Chapter 36: Management of Patients with Immune Deficiency Disorders

A nurse in a medical clinic is providing teaching to an older adult client who has OA that is affecting her knees. Which of the following client statements indicates an understanding of the teaching? "I can use either heat or ice to help relieve the discomfort." "Ibuprofen is the first step in medication therapy for osteoarthritis." "I should limit physical activity to prevent further injury." "I will elevate my legs by placing two pillows under my knees when I go to bed."

"I can use either heat or ice to help relieve the discomfort."

A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for management of gout. Which of the following statements indicates the client understands the teaching? "I will need to limit the number of fruit servings each day." "I should avoid eating liver and other organ meats." "I can drink only white wine." "I should choose red meat instead of poultry."

"I should avoid eating liver and other organ meats."

A nurse is completing discharge instructions with a client following an acute onset of gout. Which oft the following client statements indicates an understanding of the treatment regimen? "I will closely follow a high-purine diet." "I will limit my fluid intake to 1 liter per day." "I will take one aspirin every day." "I will limit my alcohol intake."

"I will limit my alcohol intake."

A nurse is caring for a client who is taking naproxen following an exacerbation of RA. Which of the following statements by the client requires further discussion by the nurse? "I signed up for a swimming class." "I've been taking an antacid to help with indigestion." "I've lost 2 pounds since my appointment 2 weeks ago." "The naproxen is easier to take when I crush it and put it in applesauce."

"I've been taking an antacid to help with indigestion."

A nurse is teaching a client who has OA. Which of the following instructions should the nurse include in the teaching? "Apply a heat pack at a temperature below your body temperature." "Elevate the affected joint on large pillows." "Take acetaminophen as the primary medication to treat the pain." "Decrease foods high in purines."

"Take acetaminophen as the primary medication to treat the pain."

A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse make? "Uric acid levels drop and calcium forms precipitate." "Tophi form in the kidneys and they impair the excretion of uric acid." "The intra-articular deposition of urate crystals causes inflammation." "Articular cartilage thins, leading to splitting and fragmentation."

"The intra-articular deposition of urate crystals causes inflammation."

A nurse is caring for a client who has RA and tells the nurse that she wears a copper bracelet to help her feel better. Which of the following responses should the nurse make? "Yes, I understand that you feel better wearing your bracelet." "Why do you think the copper helps with your arthritis?" "Believing objects have powers to make you feel better has no scientific basis." "I think you should rely more on your medication therapy than on your bracelet."

"Yes, I understand that you feel better wearing your bracelet."

HIV-1 transmitted in body fluids that contain infected cells:

-Blood and blood products -Seminal fluid -Vaginal secretions -Amniotic fluid -Breast milk -Exposure during delivery

HIV Neurologic manifestations

-Effects on cognition, motor function attention, visual memory, visuospatial function -Peripheral neuropathy -HIV encephalopathy

HIV Gynecologic manifestations

-Genital ulcers/venereal warts -Chancroid, syphilis, herpes -Persistent, recurrent vaginal candidiasis -Pelvic inflammatory disease Menstrual abnormalities

HIV Integumentary manifestations

-Herpes zoster -Seborrheic dermatitis

Wasting syndrome

-Involuntary loss of more than 10% of body weight along with diarrhea or weakness & fever for >30 days. -Loss of muscle mass and fat

Clinical Manifestations of Primary Immune Deficiency Disorders (PIDD)

-Multiple infection despite treatment -Infection with unusual/opportunistic organisms -Failure to thrive, poor growth -Positive family history

HIV encephalopathy

-Progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection. -HIV found in brain & CSF

Medical circumcision

-Reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. -This is a key intervention in generalized epidemic settings with high HIV prevalence and a low male circumcision rate

Risk Factors Associated With HIV Infection

-Sharing infected needles -Sexual relations with infected individuals -Infants born to mothers with HIV and/or who are breast fed by HIV-infected mothers -People who received organ transplants, HIV-infected blood or blood products, particularly between 1978-85

Candidiasis

-fungal infection common in HIV patients, painless, creamy white, plaque-like lesions throughout oral cavity, can be scraped off -Vulvovaginitis

Healthcare workers who receive a needle stick involving HIV-infected blood in the health care setting = ______% risk of becoming infected with HIV

0.23%

Only ____% of those infected world wide with HIV know that they are infected.

51%

A nurse is performing a physical assessment of a client who has lupus. Which of the following findings should the nurse expect? A grey colored, non-purpuric papular rash. A dry, red rash across the bridge of the nose and on the cheeks. Pitting edema of the hands and fingers. Subcutaneous nodules on the ulnar side of the arm.

A dry, red rash across the bridge of the nose and on the cheeks.

A group of nurses are discussing risk factors for transmission of HIV from clients. Which of the following individuals should the nurse identify as being at the greatest risk for contracting HIV? An occupational therapist who works with a client who has HIV A personal trainer who works with a client who has HIV A phlebotomist who collects blood from clients who have HIV A nurse who works for an insurance company and collects urine samples from clients who have HIV

A phlebotomist who collects blood from clients who have HIV

A nurse is admitting a client who has active TB to a room on a med-surge unit. Which of the following room assignments should the nurse make for the client? A room with air exhaust directly to the outdoor environment A room with another nonsurgical client A room in the ICU A room that is within view of the nurses' station

A room with air exhaust directly to the outdoor environment

Stage 3 HIV

AIDS

A nurse in a clinic is talking with a client who has a new diagnosis of OA. The nurse should anticipate that the client will require teaching about which of the following meds? Acetaminophen Celecoxib Cyclobenzaprine Ibuprofen

Acetaminophen

Human Immune Deficiency Virus (HIV)

Acquired Immune Deficiency Due to: -Due to medical treatment such as chemo -Infection from agents like HIV

A nurse is preparing a presentation at a community center about OA. The nurse should plan to include which of the following info? (Select all that apply.) Affects weight-bearing joints Crepitus can occur in affected joints Affects bilateral, symmetrical joints Causes joint stiffness Causes joint pain

Affects weight-bearing joints Crepitus can occur in affected joints Causes joint stiffness Causes joint pain

A nurse is teaching a client about risk factors for OA. Which of the following factors should the nurse include in the teaching? (Select all that apply.) Bacteria Diuretics Aging Obesity Smoking

Aging Obesity Smoking

A nurse is teaching a client who has gout about dietary recommendations. The nurse should teach the client that which of the following beverages can trigger an attack? Alcohol Orange juice Milk Coffee

Alcohol

The ______ is used as a gross index of glomerular function and the production and excretion of urea.

BUN

A client is starting celecoxib to treat OA. The nurse should instruct the client to watch for and report which of the following adverse effects? Black, tarry stools Bone pain Dry mouth Polyuria

Black, tarry stools

A nurse is teaching a client who has a new prescription for aspirin to treat RA. The nurse should include to monitor for which of the following adverse effects of this med? Constipation Bleeding Blurred vision Insomnia

Bleeding

A nurse is caring for a client who has HIV. Which of the following lab values is the nurse's priority? Positive Western blot test CD4-T-cell count 180 cells/mm3 Platelets 150,000/mm3 WBC 5,000/mm3

CD4-T-cell count 180 cells/mm3

A nurse in a clinic is assessing a client who has AIDS and a significantly decreased CD4-T-cell count. The nurse should recognize that the client is at risk for developing which of the following infectious oral conditions? Halitosis Gingivitis Xerostomia Candidiasis

Candidiasis

A community health nurse is reviewing info about infectious diseases with the nurses on her team. The nurse should remind the team that which of the following diseases are included in the list of nationally notifiable infectious diseases? (Select all that apply,) Trichomonas vaginalis Chlamydia Gonorrhea Chancroid Candidiasis albicans

Chlamydia Gonorrhea Chancroid

A nurse is admitting a client who has a wound infected with vancomycin-resistant enterococci (VRE). Which of the following types of precautions should the nurse plan to initiate? Droplet Contact Airborne Protective

Contact

A nurse is teaching a client who has a new prescription for prednisone for treatment of RA. The nurse should inform the client that which of the following is a therapeutic effect of this med? Reduces risk of infection Decreases inflammation Improves peripheral blood flow Increases bone density

Decreases inflammation

A young adult client with a new diagnosis of RA states, "The pain in my joints is just a temporary thing. If I keep eating right and exercising, it'll go away." The nurse should identify the client is exhibiting which of the following defense manifestations? Denial Displacement Rationalization Reaction formation

Denial

A nurse is admitting a client who was prescribed antibiotic therapy and now has C-diff infection. Which of the following actions should the nurse take? -Disinfect equipment in the client's room daily. -Place the client in a protective environment. -Use alcohol hand sanitizer after completing tasks for the client. -Have the client wear a mask when out of the room.

Disinfect equipment in the client's room daily.

A nurse is teaching a client who has RA about taking methotrexate. Which of the following info should the nurse include? Take an antiemetic 1 hr following administration. Drink 2 to 3 L of water per day. Take the medication with an NSAID. Rinse mouth 2 times per day with an alcohol based mouthwash.

Drink 2 to 3 L of water per day.

A nurse is caring for an older adult client who has RA and is taking aspirin 650 mg Q4HR. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this med? WBC count Rheumatoid factor (RF) Antinuclear antibody (ANA) Erythrocyte sedimentation rate (ESR)

Erythrocyte sedimentation rate (ESR)

True or False Primary immune deficiency disorders result from external factors such as infection

False

A nurse is assessing a client for early manifestations os RA. Which of the following changes is a manifestations of RA? Morning stiffness Fatigue Temporomandibular joint pain Baker's cysts

Fatigue

A nurse is caring for a female contact who has RA and asks the nurse if it is safe to take aspirin. The nurse should recognize which of the following findings in the client's history is a contraindication to this med? Report of recent migraine headaches History of gastric ulcers Current diagnosis of glaucoma Prior reports of amenorrhea

History of gastric ulcers

Kaposi sarcoma (KS)

Human herpes virus-8, more common in men, spread through sexual contact, involves epithelial layer of blood & lymphatic vessels, localized or systemic, brownish-pink to deep purple, localized to systemic, prognosis dependent on extent of tumors

Stage O HIV

Includes primary infection or acute HIV infection

HIV Oncologic manifestations

Increased risk of developing certain cancers Kaposi sarcoma (KS) AIDS-related lymphomas - Hodgkin & non-Hodgkin lymphoma Invasive cervical cancer

A nurse is planning a presentation about HIV for a church-based group. Which of the following info about HIV transmission should the nurse include? It is primarily transmitted through casual contact. It is primarily transmitted through accidental puncture wounds. It is primarily transmitted through direct contact with infected body fluids. It is primarily transmitted through mosquitoes.

It is primarily transmitted through direct contact with infected body fluids.

A nurse in a provider's office is assessing a client who has RA. Which of the following findings is a late manifestations of this condition? Anorexia Knuckle deformity Low-grade fever Weight loss

Knuckle deformity

HIV GI manifestations

Loss of appetite N and V diarrhea Candidiasis Wasting syndrome

A nurse is reviewing the guidelines for reporting nationally notifiable infectious diseases. Which of the following diseases should the nurse plan to report to the CDC? Lyme disease Cytomegalovirus Streptococcus pharyngitis Toxoplasmosis

Lyme disease

A nurse is teaching a group of clients about OA. Which of the following recommendations should the nurse include in the teaching? Use Echinacea to manage joint pain. Apply ice to the joint before exercising. Maintain a recommended body weight. Reduce the amount of purine in the diet.

Maintain a recommended body weight.

A nurse is assessing a client for late manifestations os RA. Which of the following changes is a manifestations of RA? Morning stiffness Fatigue Temporomandibular joint pain Baker's cysts

Morning stiffness Temporomandibular joint pain Baker's cysts

Stage 1 HIV

Neutralizing antibodies can be detected

A nurse is caring for a client who has RA and is experiencing difficulty feeding herself using adaptive devices. The nurse should initiate a referral with which of the following members of the health care team? Occupational therapist Social worker Registered dietitian Speech pathologist

Occupational therapist

Stage 2 HIV

Occurs when T-lymphocyte cells are between 200-499

A nurse is completing a physical assessment of a client who has early OA. Which of the following manifestations should the nurse expect? Symmetric joints affected Pain worsens with activity Weight loss Ulnar deviation

Pain worsens with activity

A nurse is preparing for the administration of client who has suspected active TB. Which of the following precautions should the nurse plan to implement to safely care for this client? -Have staff and visitors wear gowns, masks, and gloves while in the client's room. -Place the client in a private room with a special ventilation system. -Assign the client to a room with other clients who require droplet precautions. -Modify the protocol for donning and removing personal protective equipment before entering or leaving the client's room.

Place the client in a private room with a special ventilation system.

A nurse is planning care for a client who has manifestations of C-diff. Which of the following actions should the nurse plan to take? a) Place a surgical mask on the client during transport. b) Place the client on contact precautions. c) Use an alcohol-based agent to perform hand hygiene when caring for the client. d) Obtain a blood specimen to test for C. difficile.

Place the client on contact precautions.

A nurse is assessing a client who has lupus. Which of the following findings is the highest priority for the nurse to report to the provider? Client report of feelings of depression. Dry, raised rash on the face. Presence of peripheral edema. Joint pain in hands and knees.

Presence of peripheral edema.

A nurse is reviewing lab values for a client who has lupus. Which of the following values should give the nurse the best indication of the client's renal function? Serum creatinine Blood urea nitrogen (BUN) Serum sodium Urine-specific gravity

Serum creatinine

HIV Respiratory Manifestations

Shortness of breath dyspnea cough chest pain PCP MAC

Pneumocystis pneumonia (PCP)

Subacute onset progressive dyspnea, fever, nonproductive cough, chest discomfort, tachypnea, tachycardia, dry rales (cellophane), with oral thrush

True or False Primary immune deficiency disorders are genetic.

True

A nurse is caring for a group of clients in an infectious disease unit. The nurse should wear OSHA-approved N95 mask when caring for a client with which of the following infectious diseases? Pertussis Mycoplasma pneumonia Tuberculosis Respiratory syncytial virus

Tuberculosis

A nurse is caring for a client who has MRSA in an abdominal wound. The nurse enters the room to check the client's pulse. Which of the following actions should the nurse take? Wear an N95 respirator mask. Wear sterile gloves. Wear clean gloves. Wear protective eyewear.

Wear clean gloves.

enzyme immunoassay (EIA)

a blood test that can determine the presence of antibodies to HIV in the blood or saliva; a variant of this test is called enzyme-linked immunosorbent assay (ELISA)

polymerase chain reaction

a sensitive laboratory technique that can detect and quantify HIV in a person's blood or lymph nodes

immune reconstitution inflammatory syndrome (IRIS)

a syndrome that results from rapid restoration of pathogen-specific immune responses to opportunistic infections

HIV antibody test

a test that detects HIV antibodies to determine if a person has been infected with HIV

retrovirus

a virus that carries genetic material in ribonucleic acid (RNA) instead of DNA and contains reverse transcriptase

Symptoms can be confused with ____________ can mask signs of HIV/AIDS

aches and pains of aging, other diseases

viral set point

amount of virus present in the blood after the initial burst of viremia and the immune response that follows

Antiretroviral medications as post exposure prophylaxis for health care workers are started within ____ hours of exposure: a. 24 hours b. 72 hours c. 36 hours d. 12 hours

b. 72 hours

HIV targets

cells with CD4+ receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia

HIV encephalopathy

clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions

Pneumocystis pneumonia (PCP)

common opportunistic lung infection; pathogen implicated is most commonly a fungus

peripheral neuropathy

disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet

HIV Prevention

early detection and ongoing treatment are important aspects for care

reverse transcriptase

enzyme that transforms single-stranded RNA into a double-stranded DNA

candidiasis

fungal infection, usually of skin or mucous membranes, caused by Candida species

opportunistic infection

illness caused by various organisms, some of which usually do not cause disease in people with normal immune systems

Seborrheic dermatitis

indurated, diffuse, scaly, rash involving scalp & face

wasting syndrome

involuntary weight loss consisting of both lean and fat body mass

A CD4-T-cell count of __________ indicates that the client is severely immunocompromised and is at high risk for infection.

less than 180 cells/mm3

Kaposi sarcoma

malignancy that involves the epithelial layer of blood and lymphatic vessels

viral load test

measures the quantity of HIV RNA or DNA in the blood

An _________ assists clients who have physical challenges to use adaptive devices and strategies to help with self-care activities such as feeding.

occupational therapist

Mycobacterium avium complex (MAC)

opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems

progressive multifocal leukoencephalopathy

opportunistic infection that infects brain tissue and causes damage to the brain and spinal cord

Herpes zoster

painful vesicles; shingles

pre-exposure prophylaxis (PrEP)

prevention method for HIV-negative people who are at high risk of HIV infection; involves taking a specific combination of HIV medicines daily; use with condoms and other prevention tools

A ___________ provides teaching for a client about meeting nutritional needs, but does not assist with physical limitations of motor skills in the upper extremities.

registered dietitian

HIV-1

retrovirus isolated and recognized as the etiologic agent of HIV disease

Peripheral neuropathy

side effect of ART drugs, significant pain of feet & hands, functional Impairment

A ____________ coordinates community services to assist the client with meal procurement or equipment to help the client prepare meals.

social worker

A _____________ assists clients who have difficulty with feeding due to dysphagia, not because of physical limitations of motor skills in the upper extremities.

speech pathologist

post-exposure prophylaxis (PEP)

taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days

latent reservoir

the integrated HIV provirus within the CD4+ T cell during the resting memory state; does not express viral proteins and is invisible to the immune system and antiviral medications

Mycobacterium avium complex (MAC)

typically appears in patients with CD4+ cell counts <50, fever, night sweats, weight loss, fatigue, diarrhea, abdominal pain

A nurse is caring for a client who has a new diagnosis of lupus and asks where this disease originates within the body. The nurse should tell the client that lupus originates in which of the following locations of the body? ​Muscle tissue ​Connective tissue Lymphatic system Peripheral vascular system

​Connective tissue