Ch 37: Immunodeficiency, HIV Infection, and AIDS - PrepU

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

Immunosuppressive agents

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? SCID AIDS DAF CVID

AIDS

A health care provider is taking post-exposure prophylaxis (PEP) medications for exposure to a client with human immunodeficiency virus (HIV). Which topics will the health care provider need to understand regarding PEP administration prior to beginning this regimen? Select all that apply. Potential drug toxicities Adherence requirements Needed dietary changes Sleep pattern disturbances Potential drug interactions

Potential drug toxicities Potential drug interactions Adherence requirements

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

Younger than 20

A client comes to the clinic and tells the nurse, "I think I have another vaginal infection and I also have some wart-like lesions on my vagina. This is happening quite often." Which nursing action is the priority for this client? Refer the client to a support group with others experiencing the same symptoms. Recommend abstinence or safer-sex practices. Offer information on human immunodeficiency virus (HIV) testing. Provide a prescribed topical antifungal agent to treat the client's vaginal infection.

Offer information on human immunodeficiency virus (HIV) testing.

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

"The majority of primary immunodeficiencies are diagnosed in infancy."

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? "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 can ask our family members to donate blood for stem cell harvesting."

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

A patient has been newly diagnosed with AIDS. The patient is a 32-year-old mother of two young children. When the nurse is performing the patient's initial assessment, the patient expresses fear of dying. How should the nurse best respond to the patient? "Would you like to talk to someone?" "What concerns you most about death?" "Everyone dies eventually." "It's possible that you'll live for several years."

"What concerns you most about death?"

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's condition is extremely serious. Like AIDS, it will most likely be fatal." "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." "Your child does not have AIDS but this condition puts your child at risk for it later in life."

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

A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? "It doesn't matter if you take this drug with or without food." "You should take the drug with an antacid." "When you take this drug, eat a high-fat meal immediately afterwards." "Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

"Be sure to take this drug about 1/2 hour before or 2 hours after you eat."

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? "I won't go to see my nephew right after he gets his vaccines." "I won't go to see my sister while she has a cold." "I stopped smoking last year; this year I'll quit drinking alcohol." "I can eat whatever I want as long as it's low in fat."

"I can eat whatever I want as long as it's low in fat."

A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse? "I understand what you mean, you can never be sure if the blood is tainted." "No one has gotten HIV from blood in a long time. You have to have the transfusion." "If you don't have the blood transfusions, you may not make it through this episode of bleeding." "I understand your concern. The blood is screened very carefully for different viruses as well as HIV."

"I understand your concern. The blood is screened very carefully for different viruses as well as HIV."

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."

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? 12 weeks 24 weeks 6 weeks 18 weeks

6 weeks

The nurse provides care for a client who is at risk for human immunodeficiency virus (HIV). Which prevention strategy(ies) should the nurse include in the teaching plan to decrease the client's risk for HIV? Select all that apply. Use a condom and spermicide with each sexual encounter. Reuse needles and syringes after disinfection with alcohol. Avoid casual sex with multiple partners. Abstain from the use of illicit intravenous (IV) drugs. Abstain from sexual intercourse.

Abstain from sexual intercourse. Avoid casual sex with multiple partners. Abstain from the use of illicit intravenous (IV) drugs. Use a condom and spermicide with each sexual encounter.

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

Antibodies to HIV are not present in his blood.

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

Assess blood urea nitrogen and creatinine.

What intervention is a priority when treating a client with HIV/AIDS? Assessing fluid and electrolyte balance Assessing skin integrity Assessing neurologic status Assesssing psychological status

Assessing fluid and electrolyte balance

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? Ask people to donate blood. Use volume expanders in case blood is needed. Sign a refusal of blood transfusion form so the client will not receive the transfusion. Bank autologous blood.

Bank autologous blood.

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. Be alert for signs and symptoms of infection and report them immediately to the physician. 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.

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 Oral candida Nausea and vomiting Chronic diarrhea

Chronic diarrhea

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

Common variable immunodeficiency (CVID)

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. vaginal secretions semen breast milk urine blood

semen breast milk blood vaginal secretions

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? Plasmapheresis T-and C-cell assays Enzyme-linked immunosorbent assay Complete chemistry panel

Enzyme-linked immunosorbent assay

A nurse is teaching a health education class to a group of young adults and perceives that misinformation exists about the signs, symptoms, and trajectory of HIV infection. The nurse should inform participants that the first symptoms of HIV exposure include: Rapid weight loss and anorexia Pneumonia-like symptoms and increased sputum production Fever, headache, and malaise Painful lesions on the vulva or the shaft of the penis

Fever, headache, and malaise

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

Herpes simplex ulcer persisting for 2 months

Which of the following is a lack of one or more of the five immunoglobulins? Agammaglobulinemia Telangiectasia Panhypoglobulinemia Hypogammaglobulinemia

Hypogammaglobulinemia

During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer? Multiple myeloma Squamous cell carcinoma Leukemia Kaposi's sarcoma

Kaposi's sarcoma

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

Liquids

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? Pneumocystis jiroveci Mycobacterium avium complex Legionella Cytomegalovirus

Pneumocystis jiroveci

A hospital nurse has experienced percutaneous exposure to an HIV-positive client's blood because of a needlestick injury. The nurse has informed the supervisor and identified the client. What action should the nurse take next? Report to the emergency department or employee health department. Follow up with the nurse's primary care provider. Flush the wound site with chlorhexidine. Apply a hydrocolloid dressing to the wound site.

Report to the emergency department or employee health department.

A parent brings a young child to the clinic for an evaluation of an infection. The parent states, "my child has been taking antibiotics now for more than 2 months and still doesn't seem any better." During the history and physical examination, what would alert the nurse to suspect a primary immunodeficiency? Superficial wound on the child's left leg History of fungal diaper rash Weight within age-appropriate parameters Ten ear infections in the past year

Ten ear infections in the past year

A client's antibody test for HIV showed no antibodies. For which reason would the client need to have a nucleic acid test completed before being told that testing for HIV is negative? Two tests need to be done for every client The client may be in stage 0 of the disease The client engages in high risk behavior The antibody test for HIV is not sensitive

The client may be in stage 0 of the disease

A nursing educator is discussing primary immunodeficiency diseases with a group of recent graduates. What would the educator tell the nurses about primary immunodeficiency diseases? They are the result of infection. They can be acquired spontaneously. They need IVIG as treatment. Their origin is genetic.

Their origin is genetic.

Which is a major manifestation of Wiskott-Aldrich syndrome? Bacterial infection Thrombocytopenia Episodes of edema Ataxia

Thrombocytopenia

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? Tickle in the throat Mouth sores Sneezing Constipation

Tickle in the throat

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

Viral load

Which term defines the balance between the amount of HIV in the body and the immune response? Viral clearance rate Window period Primary infection stage Viral set point

Viral set point

A patient is being tested for HIV using enzyme immunoassay (EIA). The EIA shows antibodies. The nurse expects the health care provider to order what test to confirm the EIA test results? Another EIA test Viral load test CD4:CD8 ratio Western blot test

Western blot test

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: polymerase chain reaction test for confirmation of diagnosis. Western blot test for confirmation of diagnosis. p24 antigen test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis.

Western blot test for confirmation of diagnosis.

An experienced medical nurse has provided care for patients who have immunodeficiencies that are primary, as well as for patients who have secondary immunodeficiencies. Which of the following individuals is most clearly exhibiting secondary immunodeficiency? a child who had an allergic reaction to a scheduled immunization a client who developed deep vein thrombosis (DVT) after being immobilized during recovery from orthopedic surgery an older adult resident of a long-term care facility who has been diagnosed with the Norwalk virus a client whose diagnosis of sepsis is attributable to recent chemotherapy

a client whose diagnosis of sepsis is attributable to recent chemotherapy

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

biopsy.

A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? hearing impairment blindness diarrhea fatigue

blindness

Ataxia refers to uncoordinated muscle movement. difficulty swallowing. vascular lesions caused by dilated blood vessels. inability to understand spoken words.

uncoordinated muscle movement.

A 40-year-old client has been receiving increasing amounts of care at home from their parent since they were diagnosed with HIV and became symptomatic. During a home visit from a community health nurse, the parent tells the nurse that caregiving is an onerous responsibility, stating, "I'm completely at the end of my rope." What action should the nurse prioritize in response to that statement? Arrange for the transfer of the patient to a hospice setting. Identify community supports that can mobilized to provide for the patient's needs. Validate the important contributions the parent is making to their child's well-being. Have the patient admitted to hospital for a respite period.

Identify community supports that can mobilized to provide for the patient's needs.

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 may have cryptococcal meningitis and will need to be evaluated by the health care provider." "The client probably has pneumocystis pneumonia 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 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."

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

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

Respiratory or urinary system infections

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

Frequent and thorough handwashing

A nurse was administering a scheduled subcutaneous dose of heparin to a patient who has HIV when the needle penetrated the nurse's thumb. What prophylactic action should the nurse first take? Perform a thorough wash of the injury site with soap and water. Apply chlorhexidine to the wound site and to all the skin in a 3-inch radius. Maintain the hand in a dependent position. Apply negative pressure to the wound site using suction tubing.

Perform a thorough wash of the injury site with soap and water.

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? Hyperthyroidism Pernicious anemia Sickle cell anemia Gastric ulcer

Pernicious anemia

Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? Viral core Ribonucleic acid (RNA) Deoxyribonucleic acid (DNA) Glycoprotein envelope

Ribonucleic acid (RNA)

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

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

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

Malnutrition

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

Attachment

A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response? Reduce food intake. Increase the intake of iron and zinc. Encourage large, high-fat meals. Avoid residue, lactose, fat, and caffeine.

Avoid residue, lactose, fat, and caffeine.

A patient has come into the free clinic for HIV testing. The test comes back positive, and the patient is told she has HIV. While assessing the patient, the nurse is aware that many patients with HIV utilize various alternative or complementary therapies. How does the nurse address complementary or alternative therapy? "We see many patients with HIV who are using some type of alternative therapy, and there are benefits and risks. Are there any types of alternative or complementary therapies that you follow, or are there any herbs that you take?" "Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available." "You surely do not take herbs or practice some type of alternative medicine such as acupuncture, massage therapy, hypnosis or diet therapy, do you?" "Complementary therapie

"We see many patients with HIV who are using some type of alternative therapy, and there are benefits and risks. Are there any types of alternative or complementary therapies that you follow, or are there any herbs that you take?"

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 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 the term used to describe the early stages of AIDS." "Your child may die without proper medication and treatment." "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."