HIV/AIDS
***************************** A patient with AIDS has severe thrombocytopenia. Which of the following drugs prescribed for this patient should the nurse question? A.Clopidogrel B.Batrovastatin C.losartan D.acetaminophen
A
The nurse on a medical floor is caring for clients diagnosed with AIDS. Which client should be seen first? 1. The client who has flushed, warm skin with tented turgor. 2. The client who states the staff ignores the call light. 3. The client whose vital signs are T 99.9 ̊F, P 101, R 26, and BP 110/68. 4. The client who is unable to provide a sputum specimen.
1 1. Flushed warm skin with tented turgor indicates dehydration. The HCP should be notified immediately for fluid orders or other orders to correct the reason for the dehydration. 2. This is a concern but it can be taken care of after the client with the physical problem. 3. The temperature is slightly elevated and the pulse is one (1) beat higher than normal. This client could wait to be seen. 4. Many clients who have had sputum specimens ordered are unable to produce sputum, but it does not warrant immediate intervention.
The nurse is describing the HIV virus infection to a client who has been told he is HIV positive. Which information regarding the virus is important to teach? 1. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in. 2. The HIV virus can be eradicated from the host body with the correct medical regimen. 3. It is difficult for the HIV virus to replicate in humans because it is a monkey virus. 4. The HIV virus uses the client's own red blood cells to reproduce the virus in the body.
1 1. Retroviruses never die; the virus may become dormant, only to be reactivated at a later time. 2. "Eradicated" means to be completely cured or done away with. HIV cannot be eradicated. 3. The HIV virus originated in the green monkey, in which it is not deadly. HIV in humans replicates readily using the CD4 cells as reservoirs. 4. The HIV virus uses the CD4 cells of the immune system as reservoirs to replicate itself.
The nurse is admitting a client diagnosed with protein-calorie malnutrition secondary to AIDS. Which intervention should be the nurse's first intervention? 1. Assess the client's body weight and ask what the client has been able to eat. 2. Place in contact isolation and don a mask and gown before entering the room. 3. Check the HCP's orders and determine what laboratory tests will be done. 4. Teach the client about total parenteral nutrition and monitor the subclavian IV site.
1 1. The client has a malnutrition syndrome. The nurse assesses the body and what the client has been able to eat. 2. Standard Precautions are used for clients diagnosed with AIDS, the same as for every other client. 3. The nurse should check the orders but not before assessing the client. 4. The client will probably be placed on total parenteral nutrition and will need to be taught these things, but this is not the first action.
The nurse caring for a client who is HIV positive is stuck with the stylet used to start an IV. Which intervention should the nurse implement first? 1. Flush the skin with water and try to get the area to bleed. 2. Notify the charge nurse and complete an incident report. 3. Report to the employee health nurse for prophylactic medication. 4. Follow up with the infection control nurse to have laboratory work done.
1 1. The nurse should attempt to flush the skin and get the area to bleed. It is hoped this will remove contaminated blood from the body prior to infecting the nurse. 2. The nurse should notify the charge nurse after flushing the area and trying to get it to bleed. 3. This should be done within four (4) hours of the exposure, not before trying to rid the body of the potential infection.
The client diagnosed with HIV has a positive skin test for tuberculosis (TB). Whichmedication order should the nurse anticipate? Select all that apply. 1. Isoniazid. 2. Ethambutol. 3. Pyrazinamide. 4. Enfuvirtide. 5. Rifampin.
1, 2, 3, 5 1. Isoniazid (INH) is the first line therapy of active TB in combination with other medications. 2. Ethambutol (Myambutol), an anti- infective, is a treatment for TB. 3. Pyrazinamide (Tebrazid) is the first-line therapy of active TB in combination with other medications. 4. Enfuvirtide (Fuzeon), an HIV fusion inhibitor, is the newest classifi cation of drugs used to treat HIV viral infections, but it is effective against viruses, not bacteria. 5. Rifampin is the fi rst-line therapy of active TB in combination with other medications.
The clinic nurse is discussing medication compliance with a client diagnosed with acquired immunodeficiency syndrome (AIDs). Which information should the nurse discuss with the client? Select all that apply. 1. The availability of insurance to pay for the medications. 2. Whether the client wants to try to manage the disease without medications. 3. Including OTC herbs in the medication regimen. 4. The importance of taking multiple vitamins at least twice a day. 5. The ability to change the medication regimen if side effects are not tolerable.
1, 5 1. If the client does not have insurance to help pay for the medications, the client may have trouble complying with the regimen. The current regimens include four or more daily medications costing more than $6,000 per drug per year. 2. Currently, AIDS cannot be managed without the use of medications. With the medications, it is possible to reduce the viral load to undetectable in serum samples. 3. Many OTC medications and herbs inter- act with the medications used to treat AIDS. The nurse should assess each OTC preparation taken by the client, but should not encourage their use. 4. One multiple vitamin is usually suffi cient. The body excretes any water-soluble vitamin that is not needed. 5. Many antiretroviral therapies have side effects that can be effectively treated; however, if the client cannot tolerate the side effects, the medication regimen can be altered.
Ketoconazole is prescribed for a patient with a diagnosis of candidiasis. Which interventions should the nurse include when administering this medication A. Monitor liver function studies B. Monitor blood glucose level C. Restrict fluid intake D. Instruct the patient to minimize alcohol intake
A
The client diagnosed with Pneumocystis pneumonia (PCP) is being admitted to the intensive care unit.Which HCP's order should the nurse implement first? 1. Draw a serum for CD4 and complete blood count STAT. 2. Administer oxygen to the client via nasal cannula. 3. Administer trimethoprim-sulfamethoxazole, a sulfa antibiotic, IVPB. 4. Obtain a sputum specimen for culture and sensitivity.
2 1. Serum blood work, although ordered STAT, does not have priority over oxygenation of the client. 2. Oxygen is a priority, especially with a client diagnosed with a respiratory illness. 3. It is extremely important to initiate IV antibiotic therapy to a client diagnosed with an infection as quickly as possible, but this does not have priority over oxygen. 4. Culture specimens should be obtained prior to initiating antibiotic therapy, but oxygen administration is still the first action.
The nurse received a needle stick with a contaminated needle from a client diagnosed with AIDS. Which medications should the nurse begin within hours of the needle stick? 1. A combination of antiviral and antifungal medications with an antibiotic. 2. A combination of a protease inhibitor and nucleoside reverse transcriptase inhibitors. 3. Single-agent therapy with a non-nucleoside transcriptase inhibitor. 4. No medications are recommended to prevent the conversion to HIV-positive.
2 1. These medications treat actual infections and are sometimes administered prophylactically, but they will not prevent conversion to HIV-positive status. 2. The combination of specific medications depends on the health-care facility's protocol, but most include a combination of two nucleoside reverse transcriptase inhibitors and a protease inhibitor. The Centers for Disease Control and Prevention (CDC) has a hotline that can be accessed for specific recommendations at 800-458-5231 or www.cdc.gov. 3. Single-agent therapy is not recommended because of the speed at which the virus can mutate. 4. There are medications that can possibly prevent conversion to HIV-positive status.
The client diagnosed with AIDS is complaining of a sore mouth and tongue. When the nurse assesses the buccal mucosa, the nurse notes white, patchy lesions covering the hard and soft palates and the right inner cheek. Which interventions should the nurse implement? 1. Teach the client to brush the teeth and patchy area with a soft-bristle toothbrush. 2. Notify the HCP for an order for an antifungal swish-and-swallow medication. 3. Have the client gargle with an antiseptic- based mouthwash several times a day. 4. Determine what types of food the client has been eating for the last 24 hours.
2 1. This client probably has oral candidiasis, a fungal infection of the mouth and esophagus. Brushing the teeth and patchy areas will not remove the lesions and will cause considerable pain. 2. This most likely is a fungal infection known as oral candidiasis, commonly called thrush. An antifungal medication is needed to treat this condition. 3. Antiseptic-based mouthwashes usually contain alcohol, which is painful, for the client. 4. The foods the client has eaten did not cause this condition.
The nurse is caring for clients diagnosed with AIDS. Which actions by the unlicensed assistive personnel (UAP) warrants immediate action by the nurse? Select all that apply. 1. The UAP uses nonsterile gloves to empty the client's urinal. 2. The UAP takes a glass of grapefruit juice to the client. 3. The UAP dons gloves to remove the client's meal tray. 4. The UAP provides a tube of moisture barrier cream to the client. 5. The UAP fi lls the client's water pitcher with ice and water.
2, 3 1. This is standard precaution and does not require intervention by the nurse. 2. Many of the protease inhibitors used to treat AIDS interact with grapefruit juice. The nurse should stop the UAP until the nurse can determine if the client is receiving a medication that would interact with the grapefruit juice. 3. The client's meal tray does not have body fl uids that can transmit the HIV virus to the UAP; therefore, this action warrants intervention from the nurse. The UAP needs to understand how the HIV virus is transmitted. 4. The client can apply his or her own moisture barrier protection cream. This does not warrant immediate intervention by the nurse. 5. This is a comfort measure and does not warrant intervention by the nurse.
The pregnant client's HIV test is positive. Which medication should the client take to prevent transmission of the virus to the fetus? 1. Efavirenz. 2. Lopinavir. 3. Zidovudine. 4. Ganciclovir.
3 1. Efavirenz (Sustiva), a non-nucleoside reverse transcriptase inhibitor, is not approved for prevention of transmission of HIV in pregnant women. 2. Lopinavir (Kaletra), a protease inhibitor, is not approved for prevention of transmission of HIV to the fetus. 3. Although zidovudine (AZT), a nucleoside reverse transcriptase inhibitor, is a pregnancy category C drug, research has proved that taking the drug during pregnancy reduces the risk of maternal-to-fetal transmission of the HIV virus by almost 70%. This is the only medication approved for this purpose. 4. Ganciclovir (Cytovene), an antiviral, is not approved for prevention of transmission of HIV to the fetus.
Which intervention is an important psychosocial consideration for the client diagnosed with AIDS? 1. Perform a thorough head-to-toe assessment. 2. Maintain the client's ideal body weight. 3. Complete an advance directive. 4. Increase the client's activity tolerance.
3 1. Performing the head-to-toe assessment is a nursing consideration, not a client consideration. This is a physiological intervention, not a psychosocial one. 2. Maintaining body weight is physical. 3. Clients diagnosed with AIDS should be encouraged to discuss their end-of-life issue with the significant others and to put those wishes in writing. This is important for all clients, not just those diagnosed with AIDS. 4. Activity tolerance is a physical problem.
The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding? 1. The client is fortunate not to have contracted HIV from an infected needle. 2. The client must be repeatedly exposed to HIV before becoming infected. 3. The client may be in the primary infection phase of an HIV infection. 4. The antibody test is negative because the client has a different flu virus.
3 1. The client may be in the primary infection stage when the body has not had time to develop antibodies to the HIV virus. 2. Repeated exposure to HIV increases the risk of infection, but it only takes one exposure to develop an infection. 3. The primary phase of infection ranges from being asymptomatic to severe flu-like symptoms, but during this time, the test may be negative although the individual is infected with HIV. 4. The client may or may not have a different virus, but this is not the reason the test is negative.
The client diagnosed with AIDS is angry and yells at everyone entering the room, and none of the staff members wants to care for the client. Which intervention is most appropriate for the nurse manager to use in resolving this situation? 1. Assign a different nurse every shift to the client. 2. Ask the HCP to tell the client not to yell at the staff. 3. Call a team meeting and discuss options with the staff. 4. Tell one (1) staff member to care for the client a week at a time.
3 1. This does not provide continuity of care for the client. It does recognize the nurse's position, but it is not the best care for the client. 2. The HCP should be asked to attend the care plan meeting to assist in deciding how to work with the client, but asking the HCP to "tell" the client to behave is not the best way to handle the situation. The client can always refuse to behave as requested. 3. The health-care team should meet to discuss ways to best help the client deal with the anger being expressed, and the staff should be consistent in working with the client. 4. Telling a staff member to care for the client for a week could result in a buildup of animosity and make the situation worse.
The client on a medical floor is diagnosed with HIV encephalopathy. Which client problem is priority? 1. Altered nutrition, less than body requirements. 2. Anticipatory grieving. 3. Knowledge deficit, procedures and prognosis. 4. Risk for injury.
4 1. Altered nutrition may be a priority for a client with malnutrition, but HIV encephalopathy is a cognitive deficit. 2. The client might grieve if the client still has enough cognitive ability to understand the loss is occurring, but this is not the most important consideration. 3. A client diagnosed with encephalopathy may not have the ability to understand instructions. The nurse should teach the significant others. 4. Safety is always an issue with a client with diminished mental capacity.
The home health-care nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa? 1. The client has a positive HIV viral load. 2. The client's white blood cell (WBC) count is 5,000/mm3. 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3
4 1. The client who is HIV positive could be expected to have a positive viral load. This is a reason to institute HAART, but not trimethoprim sulfa (Bactrim). 2. This is a normal WBC count and is not a reason to start a prophylactic antibiotic. 3. This client is showing symptoms of Pneumocystis jiroveci pneumonia (PJP); any treatment now would not be prophylactic. 4. The client with a CD4 count of less than 300/mm3 is at risk for developing PJP. Trimethoprim sulfa (Bactrim) is prophylaxis for PJP. Normal levels for CD4 are 450 to 1,400/mm3.
*************************** A client is stared on Pre exposure prophylaxis (PrEP). The nurse know the client has an understanding of this medication when the client makes which of the following statements. Select all that apply. A."It is best if I take this medication every day". B."I need to monitor my uric acid levels to maintain effective therapy with this medication". C."I expect to renew my prescription in 90 days". D."This medication remains experimental, I need a special prescription to be eligible to take it". E."I will take this medication after I believe I have been exposed to the virus".
A, C
A patient who is newly diagnosed with HIV infection after a recent exposure calls to report fever, sore throat, myalgia, and night sweats. The nurse will notify the provider that this patient is most likely experiencing a. acute retroviral syndrome. b. AIDS. c. an increased viral load. d. an opportunistic infection.
ANS: A Acute retroviral syndrome often occurs 2 to 12 weeks after exposure and is caused by rapid viral replication that triggers an immune response, resulting in CD4 cell replacement and HIV antibody production that causes the viral load to drop. This patient is experiencing symptoms of this syndrome. AIDS is a diagnosis that indicates advanced disease. Opportunistic infection symptoms are related to the type of infection.
A patient will begin taking the protease inhibitor combination Kaletra (lopinavir/ritonavir). What information will the nurse include when teaching the patient about dietary changes? a. Consume a low-cholesterol diet. b. Consume more acidic foods. c. Take the pill on an empty stomach. d. Take the pill with fatty foods.
ANS: A Protease inhibitors generally cause elevations of cholesterol and triglycerides, so patients should be counseled to consume a low-fat diet.
A patient who is HIV-infected takes 800 mg of indinavir (Crixivan), a protease inhibitor medication. The provider has ordered adding ritonavir (Norvir) to the regimen. The nurse will teach the patient that the addition of ritonavir a. allows decreasing the dosing from 3 times daily to twice daily. b. can lead to increased cholesterol and triglycerides. c. may worsen insulin resistance. d. will require increased dietary restrictions.
ANS: A Ritonavir boosting is a mainstay of protease inhibitor therapy and can reduce dosing frequency and pill burden as well as overcome viral resistance. It does not increase the likelihood of elevated cholesterol and triglycerides or insulin resistance and does not lead to increased dietary restrictions.
An HIV-negative client who has an HIV-positive partner asks the nurse about receiving Truvada (emtricitabine and tenofovir). What information is most important to teach the client about this drug? a. Truvada does not reduce the need for safe sex practices. b. This drug has been taken off the market due to increases in cancer. c. Truvada reduces the number of HIV tests you will need. d. This drug is only used for postexposure prophylaxis.
ANS: A Truvada is a new drug used for pre-exposure prophylaxis and appears to reduce transmission of human immune deficiency virus (HIV) from known HIV-positive people to HIV-negative people. The drug does not reduce the need for practicing safe sex. Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3 months. This drug has not been taken off the market and is not used for postexposure prophylaxis.
A student nurse is learning about human immune deficiency virus (HIV) infection. Which statements about HIV infection are correct? (Select all that apply.) a. CD4+ cells begin to create new HIV virus particles. b. Antibodies produced are incomplete and do not function well. c. Macrophages stop functioning properly. d. Opportunistic infections and cancer are leading causes of death. e. People with stage 1 HIV disease are not infectious to others.
ANS: A, B, C, D In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produces are incomplete and do not function well. Macrophages also stop functioning properly. Opportunistic infections and cancer are the two leading causes of death in clients with HIV infection. People infected with HIV are infectious in all stages of the disease.
Which findings are AIDS-defining characteristics? (Select all that apply.) a. CD4+ cell count less than 200/mm3 or less than 14% b. Infection with Pneumocystis jiroveci c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) d. Presence of HIV wasting syndrome e. Taking antiretroviral medications
ANS: A, B, D A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as Pneumocystis jiroveci and HIV wasting syndrome. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.
A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load. What action should the nurse take first? a. Ask the client about travel to any foreign countries. b. Assess the client for adherence to the drug regimen. c. Determine if the client has any new sexual partners. d. Request information about new living quarters or pets.
ANS: B Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time. Since this clients viral load has increased dramatically, the nurse should first assess this factor. After this, the other assessments may or may not be needed.
A patient who is HIV-positive begins therapy with the fixed-dose combination nucleoside reverse transcriptase inhibitor (NRTI) Combivir (lamivudine/zidovudine) twice daily. The patient is in the clinic for follow-up 1 week after initiation of therapy and reports having nausea. The patients creatinine clearance is 40 mL/minute. Based on these findings, the nurse will perform which action? a. Instruct the patient to take the medication 60 minutes prior to meals. b. Notify the provider to discuss single-dose NRTI products. c. Request an order for once-daily dosing of this medication. d. Suggest that the patient increase fluid intake.
ANS: B Patients should have dosage adjustments of NRTIs if creatinine clearance is less than 50 mL/min. The patient will need single-dose medications so that adjustments can be made. Taking the medication prior to meals improves absorption of didanosine but does not alter the side effect of nausea for Combivir, which should subside in the next week or so. This combination product is not given once daily. Increasing fluid intake will not affect this patients symptoms.
A pregnant patient is HIV-positive. Which antiretroviral agent will the nurse expect the patients provider to order? a. Abacavir/lamivudine/zidovudine (Trizivir) b. Efavirenz/emtricitabine/tenofovir (Atripla) c. Lamivudine/zidovudine (Combivir) d. Rilpivirine/emtricitabine/tenofovir (Complera)
ANS: C Antiretroviral therapy is strongly recommended for all pregnant HIV-infected patients. The preferred dual nucleoside reverse transcriptase inhibitor is Combivir.
6. A patient who has HIV infection will begin treatment with efavirenz. The nurse expects this agent to be given in the combination product Atripla in order to a. avoid development of psychiatric comorbidities. b. prevent dizziness, sedation, and nightmares. c. reduce viral resistance. d. prevent severe rash and hepatotoxicity.
ANS: C Efavirenz is optimally given as a component of Atripla. The primary reason for using combination products is to reduce viral resistance. Efavirenz should not be given to patients who have psychiatric histories. Efavirenz may cause dizziness, sedation, nightmares, rash, and hepatotoxicity, but this is not minimized with combination therapy.
The nurse is caring for a patient who is HIV-positive and has been receiving antiretroviral therapy for several months. The nurse experiences a needlestick injury resulting in exposure to the patients blood. The nurse asks the Occupational Health nurse if treatment is necessary. How will the Occupational Health nurse respond? a. No treatment is necessary since the patient is receiving antiretroviral therapy. b. We will treat you if the patients VL is > 20 copies/mL. c. You will require 4 weeks of antiretroviral therapy. d. You will undergo HIV testing and will be treated if you are positive.
ANS: C Persons exposed to the blood of HIV-infected patients should receive 4 weeks of antiretroviral therapy.
A client with acquired immune deficiency syndrome is hospitalized and has weeping Kaposis sarcoma lesions. The nurse dresses them with sterile gauze. When changing these dressings, which action is most important? a. Adhering to Standard Precautions b. Assessing tolerance to dressing changes c. Performing hand hygiene before and after care d. Disposing of soiled dressings properly
ANS: D All of the actions are important, but due to the infectious nature of this illness, ensuring proper disposal of soiled dressings is vital.
A patient who has recently begun antiretroviral therapy with a combination drug develops immune reconstitution inflammatory syndrome (IRIS) with mild symptoms. What does the nurse expect that the provider will order? a. Administration of a high dose of corticosteroids b. Changing the regimen to a single antiretroviral drug c. Temporarily discontinuing the antiretroviral therapy d. Treating an underlying opportunistic infection
ANS: D IRIS is related to specific opportunistic infections that must be treated. Anti-inflammatory medications, such as corticosteroids, may be used if indicated after the underlying infection is treated. Changing or discontinuing the antiretroviral therapy regimen is not indicated.
1. The nurse is caring for a 55-year-old patient who has been HIV-infected for 15 years. The nurse understands that this patient a. has an increased risk of transmitting the HIV infection. b. is less likely to develop AIDS than younger persons with HIV infection. c. is less likely to respond to antiretroviral agents. d. may have comorbid illnesses that can complicate HIV.
ANS: D Older HIV-infected patients may have age-related comorbid illness that can complicate management of HIV infection.
An HIV-positive client is admitted to the hospital with Toxoplasma gondii infection. Which action by the nurse is most appropriate? a. Initiate Contact Precautions. b. Place the client on Airborne Precautions. c. Place the client on Droplet Precautions. d. Use Standard Precautions consistently.
ANS: D Toxoplasma gondii infection is an opportunistic infection that poses no threat to immunocompetent health care workers. Use of Standard Precautions is sufficient to care for this client.
A hospital patient is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Arrange for a portable x-ray machine to be used. B) Have the patient wear a mask to the x-ray department. C) Ensure that the radiology department has been disinfected prior to the test. D) Send the patient to the x-ray department, and have the staff in the department wear masks.
Ans: A Feedback: A patient who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the patient's room. This confers more protection than disinfecting the radiology department or using masks.
A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? A) Administer antidiarrheal medications on a scheduled basis, as ordered. B) Encourage the patient to eat three balanced meals and a snack at bedtime. C) Increase the patient's oral fluid intake. D) Encourage the patient to increase his or her activity level.
Ans: A Feedback: Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the patient's diarrhea is not caused by an infectious microorganism. Increased oral fluid may exacerbate diarrhea; IV fluid replacement is often indicated. Small, more frequent meals may be beneficial, and it is unrealistic to increase activity while the patient has frequent diarrhea.
Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? A) Cook all food thoroughly. B) Refrain from using creams or emollients on skin. C) Maintain contact only with individuals who have recently been vaccinated. D) Take OTC vitamin supplements consistently.
Ans: A Feedback: All foods must be cooked to avoid food-borne illness. The patient should avoid contact with individuals who have recently been ill or vaccinated. The nurse should apply creams and emollients to any dry, chaffed, or cracked skin. Vitamin supplements may or may not be indicated.
A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? A) Utilize a pressure-reducing mattress. B) Limit the patient's physical activity. C) Apply antibiotic ointment to dependent skin surfaces. D) Avoid contact with synthetic fabrics.
Ans: A Feedback: Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown. Activity should be promoted, not limited, and contact with synthetic fabrics does not necessary threaten skin integrity. Antibiotic ointments are not normally used unless there is a break in the skin surface.
Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV? A) Gay, bisexual, and other men who have sex with men B) Recreational drug users C) Blood transfusion recipients D) Health care providers
Ans: A Feedback: Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 61% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.
A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? A) HIV encephalopathy B) B-cell lymphoma C) Kaposi's sarcoma D) Wasting syndrome
Ans: A Feedback: HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. The other listed complications do not normally have cognitive and behavioral manifestations.
A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patient's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? A) Integration B) Attachment C) Cleavage D) Budding
Ans: B Feedback: During the process of attachment, glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors, which results in fusion of HIV with the CD4+ T-cell membrane. Integration, cleavage, and budding are steps that are subsequent to this initial phase of the HIV life cycle.
An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/μL, and the nurse recognizes the patient's increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug? A) Azithromycin B) Vancomycin C) Levofloxacin D) Fluconazole
Ans: A Feedback: HIV-infected adults and adolescents should receive chemoprophylaxis against disseminated Mycobacterium avium complex (MAC disease) if they have a CD4+ count less than 50 cells/μL. Azithromycin (Zithromax) or clarithromycin (Biaxin) are the preferred prophylactic agents. Vancomycin, levofloxacin, and fluconazole are not prophylactic agents for MAC.
A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions? A) Many older adults do not see themselves as being at risk for HIV infection. B) Many older adults are not aware of the difference between HIV and AIDS. C) Older adults tend to have more sex partners than younger adults. D) Older adults have the highest incidence of intravenous drug use.
Ans: A Feedback: It is known that many older adults do not see themselves as being at risk for HIV infection. Knowledge of the relationship between HIV infection and AIDS is not known to affect the incidence of new cases. The statements about sex partners and IV drug use are untrue.
A patient who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? A) Teach the patient guided imagery. B) Give the patient more control of her antiretroviral regimen. C) Increase the patient's activity level. D) Collaborate with the patient's physician to obtain an order for hydromorphone.
Ans: A Feedback: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other patients this may exacerbate feelings of anxiety or loss. Granting the patient control has the potential to reduce anxiety, but the patient is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.
A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? A) Perianal region and oral mucosa B) Sacral region and lower abdomen C) Scalp and skin over the scapulae D) Axillae and upper thorax
Ans: A Feedback: The nurse should inspect all the patient's skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection.
The nurse's plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk? A) Providing thorough oral care before and after meals B) Administering prophylactic antibiotics C) Promoting nutrition and adequate fluid intake D) Applying skin emollients as needed
Ans: A Feedback: Thorough mouth care has the potential to prevent or limit the severity of this infection. Antibiotics are irrelevant because of the fungal etiology. The patient requires adequate food and fluids, but these do not necessarily prevent candidiasis. Skin emollients are not appropriate because candidiasis is usually oral.
A nurse is performing the admission assessment of a patient who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A) Current medication regimen B) Identification of patient's support system C) Immune system function D) Genetic risk factors for HIV E) History of sexual practices
Ans: A, B, C, E Feedback: Nursing assessment includes numerous focuses, including identification of medication use, support system, immune function and sexual history. HIV does not have a genetic component.
A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A) Serum albumin level B) Weight history C) White blood cell count D) Body mass index E) Blood urea nitrogen (BUN) level
Ans: A, B, D, E Feedback: Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the patient's ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status. White cell count is not a typical component of a nutritional assessment.
A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? A) Promoting appropriate use of complementary therapies B) Addressing possible barriers to adherence C) Educating the patient about the pathophysiology of HIV D) Teaching the patient about the need for follow-up blood work
Ans: B Feedback: ART is highly dependent on adherence to treatment, and the nurse should proactively address this. Blood work is necessary, but this will not have a direct bearing on the success or failure of treatment. Complementary therapies are appropriate, but are not the main factor in successful treatment. The patient may or may not benefit from teaching about HIV pathophysiology.
A hospital nurse has experienced percutaneous exposure to an HIV-positive patient's blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next? A) Flush the wound site with chlorhexidine. B) Report to the emergency department or employee health department. C) Apply a hydrocolloid dressing to the wound site. D) Follow up with the nurse's primary care provider.
Ans: B Feedback: After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility. Flushing is recommended, but chlorhexidine is not used for this purpose. Applying a dressing is not recommended. Following up with the nurse's own primary care provider would require an unacceptable delay.
A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patient's gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis? A) Acute Abdominal Pain B) Diarrhea C) Bowel Incontinence D) Constipation
Ans: B Feedback: Diarrhea is a problem in 50% to 60% of all AIDS patients. As such, this nursing diagnosis is more likely than abdominal pain, incontinence, or constipation, though none of these diagnoses is guaranteed not to apply.
A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? A) Oral temperature of 100°F B) Tachypnea and restlessness C) Frequent loose stools D) Weight loss of 1 pound since yesterday
Ans: B Feedback: In prioritizing care, the pneumonia would be assessed first by the nurse. Tachypnea and restlessness are symptoms of altered respiratory status and need immediate priority. Weight loss of 1 pound is probably fluid related; frequent loose stools would not take short-term precedence over a temperature or tachypnea and restlessness. An oral temperature of 100°F is not considered a fever and would not be the first issue addressed.
A patient with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? A) Appropriate use of prophylactic antibiotics B) Importance of personal hygiene C) Signs and symptoms of wasting syndrome D) Strategies for adjusting antiretroviral dosages
Ans: B Feedback: Infection control is of high importance in patients living with HIV, thus personal hygiene is paramount. This is a more important topic than signs and symptoms of one specific complication (wasting syndrome). Drug dosages should never be independently adjusted. Prophylactic antibiotics are not normally prescribed unless the patient's CD4 count is below 50.
A patient who has AIDS has been admitted for the treatment of Kaposi's sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? A) Risk for Disuse Syndrome Related to Kaposi's Sarcoma B) Impaired Skin Integrity Related to Kaposi's Sarcoma C) Diarrhea Related to Kaposi's Sarcoma D) Impaired Swallowing Related to Kaposi's Sarcoma
Ans: B Feedback: Kaposi's sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.
A patient is in the primary infection stage of HIV. What is true of this patient's current health status? A) The patient's HIV antibodies are successfully, but temporarily, killing the virus. B) The patient is infected with HIV but lacks HIV-specific antibodies. C) The patient's risk for opportunistic infections is at its peak. D) The patient may or may not develop long-standing HIV infection.
Ans: B Feedback: The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection. The virus is not being eradicated and infection is certain. Opportunistic infections emerge much later in the course of the disease.
A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patient's diarrhea? A) Zithromax B) Sandostatin C) Levaquin D) Biaxin
Ans: B Feedback: Therapy with octreotide acetate (Sandostatin), a synthetic analogue of somatostatin, has been shown to be effective in managing chronic severe diarrhea. Zithromax, Levaquin, and Biaxin are not used to treat chronic severe diarrhea.
A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions? A) Lifestyle actions that improve immune function B) Educational programs that focus on control and prevention C) Appropriate use of standard precautions D) Screening programs for youth and young adults
Ans: B Feedback: Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not prevent HIV infection. Ineffective use of standard precautions apply to very few cases of HIV infection.
A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurse's best response? A) "Do you think that you might already have HIV?" B) "Don't worry. Your immune system is likely very healthy." C) "AIDS isn't transmitted by casual contact." D) "You can't contract AIDS in a hospital setting."
Ans: C Feedback: AIDS is commonly transmitted by contact with blood and body fluids. Patients, family, and friends must be reassured that HIV is not spread through casual contact. A healthy immune system is not necessarily a protection against HIV. A hospital setting does not necessarily preclude HIV infection.
A nurse is admitting an adolescent patient with a diagnosis of ataxia-telangiectasis. Which of the following nursing diagnoses should the nurse include in the patient's plan of care? A) Fatigue Related to Pernicious Anemia B) Risk for Constipation Related to Decreased Gastric Motility C) Risk for Falls Due to Loss of Muscle Coordination D) Disturbed Kinesthetic Sensory Perception Related to Vascular Changes
Ans: C Feedback: Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination), telangiectasia (vascular lesions caused by dilated blood vessels), and immune deficiency. Decreased coordination is likely to constitute a risk for falls. The patient does not characteristically lose tactile sensation or experience pernicious anemia or constipation.
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors? A) The nurse wears face protection, gloves, and a gown when irrigating a wound. B) The nurse washes the hands with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. D) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.
Ans: C Feedback: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same patient. Each of the other listed actions adheres to standard precautions.
A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in AIDS patients by increasing body fat stores? A) Advera B) Momordicacharantia C) Megestrol D) Ranitidine
Ans: C Feedback: Megestrol acetate (Megace), a synthetic oral progesterone preparation, promotes significant weight gain. In patients with HIV infection, it increases body weight primarily by increasing body fat stores. Advera is a nutritional supplement that has been developed specifically for people with HIV infection and AIDS. Momordicacharantia (bitter melon) is given as an enema and is part of alternative treatment for HIV/AIDS. Ranitidine prevents ulcers.
The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? A) Maximize the patient's fluid intake. B) Provide total parenteral nutrition (TPN). C) Keep the patient's bed linens free of wrinkles. D) Provide the patient with snug clothing at all times.
Ans: C Feedback: Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding tight or restrictive clothing. Fluid intake should be adequate, and must be monitored, but maximizing fluid intake is not a goal. TPN is a nutritional intervention of last resort.
A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? A) Another EIA test B) Viral load test C) Western blot test D) CD4/CD8 ratio
Ans: C Feedback: The Western blot test detects antibodies to HIV and is used to confirm the EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but is not used to confirm results of EIA testing.
The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient? A) "Would you like me to have the chaplain come speak with you?" B) "You'll learn much about the promise of a cure for HIV." C) "Can you tell me what concerns you most about dying?" D) "You need to maintain hope because you may live for several years."
Ans: C Feedback: The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the patient to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the patient's expressed fears.
A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? A) "Complementary therapies generally have not been approved, so patients are usually discouraged from using them." B) "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." C) "Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks." D) "You'll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach."
Ans: C Feedback: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.
A patient's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the patient's immune response. This physiologic state is known as which of the following? A) Static stage B) Latent stage C) Viral set point D) Window period
Ans: C Feedback: The remaining amount of virus in the body after primary infection is referred to as the viral set point, which results in a steady state of infection that lasts for years. This is not known as the static or latent stage. The window period is the time a person infected with HIV tests negative even though he or she is infected.
The nurse is caring for a patient who has been admitted for the treatment of AIDS. In the morning, the patient tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action? A) Assess the patient for additional signs and symptoms of Kaposi's sarcoma. B) Review the patient's most recent viral load and CD4+ count. C) Place the patient on respiratory isolation and inform the physician. D) Perform oral suctioning to reduce the patient's risk for aspiration.
Ans: C Feedback: These signs and symptoms are suggestive of tuberculosis, not Kaposi's sarcoma; prompt assessment and treatment is necessary. There is no indication of a need for oral suctioning and the patient's blood work will not reflect the onset of this opportunistic infection.
A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient? A) Position the patient in the high Fowler's position whenever possible. B) Temporarily eliminate animal protein from the patient's diet. C) Make sure the patient eats at least two servings of raw fruit each day. D) Obtain a stool culture to identify possible pathogens.
Ans: D Feedback: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Patients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the patient's bed.
A patient's current antiretroviral regimen includes nucleoside reverse transcriptase inhibitors (NRTIs). What dietary counseling will the nurse provide based on the patient's medication regimen? A) Avoid high-fat meals while taking this medication. B) Limit fluid intake to 2 liters a day. C) Limit sodium intake to 2 grams per day. D) Take this medication without regard to meals.
Ans: D Feedback: Many NRTIs exist, but all of them may be safely taken without regard to meals. Protein, fluid, and sodium restrictions play no role in relation to these drugs.
An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? A) "There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV." B) "Your physician is likely the best one to ask that question." C) "If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now." D) "It's possible that your baby could contract HIV, either before, during, or after delivery."
Ans: D Feedback: Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding. There is no evidence that the infant's risk is 25%. Deferral to the physician is not a substitute for responding appropriately to the patient's concern. Downplaying the patient's concerns is inappropriate.
A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurse's best response? A) "There's no way to be sure you won't get HIV except to use condoms correctly." B) "Only the correct use of a female condom protects against the transmission of HIV." C) "There are new ways of protecting yourself from HIV that are being discovered every day." D) "Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV."
Ans: D Feedback: Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.
A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? A) The patient is immune to HIV. B) The patient's immune system is intact. C) The patient has AIDS-related complications. D) The patient has been infected with HIV.
Ans: D Feedback: Positive test results indicate that antibodies to the AIDS virus are present in the blood. The presence of antibodies does not imply an intact immune system or specific immunity to HIV. This finding does not indicate the presence of AIDS-related complications.
The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? A) Attach the condom prior to erection. B) A condom may be reused with the same partner if ejaculation has not occurred. C) Use skin lotion as a lubricant if alternatives are unavailable. D) Hold the condom by the cuff upon withdrawal.
Ans: D Feedback: The condom should be unrolled over the hard penis before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, or cold cream should not be used with condoms because they cause latex deterioration/condom breakage. The condom should be held during withdrawal so it does not come off the penis. Condoms should never be reused.
During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? A) Salmonella infection B) Mycobacterium tuberculosis C) Clostridium difficile D) Pneumocystis pneumonia
Ans: D Feedback: There are a number of opportunistic infections that can infect individuals with AIDS. The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly carinii). Other opportunistic infections may involve Salmonella, Mycobacterium tuberculosis, and Clostridium difficile.
************************* A HIV positive patient is being tested every 6 month for CD4 count and viral load. The nurse should explain to the patient that the primary purpose for these tests are for which of the following? A. Evaluate the effectiveness of the treatment of an opportunistic infection B. Evaluate the course of the HIV disease C. Identify the risk for transmitting HIV D Identify viral mutation
B
************************** The nurse is assisting in planning care for a patient with a diagnosis of Acquired Immune Deficiency Syndrome and should incorporate which action as a priority in the patient's plan of care? A. Providing emotional support to decrease fear B. Protecting the patient from infection C. Encouraging discussion about lifestyle changes D. Identifying factors that decrease the immune function
B
*************************** A patient with HIV has developed Pneumocystic jirovecii pneumonia. What does the nurse infer from this new diagnosis ? A.The viral load is likely low B.The patient most likely developed AIDS C.This is a common cancer affecting the skin of AIDS patients D.The CD4 count is likely >500
B
*************************** A patient with chronic anemia due to AIDS is prescribed erythropoietin therapy. Which other intervention does the nurse expect will be prescribed to make this therapy effective? A. discontinuation of any antibiotics B. iron and multivitamin supplement C. weekly measurement of serum erythopoietin levels D. Vitamin B12, IM daily
B
*************************** The nurse counsels a patient who has tested negative for human immunodeficiency virus( HIV) after a recent exposure to contaminated blood . Which instruction does the nurse provide? A."This indicates that you have immunity to HIV" B." You will need to repeat the test in three months" C."This indicates that you are not contagious." D." The test shows that you are not infected with HIV"
B
**************************** The nurse prepares to give a bath and change the bed linens of a patient with Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which would the nurse incorporate into the plan during the bathing of this patient? A. wearing gloves and a mask B. Wearing a gown and gloves C. gloves D. wear a gown and gloves to change the bed linens and gloves only for the bath
B
************************* After having a positive rapid antibody test for HIV, a patient comes to the clinic to confirm test. The patient is anxious and does not appear to hear what the nurse is saying. At this time, how should the nurse respond? A.Ask the patient to identify all forms of high risk behaviors. B.Inform the patient how to protect sexual and needle sharing partners. C.Remind the patient about the need to return for retesting to verify the results. D.Teach the patient about the medications available for treatment.
C
*************************** A patient with AIDS is admitted due to diarrhea for four days. The nurse should be most concerned with which of these findings? A.CD4 count of 450 cells/mm3 B.a viral load of 1,000 copies/ml C.a diastolic pressure 30 mmHg lower when standing than when lying down D.patient's complaint of generalized weakness
C
**************************** The nurse is instructing the parents of a young adult with acquired immunodeficiency syndrome (AIDS) how to look for signs and symptoms of infection when the child has a cut or open wound. What should the nurse tell the parents to report? A. Erythema around the area B. Tenderness around the area C. Rectal temperature higher than 100.5 F (38C) D. Increased warmth of the skin in the involved area
C
***************************** The patient with HIV gets recurrent Candida infections of the mouth. The nurse has given the patient instructions to minimize discomfort of thrush and determines that the patient understands the instructions if which statement is made by the patient? A. "Increasing the amount of red meat in my diet will keep this from reoccurring." B. " I should use a strong mouthwash at least once per week." C. "Fluconazole should help relieve this condition." D. " I should brush my teeth and rinse my mouth at least once per day."
C
***************************** The school nurse is interviewing a teenager with skin rash and enlarged lymph nodes and muscle aches. Which of the following questions would be most important for the nurse to ask? A."Do you have a boyfriend?" B."Do you suffer from any allergies?" C."Have you been sexually active within the past two weeks?" D."Have you been exposed to the flu?"
C
************************* A nursing is developing a care plan for a patient with AIDS and severe immunodeficiency . The nurse should include which of the following ? A. report any episode of loose stool immediately B. increase intake of vitamins and minerals by consuming lightly cooked vegetables C. refrain from using creams on the skin D. avoid people who have been vaccinated recently with a live virus vaccine
D
************************** The most common opportunist infection for those infected with AIDS is: A. Gastroenteritis B. Meningitis C. Karposi's Sarcoma D. Pneuomocystis jiroveci pneumonia
D
*************************** A patient with AIDS comes in the Emergency Department (ED) complaining of night sweats, weight loss, hemoptysis and weakness. The lab results are Hgb 7.0 g/dl, Hct 28%, platelets 200,000/mm3, CD4 300 cells/mm3. The vital signs are B/P 106/52, P 90, RR 29, and T 101.1° F, and the client appears slightly dehydrated. Which order should the nurse implement first? A. type and cross match for 2 units of packed red blood cells B. Acetaminophen 2 tab PO PRN for fever C. IV N/S 125 ml/h D.Airborne isolation
D
*************************** The nurse is reviewing the treatment for a patient recently diagnosed with AIDS. Which of the following recommendations is correct according to the current treatment protocol for patients with AIDS? A. Viral load is used to determine the dosage of each antiretroviral drug needed for the patient B. The patient should be tested for antibiotic resistance prior to initiation of therapy C. Anti-retroviral therapy should be offered only for patients with CD4 count of less than 500 cells/mm3 D. Therapy should be started immediately and it must be maintained and be very aggressive
D
****************************** The school nurse is teaching a group of high school students about HIV/AIDS virus transmission. Which statement would be appropriate? A."If a person is exposed it takes about 3 weeks for the person to become positive and be able to infect another person." B."The use of condoms can provide you total protection against transmission of the virus." C."The use of pre-exposure prophylaxis drugs just before sexual contact will prevent infection." D."If allergic to latex, use polyurethane condoms."
D
Why should the nurse encourage serologic testing for human immunodeficiency virus (HIV) in the patient with syphilis? a. Syphilis is more difficult to treat in patients with HIV infection. b. The presence of HIV infection increases the risk of contracting syphilis. c. Central nervous system (CNS) involvement is more common in patients with HIV infection and syphilis. d. The incidence of syphilis is increased in those with high rates of indiscriminate sexual activity and drug abuse.
d. The risk factors of drug abuse and sexual activity with multiple partners or homosexuality are found in patients with both syphilis and human immunodeficiency virus (HIV) infection and persons at highest risk for acquiring syphilis are also at high risk for acquiring HIV. Syphilitic lesions on the genitals enhance HIV transmission. Also, HIV-infected patients with syphilis appear to be at greatest risk for central nervous system (CNS) involvement and may require more intensive treatment with penicillin to prevent this complication of HIV.
