills -Tightness in the chest 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.

What does the nurse understand will result if the patient has a deficiency in the normal level of complement? -Increased susceptibility to infection -Decrease in vascularity to the extremities -Development of congestive heart failure -Risk of stroke

-Increased susceptibility to infection The complement system is an integral part of the immune system, and deficiencies in normal levels of complement result in increased susceptibility to infectious diseases and immune-mediated disorders.

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? -Mycobacterium avium complex -Legionella -Cytomegalovirus -Pneumocystis jiroveci

-Pneumocystis jiroveciAlthough mycobacterium, legionella, and cytomegalovirus may cause the signs and symptoms described, the most common infection in people with AIDS is pneumocystitis pneumonia caused by pneumocystis jiroveci. It is the most common opportunistic infection associated with AIDS.

What severe complication does the nurse monitor for in a patient with ataxia-telangiectasia? -Acute kidney injury -Chronic lung disease -Neurologic dysfunction -Overwhelming infection

-Overwhelming infection Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination), telangiectasia (vascular lesions caused by dilated blood vessels), and immune deficiency. The immunologic defects reflect abnormalities of the thymus. The disorder is characterized by some degree of T-cell deficiency, which becomes more severe with advancing age. Immunodeficiency is manifested by recurrent and chronic sinus and pulmonary infections, leading to bronchiectasis.

More than 50% of individuals with this disease develop pernicious anemia: -Bruton disease -Common variable immunodeficiency (CVID) -DiGeorge syndrome -Nezelaf syndrome

-Common variable immunodeficiency (CVID) More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.

A majority of clients with CVID develop which type of anemia? -Hemolytic -Pernicious -Macrocytic -Sickle cell

-Pernicious A majority of clients with CVID develop pernicious anemia. They majority do not develop the other types of anemia listed.

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? -"Your child may die without proper medication and treatment." -"Selective immunoglobulin A deficiency is the term used to describe the early stages of AIDS." -"If left untreated, selective immunoglobulin A deficiency can cause uncontrolled muscle movements with progressive neurologic deterioration." -"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."

-"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." Selective immunoglobulin A deficiency is congenital and characterized by a lack of immunoglobulin A, which predisposes clients to recurrent infections, adverse reactions to blood transfusions or immunoglobulin, autoimmune diseases, and hypothyroidism. There is no current treatment.

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? -6 weeks -12 weeks -18 weeks -24 weeks

-6 weeks 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.

HIV is harbored within which type of cell? -Lymphocyte -Platelet -Erythrocyte -Nerve

-Lymphocyte Because HIV is harbored within lymphocytes, a type of white blood cell, any exposure to infected blood results in significant risk of infection. HIV infection is not harbored in platelets, erythrocytes, or nerve cells.