Chapter 36: Management of Patients with Immune Deficiency disorders

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

Answer: A.) develop early in life after protection from maternal antibodies decreases. 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.

The nurse teaches the client that reducing the viral load will have what effect? A.) Shorter time to AIDS diagnosis B.) Longer survival C.) Shorter survival D.) Longer immunity

Answer: B.) Longer survival Rationale: The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.

A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client? A.) diarrhea and abdominal pain B.) numbness in the extremities and decreased cognition C.) alterations in renal function D.) pancreatitis

Answer: A.) diarrhea and abdominal pain Rationale: Common adverse effects associated with the administration of zidovudine and other NRTIs include nausea, abdominal pain and diarrhea. The drug does not cause nephropathy, decreased cognition, or pancreatitis.

A female 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." What should the nurse consult with the physician regarding? A.) testing the client for the presence of HIV B.) instructing the client to wear cotton underwear C.) having the client abstain from sexual activity for 6 weeks while the medication is working D.) using a medicated douche in order to keep the vaginal pH normal

Answer: A.) testing the client for the presence of HIV

An older adult widowed woman informs the nurse that she notices vaginal dryness now that she has become sexually active again. She is not using barrier protection because it makes the dryness worse. What education should the nurse provide to the patient? A.) Use a lamb skin condom instead of latex. B.) Vaginal dryness is common in postmenopausal women, and there are creams that can be used, but she should use a latex condom. C.) Since the patient is older, it is not likely that she will acquire HIV. D.) She should abstain from sexual activity because she is at greatest risk for acquiring HIV.

Answer: B.) Vaginal dryness is common in postmenopausal women, and there are creams that can be used, but she should use a latex condom. Rationale: Other than abstinence, consistent and correct use of condoms (Chart 37-3) is the only effective method to decrease the risk of sexual transmission of HIV infection. When latex male condoms are used consistently and correctly during vaginal or anal intercourse, they are highly effective in preventing the sexual transmission of HIV (CDC, 2011d). Nonlatex condoms made of natural materials such as lambskin are available for people with latex allergy but will not protect against HIV infection.

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

Answer: B.) alcohol. Rationale: 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.

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

Answer: C.) "Although AIDS is an immune deficiency, your child's condition is different from AIDS." Rationale: 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 secondary immunodeficiency.

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? A.) distal sensory polyneuropathy (DSP) B.) candidiasis C.) AIDS dementia complex (ADC) D.) cytomegalovirus (CMV)

Answer: C.) AIDS dementia complex (ADC) Rationale: 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.

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? A.) Deficient knowledge related to the effects of the disease B.) Risk for infection related to the immune system dysfunction C.) Disturbed body image related to loss of fat in the face and arms D.) Risk for impaired liver function related to drug therapy effects

Answer: C.) Disturbed body image related to loss of fat in the face and arms

A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? A.) Limit interactions with people who are not HIV infected. B.) Limit interactions with people who are already HIV infected. C.) Follow the same sexual precautions as someone who has been diagnosed with AIDS. D.) Quit their job and get admitted to a hospital or a cancer treatment center.

Answer: C.) Follow the same sexual precautions as someone who has been diagnosed with AIDS. Rationale: The healthcare worker will be tested for HIV at regular intervals and treated with antiretrovirals depending on the results of the tests or the potential for infection. While awaiting the results, the healthcare worker should follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker should not limit interactions with either non-HIV-infected or HIV-infected people. In addition, the healthcare worker should not quit and be admitted to a hospital for treatment. Treatment, if required, can begin if the result of the test is positive.

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

Answer: D.) Bring the viral load to a virtually undetectable level Rationale: The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.

Which blood test confirms the presence of antibodies to HIV? A.) Erythrocyte sedimentation rate (ESR) B.) p24 antigen C.) Reverse transcriptase D.) Enzyme immunoassay (EIA)

Answer: D.) Enzyme immunoassay (EIA) Rationale: EIA and Western blotting identify and confirm the presence of antibodies to HIV. ESR is an indicator of the presence of inflammation in the body. 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.

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

Answer: B.) "I can eat whatever I want as long as it's low in fat." Rationale: The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

Which type of phagocytic disorder occurs when white blood cells cannot initiate an inflammatory response to infectious organisms? A.) Agammaglobulinemia B.) Hyperimmunoglobulinemia C.) Panhypoglobulinemia D.) Telangiectasia

Answer: B.) Hyperimmunoglobulinemia Rationale: In hyperimmunoglobulinemia, white blood cells cannot initiate an inflammatory response to an infectious organism. Agammaglobulinemia is a disorder marked by an almost complete lack of immunoglobulins or antibodies. Panhypoglobulinemia is a general lack of immunoglobulins in the blood. Telangiectasias are vascular lesions caused by dilated blood vessels.

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

Answer: - semen - breast milk - blood - vaginal secretions

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

Answer: B.) Pernicious

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

Answer: B.) Chronic diarrhea Rationale: 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.

When the nurse administers intravenous gamma-globulin infusion, she recognizes that which symptom, if reported by the client, may indicate an adverse effect of the infusion? A.) Tightness in the chest B.) Nasal stuffiness C.) Increased thirst D.) Burning urination

Answer: A.) Tightness in the chest Rationale: Flank pain, tightness in the chest, or hypotension indicates adverse effects of gamma-globulin infusion. Nasal stuffiness and increased thirst are not recognized as adverse effects of gamma-globulin infusion. Burning urination is a sign of urinary tract infection, not an adverse effect of gamma-globulin infusion.

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

Answer: D.) CD4+ counts

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

Answer: - Low levels of IgM - Absent B cells Rationale: 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 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? A.) 6 weeks B.) 12 weeks C.) 18 weeks D.) 24 weeks

Answer: A.) 6 weeks Rationale: 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.

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

Answer: A.) Liquids

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

Answer: B.) biopsy. Rationale: 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.

There are major differences between primary and secondary immunodeficiencies. Select the most accurate statement the nurse would use to explain the cause of a secondary immunodeficiency. A.) "Your diagnosis was inherited." B.) "Your condition will predispose you to frequent and recurring infections." C.) "Your immune system was most likely affected by an underlying disease process." D.) "You will now be more likely to develop cancer in the future."

Answer: C.) "Your immune system was most likely affected by an underlying disease process." Rationale: A secondary immunodeficiency is the result of an underlying disease process or the treatment of a disorder. It is not genetically inherited. Some examples of a secondary immunodeficiency are chronic stress and diabetes mellitus.

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

Answer: C.) Teach the client about medication side effects. Rationale: 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.

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

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

Answer: A.) Avoid residue, lactose, fat, and caffeine. Rationale: Diarrhea may subside when the client avoids residue, 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, 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.

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

Answer: D.) Herpes simplex ulcer persisting for 2 months Rationale: A diagnosis of AIDS cannot be made until the person with HIV meets case criteria established by the Centers for Disease Control and Prevention. The immune system becomes compromised. The CD4 T-cell count drops below 200 cells and develops one of the opportunistic diseases, such as Pneumocystis carinii pneumonia, candidiasis, cytomegalovirus, or herpes simplex.

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

Answer: D.) Risk for injury Rationale: 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.

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

Answer: B.) Headache Rationale: Early manifestations of HIV encephalopathy include headache, memory deficits, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. Later stages include hyperreflexia, a vacant stare, and hallucinations.

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

Answer: B.) Pernicious anemia 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.

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: A.) p24 antigen test for confirmation of diagnosis. B.) Western blot test for confirmation of diagnosis. C.) polymerase chain reaction test for confirmation of diagnosis. D.) T4-cell count for confirmation of diagnosis.

Answer: B.) Western blot test for confirmation of diagnosis. Rationale: The enzyme-linked immunosorbent assay (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. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.

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

Answer: C.) "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." Rationale: Didanosine (Videx) should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

A client with ataxia-telangiectasia is admitted to the unit. The nurse caring for the client would expect to see what included in the treatment regimen? A.) IV gamma globulin administration B.) Platelet administration C.) Factor VIII administration D.) Thymus grafting

Answer: A.) IV gamma globulin administration Rationale: 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.

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

Answer: A.) Increased susceptibility to infection Rationale: 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.

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

Answer: A.) Bone marrow transplantation Rationale: Treatment options for SCID include stem cell and bone marrow transplantation.

Which of the following tests determines initiation of antiretroviral treatment? A.) CD4/CD8 ratio B.) Enzyme immunoassay (EIA) C.) Western blot D.) Viral load

Answer: A.) CD4/CD8 ratio Rationale: The CD4/CD8 ratio determines initiation of antiretroviral treatment and use of prophylactic medications. EIA is an enzyme immunoassay that detects HIV antibodies. The Western blot test detects antibodies to HIV and is used to confirm EIA. Viral load quantifies HIV RNA in the plasma. It monitors efficacy of antiretroviral treatment through virological suppression.

A nurse works in an employee health department of a hospital. She was asked to treat a staff nurse who was exposed to blood from a patient with an HIV infection. The nurse practitioner instituted a PEP protocol that includes which of the following actions? Select all that apply. - Start prophylaxis medications between 3 to 6 hours after exposure. - Continue HIV medications for 4 weeks postexposure. - Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level). - Initiate postexposure testing after 4 weeks. - Finish postexposure testing at 6 months.

Answer: - Continue HIV medications for 4 weeks postexposure. - Initiate postexposure testing after 4 weeks. - Finish postexposure testing at 6 months. Rationale: Refer to Box 37-4 in the text

A nurse knows that more than 50% of clients with CVID develop the following disorder. A.) Pernicious anemia B.) Neutropenia C.) Hypocalcemia D.) Chronic diarrhea

Answer: A.) Pernicious anemia Rationale: More than 50% of clients with CVID develop pernicious anemia. Although chronic diarrhea may occur in clients with CVID, it does not happen in 50% of them. Hypocalcemia and neutropenia are not concerns for clients with CVID.

A client with HIV will be started on a medication regimen of three medications. What class of drugs will the nurse instruct the client about? A.) Anticholinergics B.) Disinhibitors C.) Reverse transcriptase inhibitors D.) Hydroxyurea

Answer: C.) Reverse transcriptase inhibitors Rationale: 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 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? A.) Peripheral edema B.) Uncoordinated muscle movement C.) Vascular lesions caused by dilated blood vessels D.) A condition marked by development of urticaria

Answer: C.) Vascular lesions caused by dilated blood vessels Rationale: 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.

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

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

The two types of inherited B-cell deficiencies result from lack of differentiation of B cells. These types result from which two of the following deficiencies? Choose the two that apply. - Mature B-cells - Plasma cells - Combined B- and T-cells - Complement production

Answer: - Mature B-cells - Plasma cells Rationale: Two types of inherited B-cell deficiencies exist. The first type results from lack of differentiation of B-cell precursors into mature B cells. As a result, plasma cells are absent, and the germinal centers from all lymphatic tissues disappear, leading to a complete absence of antibody production against invading bacteria, viruses, and other pathogens.

The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? A.) The client has converted from HIV infection to AIDS. B.) The client has advanced HIV infection. C.) The client's CD4+ cell count has decreased due to the pneumocystis pneumonia. D.) The client has another infection present that is causing a decrease in the CD4+ cell count.

Answer: A.) The client has converted from HIV infection to AIDS. Rationale: AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased CD4+ cell count from a normal level of 500 to 1000/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 CD4+ cell count is not decreasing due to an infection.

The nurse is caring for a young client who has agammaglobulinemia. The nurse is teaching the family how to avoid infection at home. Which statement by the family indicates that additional teaching is needed? A.) "I will let my neighbor have my pet iguana." B.) "I will apply lotion following every bath to prevent dry skin." C.) "I can take my child to the beach, as long as we play in the sand rather than swim in the water." D.) "I will avoid letting my child drink any juice that has been sitting out for more than an hour."

Answer: C.) "I can take my child to the beach, as long as we play in the sand rather than swim in the water." Rationale: Parents should verbalize ways to plan for regular exercise and activity that does not pose a risk of infections. Immunocompromised clients should avoid touching sand or soil because of the high level of bacteria and increased risk of diseases such as toxoplasmosis.

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

Answer: C.) Assess blood urea nitrogen and creatinine. 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.