Chapter 14: Infection
The nurse assesses a patient who tests positive for human immunodeficiency virus (HIV). Which finding would the nurse identify as the highest priority for follow-up? 1 Anorexia 2 Insomnia 3 Mood swings 4 New or productive cough
4 The patient who tests positive for HIV should be informed to report a new or productive cough within 24 hours after symptoms begin. After evaluation of the cough, follow-up care for anorexia, insomnia, and mood swings is secondary.
Which lab value would indicate that a client with HIV is at risk for an opportunistic infection? viral load of 0 Albumin level of 4.0 CD4+ count of 100 WBC of 9,000
CD4+ count of 100
The nurse manager has noted a recent increase in the incidence of hospital care-associated infections (HAIs) on the unit. Which nursing action should be prioritized in the response to this trend? Double glove use during procedures. Frequent and thorough hand washing. Prophylactic, broad-spectrum antibiotics. Fitting and appropriate use of N95 masks.
Frequent and thorough hand washing. Rationale: Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient.
The nurse is teaching a group of young adults who live in a dormitory about the prevention of antibiotic-resistant infections. What should be included in the teaching plan? Save leftover antibiotics for future uses. Hand washing can prevent many infections. Antibiotics are indicated for preventing most colds. Stop taking prescribed antibiotics when symptoms improve.
Hand washing can prevent many infections. Rationale: Hand washing is the single most important action to prevent infections. Antibiotics are used to treat bacterial infections, not colds and flu caused by viruses. Patients should complete the entire prescription of antibiotics to prevent the development of resistant bacteria. Antibiotics should not be taken to prevent infections unless they are given prophylactically before undergoing certain surgeries and dental work.
A patient with human immunodeficiency virus (HIV) is educated about health promotion activities. What should the nurse inform the patient the importance of these activities is? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities
1 These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.
A patient is admitted to the emergency department (ED) with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing actions will help identify the need for further assessment of the cause of this patient's manifestations if the nurse suspects the patient is at risk for HIV infection? (Select all that apply.) Assessment of lung sounds Reviewing living conditions Assessment of sexual behavior Assessment of drug and syringe use Evaluating for exposure to an ill person
Assessment of sexual behavior Assessment of drug and syringe use Rationale: With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for HIV infection should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).
A nurse was accidently stuck with a needle used on a patient who is infected with human immunodeficiency virus (HIV). After reporting the incident, what care should this nurse receive first? Personal protective equipment Combination antiretroviral therapy Counseling to report blood exposures A negative evaluation by the manager
Combination antiretroviral therapy Rationale: Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.
The nurse is providing postoperative care for a patient with human immunodeficiency virus (HIV) infection after an appendectomy. What type of precautions should the nurse observe to prevent the transmission of this disease? Droplet precautions Contact precautions Airborne precautions Standard precautions
Standard precautions Rationale: Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or though breastfeeding.
When teaching a patient infected with HIV about transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? "I will need to isolate any tissues I use so as not to infect my family." "I will notify all of my sexual partners so they can get tested for HIV." "Unprotected sexual contact is the most common mode of transmission." "I do not need to worry about spreading this virus to others by sweating at the gym
"I will need to isolate any tissues I use so as not to infect my family." Rationale: HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.
A patient was recently diagnosed with a sinus infection and prescribed a 10 day course of an antibiotic. After 3 days the patient felt back to normal and informed the nurse that he decided to stop the antibiotics and save the rest of the antibiotics in case he gets another infection. Which statement by the nurse would be correct in providing education to the patient? "You should keep left over antibiotics in a cool, dry place so they do not expire." "It is okay to save the antibiotics for next time, but you should check the expiration date." "If you have left over antibiotics, please return them back to the clinic so we can give them to patients who cannot afford their medication." "If you are prescribed antibiotics, you should complete the entire course of treatment because you may create drug resistance by stopping early."
"If you are prescribed antibiotics, you should complete the entire course of treatment because you may create drug resistance by stopping early." Rationale: To decrease the risk of antibiotic resistance, patients should be educated to complete the entire course of antibiotic therapy, even if they feel better before the treatment course is finished. Patients should never share or keep left over antibiotics.
A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? "The baby will be infected with HIV." "Having a cesarean section will keep your baby from having HIV." "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
"Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." Rationale: On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.
During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidioides immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans
1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus and the presence of thrush indicate Candida albicans. Infection by Coccidioides immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans.
The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). The patient asks what would determine the actual development of acquired immunodeficiency syndrome (AIDS). The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? 1 Presence of HIV antibodies 2 CD4 +T cell count below 200/µL 3 Presence of oral hairy leukoplakia 4 White blood cell (WBC) count below 5000/µL
2 Diagnostic criteria for AIDS include a CD4 +T cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or oral hairy leukoplakia or WBC count below 5000/µL may be found in patients with HIV disease, but do not define the advancement of HIV infection to AIDS.
The nurse is monitoring the CD4 counts from a patient with human immunodeficiency virus (HIV). When does the nurse determine that the patient will need to observe for signs of immune problems? 1 The CD4 count is 1200. 2 The CD4 count falls to 500. 3 The CD4 count falls below 200. 4 The CD4 count is greater than 500.
2 Immune problems start to occur when the count drops below 500 CD4 T cells. When it drops below 200 CD4 T cells, severe immune problems will develop and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 to 1200 CD4 T cells is normal for adults who do not have any immune dysfunction.
A patient was exposed to human immunodeficiency virus (HIV) during unprotected intercourse. Two weeks later, the patient reports fever, swollen lymph nodes, sore throat, headache, malaise, nausea, and muscle and joint pain. Which process explains these manifestations? Select all that apply. 1 Flu 2 Seroconversion 3 Mononucleosis 4 Acute HIV infection 5 Guillain-Barré syndrome
2,4 In this case, the patient would have acquired HIV infection from the donor. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompany seroconversion (when HIV-specific antibodies develop). These symptoms, called acute HIV infection, generally occur within 2 to 4 weeks after the initial infection and last for 1 to 3 weeks, although some symptoms may persist for several months. Many people, including health care providers, mistake acute HIV symptoms for a bad case of the flu. Some people also develop neurologic complications, such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome. This patient has not yet developed neurologic symptoms.
A patient is diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse monitor for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex
2,4,5 Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS, because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with HIV due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus, and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence.
. The nurse is educating a patient that has human immunodeficiency virus (HIV) about monitoring for the development of opportunistic diseases. What statement made by the patient demonstrates an understanding of the education provided? 1 "These diseases are usually benign." 2 "Opportunistic diseases are not treatable if they occur." 3 "They don't usually occur in people with healthy immune systems." 4 "Opportunistic diseases only occur at the end stages of HIV infection."
3 Opportunistic diseases generally do not occur in the presence of a functioning immune system. Organisms that do not cause severe disease in people with functioning immune systems can cause debilitating, disseminated, and life-threatening infections during this stage. Several opportunistic diseases may occur at the same time, compounding the difficulties of diagnosis and treatment. Advances in HIV treatment have decreased the occurrence of opportunistic diseases. These diseases can occur early in the process of HIV infection and sometimes are used to diagnose the presence of HIV.
A patient asks the nurse about rapid testing for human immunodeficiency virus (HIV) infection at home. What is the best response by the nurse? 1 "These tests are done on freshly voided urine." 2 "Positive rapid tests should be repeated for confirmation." 3 "Rapid tests are screening tests for antibodies, not for antigens." 4 "These tests are not recommended by the Centers for Disease Control and Prevention (CDC)
3 Rapid testing is recommended strongly by the CDC and can be done in a variety of settings. These tests are screening tests for antibodies, not antigens; testing is done on oral fluid samples. Positive rapid tests need to be confirmed with the more specific Western blot (WB) or immunofluorescence assay (IFA). This step necessitates a blood draw and a return appointment to get results.
A patient was diagnosed with human immunodeficiency virus (HIV) approximately 12 years ago. The nurse recognizes that which assessment findings are diagnostic of acquired immunodeficiency syndrome (AIDS)? Select all that apply. 1 Typhoid fever 2 Hepatitis A infection 3 Esophageal candidiasis 4 Pulmonary cryptococcosis 5 CD4 count less than 200 cells/µ
3,5, To diagnose AIDS, the patient should have an opportunistic infection such as esophageal candidiasis, or the CD4 count should be less than 200 cells/µL of blood. Typhoid fever is not a diagnostic parameter for diagnosis of AIDS. Hepatitis A infection is not diagnostic of AIDS because it is not an opportunistic infection. Extrapulmonary cryptococcosis is diagnostic of AIDS, but pulmonary cryptococcosis is not.
The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A new onset of polycythemia Presence of mononucleosis-like symptoms A sharp decrease in the patient's CD4+ count A sudden increase in the patient's WBC count
A sharp decrease in the patient's CD4+ count Rationale: A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.
The nurse teaches the staff that standard precautions should be used when providing care for which type of patient? Pediatric and older adult patients All patients regardless of diagnosis Patients who are immunocompromised Patients with a history of infectious diseases
All patients regardless of diagnosis Rationale: Standard precautions are designed for all care of all patients in hospitals and health care facilities.
The patient is diagnosed with vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to prevent transmission of the infection to others? Droplet precautions Contact precautions Airborne precautions Standard precautions
Contact precautions Rationale: Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., tuberculosis, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.
A patient who is infected with human immunodeficiency virus (HIV) is being taught by the nurse about health promotion activities such as good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale for these interventions? Delaying disease progression Preventing disease transmission Helping to cure the HIV infection Enabling an increase in self-care activities
Delaying disease progression Rationale: These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.
A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? Cough, diarrhea, headaches, blurred vision, muscle fatigue Night sweats, fatigue, fever, and persistent generalized lymphadenopathy Oropharyngeal candidiasis or thrush, vaginal candida infection, or oral or genital herpes Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea
Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Rationale: Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lymphadenopathy. Intermediate chronic HIV infection clinical manifestations include candida infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).
The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a patient with human immunodeficiency virus (HIV). What laboratory study result indicates the medications are effective? Increased viral load Decreased neutrophil count Increased CD4+ T-cell count Decreased white blood cell count
Increased CD4+ T-cell count Rationale: Antiretroviral therapy is effective if the HIV viral load is decreased, and the CD4+ T-cell count is increased.
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? Methods to prevent perinatal HIV transmission Ways to sterilize needles used by injectable drug users Prevention of HIV transmission between sexual partners Means to prevent transmission through blood transfusions
Prevention of HIV transmission between sexual partners
A patient has human immunodeficiency virus (HIV) infection and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? The patient has the virus but the infection is well controlled. The syndrome has been cured, and the patient can discontinue all medications. The patient will be prescribed lower doses of antiretroviral medications for 2 months. The patient is not taking antiretrovirals and needs to be taught the benefits of therapy.
The patient has the virus but the infection is well controlled. Rationale: In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" indicates that the patient still has the virus, but the virus is well controlled.
The nurse is caring for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? The patient complains of feeling "constantly tired." The patient can't explain the effects of ART medicine. The patient reports missing some doses of zidovudine (AZT). The patient reports having no side effects from the medications.
The patient reports missing some doses of zidovudine (AZT).
A parent does not want their child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? There is currently no need for those older vaccines. There is a reemergence of some of the infections, such as pertussis. There is no longer an immunization available for some of those diseases. The only way to protect your child is to have the federally required vaccines.
There is a reemergence of some of the infections, such as pertussis. Rationale: Teaching the parent that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.
A heterosexual patient is concerned that they may contract human immunodeficiency virus (HIV) from a bisexual partner. What should the nurse include when teaching about preexposure prophylaxis? (Select all that apply.) Take fluconazole (Diflucan). Take amphotericin B (Fungizone). Use condoms for risk-reducing sexual relations. Take emtricitabine and tenofovir (Truvada) regularly. Have regular HIV testing for herself and her husband
Use condoms for risk-reducing sexual relations. Take emtricitabine and tenofovir (Truvada) regularly. Have regular HIV testing for herself and her husband. Rationale: Using male or female condoms, having regular HIV testing for the patient and partner, and taking emtricitabine and tenofovir regularly have shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcus neoformans, which are all opportunistic diseases associated with HIV infection.
A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What rationale for taking more than one antiretroviral medication should the nurse give to the patient to improve compliance? Viral replication will be inhibited. They will decrease CD4+ T-cell counts. It will prevent interaction with other drugs. More than one drug has a better chance of curing HIV.
Viral replication will be inhibited. Rationale: The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T-cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.
What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection? (Select all that apply.)? Wash hands frequently. Take antibiotics as prescribed. Take the antibiotic until it is gone. Take antibiotics to prevent illnesses like colds. Save leftover antibiotics to take if needed late
Wash hands frequently. Take antibiotics as prescribed. Take the antibiotic until it is gone. Rationale: To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, finish the antibiotic, do not request antibiotics for colds or flu, do not save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider.
Which teaching is important to include when instructing the client about ART? ART will cure your HIV infection You must take all doses of ART as directed You may skip a dose if you are too tired You may experience fatigue or nausea
You must take all doses of ART as directed
The nurse is advising a clinic patient who was exposed a week ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen and antibody test has just been reported as negative for HIV. What instructions should the nurse give to this patient? a. "You will need to be retested in 2 weeks." b. "You do not need to fear infecting others." c. "Since you don't have symptoms and you have had a negative test, you do not have HIV)." d. "We won't know for years if you will develop acquired immunodeficiency syndrome (AIDS)."
a. "You will need to be retested in 2 weeks."
A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Clean drug injection equipment before each use." b. "Ask those who share equipment to be tested for HIV." c. "Consider participating in a needle-exchange program." d. "Avoid sexual intercourse when using injectable drugs."
c. "Consider participating in a needle-exchange program."
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/μL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient will develop symptomatic HIV infection within 1 year." b. "The patient meets the criteria for a diagnosis of acute HIV infection." c. "The patient will be diagnosed with asymptomatic chronic HIV infection." d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
The nurse is caring for an older patient who has been receiving antiretroviral therapy for HIV infection for many years. The nurse is aware that complications of long-term antiretroviral use can include: (Select all that apply.) osteoporosis. insulin resistance. cognitive problems. urinary incontinence. cardiovascular disease.
osteoporosis. insulin resistance. cardiovascular disease. Rationale: Patients receiving HIV antiretroviral therapy are more likely to develop other conditions include osteoporosis, insulin resistance, and cardiovascular disease.