Brunner Review Ch. 32

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment? a. Past substance abuse b. Depression c. Active substance abuse d. Lack of social support

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

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

A Rationale: The majority of primary immunodeficiencies are diagnosed in infancy, with a male-to-female ratio of 5 to 1.

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? a. CD4+ counts b. HIV RNA c. ELISA d. Western blotting assay

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

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? a. Liquids b. Sucrose c. Gluten d. Iron and zinc

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

A Rationale: 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.

A treatment option for severe combined immune deficiency (SCID) includes a. a stem cell transplant. b. vitamin D supplements. c. chemotherapy. d. IV immunoglobulin.

A Rationale: Treatment options for SCID include stem cell and bone marrow transplantation. Other treatment regimens include administration of IVIG or thymus-derived factors and thymus gland transplantation.

What intervention is a priority when treating a client with HIV/AIDS? a. Assessing neurologic status b. Assessing fluid and electrolyte balance c. Monitoring psychological status d. Monitoring skin integrity

B Rationale: Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.

A nurse is reviewing the causes of genetic diseases with parents of an infant born with severe combined immunodeficiency disease (SCID). Which would be inaccurate information pertaining to SCID? a. This is one of the most common causes of primary immunodeficiencies. b. The inheritance of SCID can be autosomal dominant. c. The incidence is unknown. d. This illness occurs in all racial groups and both genders.

B Rationale: SCID is rare in most population groups, but is one of the most common causes of primary immunodeficiencies. Inheritance of this disorder can be X linked, autosomal recessive, or sporadic. The exact incidence of SCID is unknown; it is recognized as a rare disease in most population groups, with an incidence of about 1 case in 1,000,000. This illness occurs in all racial groups and both genders.

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

B Rationale: 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.

The nurse is teaching the client with HIV about therapy. Which elements are essential for the nurse to include in the teaching plan? Select all that apply. a. Medication therapy is rarely effective. b. The CD4 count is the major indicator of immune function and guides therapy. c. Antiretroviral therapy targets different stages of the HIV life cycle. d. The goal of antiretroviral therapy is to prevent opportunistic infections. e. Clients rarely respond to medication therapy.

B & C Rationale: The CD4 count is the major indicator of immune function. Antiretroviral therapy in HIV targets different stages of the HIV life cycle. Therapy does not prevent opportunistic infections. Medication therapy is effective, and most clients respond well to it.

What intervention is appropriate before the client begins taking efavirenz therapy? a. Teaching the client about restricted foods b. Testing for Stevens-Johnson syndrome c. Assessing renal function d. Administering diphenhydramine

B. Testing for Stevens-Johnson syndrome Rationale: A client should be tested for the gene for Stevens-Johnson syndrome before receiving any drugs that potentially can cause this condition. The client does not have to receive diphenhydramine or have renal function tests. No particular foods should be restricted.

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. Sneezing b. Tickle in the throat c. Constipation d. Mouth sores

B. Tickle in the throat Rationale: 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 client being treated for HIV/AIDS has a decreased appetite, almost to the point of anorexia. What is the best action by the nurse? a. Ask the dietician to prepare the client's favorite meals. b. Ask the client's family to bring in food the client enjoys. c. Administer megestrol acetate. d. Talk to the client about his unwillingness to eat.

C Rationale: Appetite stimulants are successfully used in clients with AIDS-related anorexia. The anorexia is compounded by medications that cause nausea and vomiting. The anorexia has a physiologic cause, and this must be addressed. Bringing in favorite foods or making favorite foods may have little or no effect on the client's appetite; it is physiological rather than psychological.

Thirty minutes after the nurse begins an intravenous immunoglobulin (IVIG) infusion, the client reports itching at the site and a lump in the throat. Which action should the nurse take first? a. Notify the physician. b. Apply a tourniquet above the infusion site. c. Stop the infusion. d. Administer subcutaneous epinephrine.

C Rationale: Continually assess the client for adverse reactions; be especially aware of complaints of a tickle or lump in the throat as the precursor to laryngospasm that precedes bronchoconstriction. Stop the infusions at the first sign of reaction and initiate the institutional protocol to be followed in this emergent situation.

Which microorganism is known to cause retinitis in people with HIV/AIDS? a. Mycobacterium avium b. Pneumocystis carinii c. Cytomegalovirus d. Cryptococcus neoformans

C Rationale: 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 blood test confirms the presence of antibodies to HIV? a. p24 antigen b. Reverse transcriptase c. Enzyme-linked immunosorbent assay (ELISA) d. Erythrocyte sedimentation rate (ESR)

C Rationale: 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.

Kaposi sarcoma (KS) is diagnosed through a. visual assessment. b. skin scraping. c. biopsy. d. computed tomography.

C Rationale: 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.

Which nursing action is essential before an EIA test is performed? a. Performing Western blotting b. Obtaining a written consent from the client c. Obtaining a general consent for medical care from the client d. Performing a polymerase chain reaction test

C Rationale: Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Western blotting is performed if the results of an EIA test are positive. A polymerase chain reaction test, which measures viral loads, is used if a positive diagnosis is confirmed.

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? a. "I will make sure to have my own toothbrush and tube of toothpaste at home." b. "I will wash my hands whenever I get home from work." c. "I will be sure to eat lots of fresh fruits and vegetables every day." d. "I will avoid contact with people who are sick or who have recently been vaccinated."

C Rationale: 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.

What test will the nurse assess to determine the client's response to antiretroviral therapy? a. Complete blood count b. Enzyme immunoassay c. Viral load d. Western blotting

C. Viral load Rationale: 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.

Which diagnostic test measures HIV RNA in the plasma? a. Western blotting assay b. Enzyme immunoassay c. Enzyme-linked immunoassay d. Viral load

D Rationale: 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 immunosorbent 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 receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? a. Administer fluids 100 mL/hour IV. b. Assess liver function tests. c. Encourage the client to drink more fluids. d. Assess blood urea nitrogen and creatinine.

D Rationale: 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 is administered foscarnet to treat a case of cytomegalovirus (CMV) retinitis. Which adverse effect should the nurse closely monitor in this client? a. Hypotension b. Anemia c. Peripheral neuropathy d. Electrolyte imbalances

D Rationale: Alterations in renal function, fever, nausea, electrolyte imbalances, and diarrhea are the most common adverse effects of foscarnet and should be closely monitored. The drug does not cause hypotension. On the other hand, peripheral neuropathy is an adverse effect of administering drugs such as didanosine and zalcitabine. Anemia is an adverse effect of administering zidovudine.

Which statement reflects the treatment of HIV infection? a. Treatment should be offered to only select clients once they reach CDC category B: HIV symptomatic. b. Treatment should be offered to clients with plasma HIV RNA levels less than 55,000 copies/mL (RT-PCR assay). c. Treatment should be offered to all clients once they reach CDC category B: HIV symptomatic. d. Treatment of HIV infection for an individual client is based on the client's clinical condition, CD4 T cell count, and HIV RNA (viral load).

D Rationale: Although specific therapies vary, treatment of HIV infection for an individual client is based on three factors: the patient's clinical condition, CD4 T cell count, and HIV RNA (viral load). Treatment should be offered to all clients with the primary infection (acute HIV syndrome). In general, treatment should be offered to clients with fewer than 350 CD4+ T cells/mm or plasma HIV RNA levels exceeding 55,000 copies/mL (RT-PCR assay).

A client taking abacavir has developed fever and rash. What is the priority nursing action? a. Administer acetaminophen. b. Document the information. c. Administer lidocaine cream for the rash. d. Report to the health care provider.

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

In an adult client, which stage of HIV infection is indicated when the results are more than 500 CD4+ lymphocytes/mm? a. CDC stage 0: Early infection b. CDC stage 3: Acquired immunodeficiency syndrome (AIDS) c. CDC stage 2: Clinical latency (HIV inactivity or dormancy) d. CDC stage 1: Acute HIV infection

D Rationale: In a person aged 6 to adult, more than 500 CD4+ T lymphocytes/mm3 indicates CDC stage 1: Acute HIV infection. If there is a negative HIV test within 6 months of the diagnosis of HIV that is CDC stage 0. A count of 200 to 499 CD4+ T lymphocytes/mm3 indicates CDC stage 2: Clinical latency (HIV inactivity or dormancy). Less than 200 CD4+ T lymphocytes/mm3 indicates CDC stage 3: Acquired immunodeficiency syndrome (AIDS).

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. Sickle cell anemia b. Hyperthyroidism c. Gastric ulcer d. Pernicious anemia

D Rationale: 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.

When do most perinatal HIV infections occur? a. In utero b. Through casual contact c. Through breastfeeding d. After exposure during delivery

D Rationale: 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.

Other than abstinence, what is the only proven method of decreasing the risk of sexual transmission of HIV infection? a. Birth control pills b. Spermicides c. Vaginal lubricants d. Consistent and correct use of condoms

D Rationale: Other than abstinence, consistent and correct use of condoms is the only method proven to decrease the risk for sexual transmission of HIV infection. Vaginal lubricants, birth control pills, and spermicides are not proven means of decreasing the risk for sexual transmission of HIV infection.

Which would be inaccurate information pertaining to SCID? a. It is one of the most common causes of primary immunodeficiencies. b. The incidence is unknown. c. This disease affects B cells and T cells. d. The inheritance of SCID can be autosomal dominant.

D Rationale: The inheritance of SCID can be X-linked, autosomal recessive, or sporadic. The incidence is unknown. It is one of the most common causes of primary immunodeficiency and affect B cells and T cells.

The nurse teaches the client that reducing the viral load will have what effect? a. Shorter survival b. Longer immunity c. Shorter time to AIDS diagnosis d. Longer survival

D Rationale: The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies a. disappear with age. b. develop as a result of treatment with antineoplastic agents. c. occur most commonly in the aged population. d. develop early in life after protection from maternal antibodies decreases.

D Rationale: These disorders may involve one or more components of the immune system. Primary immunodeficiencies are seen primarily in infants and young children. Primary immunodeficiencies are rare disorders with genetic origins. Without treatment, infants and children with these disorders seldom survive to adulthood.