Immunity

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis jirovecii pneumonia (PJP, PCP). Which nursing problem has the highest priority for this client? 1. Impaired oxygenation 2. Ineffective use of coping mechanisms 3. Poor nutrition 4. Activity tolerance

1 Rationale: Although all of these are nursing problems that are appropriate for the client with AIDS, according to Maslow's hierarchy of needs, impaired oxygenation is the priority nursing problem for the client with Pneumocystis jirovecii pneumonia

The nurse is caring for a client who is categorized as HIV-positive, acute infection. What would the nurse anticipate finding on the nursing assessment? 1. Fatigue, weight loss, night sweats 2. Confusion, disorientation, loss of coordination 3. Dyspnea, tachycardia on exertion, fever 4. Red, raised lesions on neck and face, fever

1 Rationale: An acute infection occurs when the primary condition is identified or the client has recently been infected. He may be asymptomatic at this time, or he may have symptoms of early nonspecific changes characterized by fatigue, weight loss, persistent fever, diarrhea, night sweats, and generalized lymphadenopathy. The symptoms noted in the remaining options are seen with chronic disease.

A client is diagnosed with an immunodeficiency disease. The nurse would understand what is characteristic of this condition? 1. Occurs when a client's body is unable to defend itself from an invading microorganism 2. Creates a severe, sudden problem that is characterized by increased vascular permeability 3. Is precipitated by the destruction of the normal lymphocytes in the attempt to reduce the serum level of the antigen 4. Is a condition in which the normal immune response is interrupted and the body cells do not recognize healthy tissue

1 Rationale: Immunodeficiency is the condition when the immune system is depressed, weak, or compromised and is unable to defend the body from invading microorganisms. Immunodeficiency may be primary if it is caused by an absence of immune cells or by poorly developed immune cells. It is secondary if it is caused by illnesses or treatment. A severe, sudden problem characterized by increased vascular permeability describes an anaphylactic reaction. The destruction of normal lymphocytes in the attempt to reduce the serum level of the antigen reflects phagocytosis as the white cells destroy the foreign protein. When the normal immune response is interrupted and body cells do not recognize healthy tissue, this is characteristic of an autoimmune condition.

A new mother tells the clinic nurse that her 6-week-old infant was born positive for human immunodeficiency virus (HIV). She asks the nurse how long her baby has to live. The nurse's response would be based on the knowledge that: 1. The antibodies present in the baby's blood may reflect the antibodies received from the mother at the time of birth, and further testing is required to validate the presence of HIV. 2. If antibodies were present at birth, the baby has acquired immunodeficiency syndrome (AIDS) and will probably become symptomatic within 6 months. 3. Because the baby is HIV positive and the virus is present this early, the prognosis is very poor; the majority of the children die within the first 3 years. 4. The antibodies detected at birth indicate the presence of HIV; the test does not indicate when the child will become HIV positive.

1 Rationale: It is important to give the mother as much hope as possible but still be realistic about the condition. There is no way to tell when or if the child will become HIV positive or develop active AIDS. Many infants seroconvert to HIV negative status. The HIV antibodies present at birth may have been received from the mother. If the virus is present and the infant begins to manufacture his or her own antibodies, then the infant is considered to be HIV positive and will probably develop AIDS. A series of tests should be done on the infant, one at the time of birth, repeated around 1 to 2 months, and another at 3 to 6 months to verify the presence of HIV. Most infants will begin antibody production by age 6 months if they are positive for HIV.

A client who is positive for the human immunodeficiency virus (HIV) has white raised lesions or plaques in his mouth on the inner cheek and tongue. Nystatin (Mycostatin) has been ordered. What will be important to teach the client about this medication? 1. Perform oral hygiene, then place medication in your mouth, and "swish and swallow." 2. Apply a small amount of the medication to each lesion; do not drink any oral fluids for 30 minutes. 3. Mix the medication with a small amount of water, and hold the solution in your mouth for about 5 minutes. 4. Place the medication under the tongue and allow it to absorb.

1 Rationale: The mycostatin must come in contact with all the lesions. It is easier to have the client swish it around the mouth than to try to place the medication on each lesion. The medication should not be mixed with water and should not be placed under the tongue. Candidiasis of the esophagus, mouth, and vagina is a common problem for the HIV client.

A client with AIDS has several cutaneous lesions identified as Kaposi's sarcoma. How will the nurse care for these areas? 1. Gently cleanse the areas, keeping them dry and free of abrasions. 2. Place sterile, saline-soaked gauze over the areas. 3. Apply a topical corticosteroid cream. 4. Decrease infection by applying an antibiotic ointment.

1 Rationale: There is no specific nursing care required for Kaposi's sarcoma lesions. Gently cleansing the area and protecting it from abrasive trauma, which could open the lesions, would be appropriate. Dressings, steroid cream, and antibiotic ointment are not indicated. Standard precautions should be followed when caring for the lesions.

It has been 3 years since seroconversion for a client who is positive for the human immunodeficiency virus (HIV). The client currently has CD4+ T cell count of 700. What would the nurse explain to the client regarding this information? 1. Currently the body is producing an adequate number of CD4+ T helper cells to protect against the virus. 2. The virus has stopped all replication and is in a dormant phase for an undetermined time. 3. The CD4+ T cell count means the virus is replicating and increased risk of opportunistic infections. 4. Antiretroviral medications are effectively protecting the client against an increase in the viral load.

1 Rationale: When the client is in the early stages, the body is able to produce enough CD4+ cells to maintain a normal level. The risk for opportunistic infection is low because of the normal CD4+ count. With this level of CD4+ cells the client is not experiencing an increased viral load.

After a repeat of the antibody test for the human immunodeficiency virus (HIV), a client continues to have a positive test result but is asymptomatic. The nurse understands which of the following about possible transmission of the virus by the client? 1. The client is infectious when symptoms are active. 2. The client is infectious for life. 3. The dormant virus is not infectious while the client is asymptomatic. 4. Laboratory tests should be done monthly to identify the infectious periods.

2 Rationale: HIV infection creates a chronic infectious state in the body; the infection is transmitted via blood and body fluids and transplacentally. The virus remains in the body, even when the client is asymptomatic. If the client has a positive test result on two consecutive occasions, he is HIV positive and will remain infectious for life.

Which assessment finding would lead the nurse to conclude that a female client may be HIV-positive? Select all that apply. 1. Unprotected intercourse 2. Frequent vaginal yeast infections in the last 12 months 3. Heavy menstrual flow 4. Difficulty becoming pregnant for the past 3 years 5. Nasal congestion and runny nose 6. Severe cramping and irregular periods

1.2 Rationale: Unprotected intercourse and frequent or persistent vaginal candidiasis may be the first symptoms of HIV in women. The body's diminished immune response permits overgrowth of Candida albicans. Menstrual problems and infertility are not generally indicative of HIV. Nasal congestion and a runny nose often indicate allergy.

A woman explains to the nurse that she thinks she has been exposed to HIV. However, she had a test 1 week after the exposure and the result was negative. What is most important for the nurse to explain to this client? 1. Make sure she understands the importance of safe sex practices, especially the use of condoms and contraceptive practices to prevent pregnancy. 2. Even though the client tested negative, she needs to have a series of follow-up blood tests because of the possibility of seroconversion. 3. It is important that she obtain counseling regarding the transmission of the virus and how she may protect herself and her partner. 4. The client should abstain from sexual activity for the next 3 months until the blood test confirms that she is negative for HIV.

2 Rationale: After initial infection, there is a window of seroconversion in which the virus begins to replicate and produce antibodies. The client may have a negative test result early in the window. When the body begins to produce antibodies against the virus, the test result will convert to a positive. She should not get pregnant, but contraceptives (oral birth control) do not protect her against human immunodeficiency virus (HIV). Abstaining from sexual activity is frequently unrealistic, and counseling would be beneficial but it is not the priority. Although emphasizing the importance of safe sex practices is correct, it is not the best response. The priority in this situation is the necessity for follow-up blood tests because of the initial negative test result.

The nurse is reviewing with a client, who is positive for human immunodeficiency virus, important implications of his antiretroviral therapy. In reviewing the medications the client currently takes, which one would cause the nurse the most concern? 1. Nonsteroidal antiinflammatory drugs (NSAIDs) 2. St. John's wort 3. Fexofenadine (Allegra) 4. Albuterol (Provental)

2 Rationale: St. John's wort should not be taken with any of the protease inhibitors, which is one of the most common classification of medications administered and one of the most effective. The other drugs listed are not contraindicated.

A nurse experiences a needle stick from an IM injection that was just administered to a client who is positive for human immunodeficiency virus (HIV). What would be the best nursing action? 1. Report the needle stick to the local public health department and inform any sexual contacts. 2. Notify the employee health center and report the circumstances regarding the needle stick. 3. Contact the personal physician to determine the risk factor for seroconversion and medications to prevent seroconversion. 4. Notify the unit manager and ask for advice regarding to whom, if anyone, you should report the incident.

2 Rationale: The employee health center should be notified of any needle stick or other exposure to infections, diseases, or conditions. Circumstances surrounding the incident will determine if any prophylactic treatment must be initiated. Reporting to the local public health department and notifying sexual contacts are not necessary at this point. The personal physician can be contacted, but the employee health center must still be notified. The unit manager should be notified, but the priority is to notify the employee health center.

The nurse is teaching a client about risk factors and prevention of transmission of human immunodeficiency virus (HIV). Which statement by the nurse is most accurate? 1. HIV can be transmitted by kissing or using the same eating utensils. 2. Unprotected oral sex with an infected partner is not advised. 3. Sharing an office with an HIV-positive person increases the risk of exposure to HIV. 4. Using the same bathroom as an infected family member puts you at risk of exposure to HIV.

2 Rationale: Unprotected oral sex with an HIV-positive person puts one at risk for exposure to the virus. The person receiving the semen is at increased risk; therefore, a condom should be worn for oral sex. Contact, such as casual kissing, sharing an office or bathroom, or sharing a kitchen and eating utensils, does not transmit the virus. The virus is not transmitted by saliva. The virus is transmitted primarily prenatally and in blood, semen, and breast milk.

The roommate of a client with acquired immunodeficiency syndrome (AIDS) comes to visit, follows the nurse out of the room, and says, "I am so scared I am going to get AIDS. I have been living with him." The nurse's response would be based on which principle? 1. The majority of people living with a client with AIDS are going to be HIV positive because of direct contact with the client. 2. The chance of getting AIDS is significantly decreased if the person has been in contact with a client with AIDS for less than 3 months. 3. HIV is spread by direct contact with the blood of an infected person and through sexual activity. 4. This is information the nurse cannot discuss with the roommate; therefore, the client should be referred to his primary care physician.

3 Rationale: According to the CDC, the primary route of transmission of the HIV that causes AIDS is through blood and body fluids. This option gives the roommate information so that he may determine whether he has been exposed. The other options are not true regarding HIV transmission.

A young woman has just received news of a positive test for human immunodeficiency virus (HIV). She does not want her sexual partner to be informed. What is the most appropriate nursing response to her decision? 1. Respect the client's decision, even if you disagree; it is her choice to make. 2. Let the client know that you have a legal responsibility to inform her partner. 3. Discuss with the client the ethical responsibility to inform all sexual partners. 4. Note the client's decision in the record for future reference.

3 Rationale: Although nurses are taught to respect clients' decisions and acknowledge their feelings, the ethical response to her comment would be to counsel her about her responsibility to notify all persons at risk. HIV is a reportable disease in some states. If it is legally reportable in the state, it is the responsibility of the public health department to contact the partner. In some states, a person who knowingly exposes another to HIV can face potential legal action.

The nurse would identify the occurrence of which situation that would indicate a need for further evaluation because of the client's increased risk for exposure to the human immunodeficiency virus (HIV)? 1. Frequent episodes of pneumonia 2. Recipient of three units of packed red cells 3. Frequent sexually transmitted diseases 4. Reports swollen glands, diarrhea, and fatigue

3 Rationale: Frequent sexually transmitted diseases would alert the nurse to the client's lack of protected sex and the possibility of multiple partners. Malaise, fatigue, swollen glands, and diarrhea are associated with the early symptoms of HIV+, not someone who would be at an increased risk for being infected. The virus is rarely transmitted by blood transfusions.

The nurse is teaching a client about preventing the spread of HIV. The client asks the nurse why women are at greater risk than men for development of HIV disease through intercourse. The nurse's response is based on which of the following? 1. Vaginal secretions contain prostaglandins that can suppress HIV replication. 2. Hormonal fluctuations make it more difficult for the woman's body to fight off viral infections. 3. The vagina has a greater amount of mucous membrane surface than the penis. 4. A woman's immune system is less competent during menses, which makes her more susceptible.

3 Rationale: Gender affects HIV transmission. HIV is most easily transmitted when infected body fluids come into contact with mucous membranes or nonintact skin. The vagina has much more mucous membrane than the penis. HIV is more easily transmitted from an infected male to an uninfected female than vice versa. Vaginal secretions do not contain prostaglandins to suppress HIV replication: only antiretroviral drugs can suppress replication. Female hormones associated with the menstrual cycle do not alter the woman's ability to fight off an HIV viral infection.

A woman is pregnant and is being seen in the clinic for the first time. She has a history of being HIV positive. What will be important for the nurse to teach this client? 1. Because the woman is HIV positive, the infant will not be infected with the virus. 2. All infants of HIV-positive mothers are negative for the virus at birth and convert within 6 weeks after delivery. 3. The woman should continue antiretroviral prophylaxis throughout pregnancy and will be scheduled for a cesarean delivery to reduce the risk of mother-to-child transmission of HIV. 4. The infant will be tested at birth and, if positive, can start breastfeeding and be started on the antiretroviral medications to prevent the growth of the HIV virus.

3 Rationale: The rate of mother-to-child transmission of HIV continues to decrease due to such interventions as increased HIV testing of pregnant women, elective cesarean delivery, use of antiretroviral prophylaxis, and avoidance of breastfeeding. HIV-exposed infants who test negative initially should undergo further testing at 1 to 2 months and at 4 to 6 months of age to exclude or identify HIV infection. Perinatally acquired HIV has declined with the use of preventive measures such as HIV counseling, voluntary testing practices, and highly active antiretroviral therapy (HAART). Breastfeeding is delayed until confirmatory testing is done. If the test is negative, prophylaxis is stopped and breastfeeding may start. If the test is positive, infants should be treated with antiretroviral prophylaxis for 6 weeks, and the mother should not breast-feed.

A client is worried he may have been exposed to AIDS. What will be important for the nurse to explain to this client? 1. Symptoms of AIDS will develop immediately in sexually active individuals. 2. Clients may remain asymptomatic for an indefinite period of time. 3. Symptoms of AIDS are usually seen before the client is found to be HIV-positive. 4. After exposure to the virus, symptoms may develop within 6 to 12 weeks or as late as 6 months.

4 Rationale: Clients usually have symptoms within 6 to 12 weeks of exposure; however, symptoms may not develop until 6 months after exposure. This is the period of seroconversion. The symptoms do not develop immediately in sexually active individuals. The client may remain asymptomatic for an undetermined period of time. The client may be HIV-positive for years before he is diagnosed as having AIDS.

A client who has been recently diagnosed as positive for the human immunodeficiency virus (HIV) asks the nurse about the medicine for the virus. The nursing response would be based on what concept? 1. The virus is frequently resistant to medication; therapy may be delayed to decrease client resistance. 2. Antiviral medications will be started when the client's CD4+ T cell counts are above 200 μL and the viral load is low. 3. Treatment will be started when the client begins to show evidence of seroconversion and development of symptoms 4. Antiviral therapy is individualized and will be based on the client's CD4+ T cell count and the viral load.

4 Rationale: Goals of antiretroviral therapy (ART) therapy are to decrease the viral load, increase or maintain the CD4+ T cell count, and delay the development of symptoms and opportunistic infections. ART usually is started when the CD4+ count drops below normal levels or the viral load is high. ART is not delayed to decrease development of resistance.

A client with a diagnosis of AIDS has developed P. jiroveci pneumonia (PJP, PCP). What will be important for the nurse to include in the nursing care plan? 1. Put a mask on the client whenever he has visitors in his room. 2. Explain to the client why he cannot go outside his room. 3. Wear a mask and gown when providing direct care to the client. 4. Wear a gown and gloves when assisting the client with personal hygiene.

4 Rationale: P. jiroveci pneumonia (PJP, PCP) is not easily transmitted from an infected person to a healthy person. The pathogen is frequently dormant in the body and is reactivated when the client's immune system is significantly depressed. There is no need for airborne or droplet precautions, but standard precautions must be strictly adhered to with this client.

A client who is positive for the human immunodeficiency virus (HIV) has been receiving antiviral medication for the past 3 months. He calls the clinic complaining of polydipsia, polyuria, and polyphagia. The nurse understands that these symptoms are most likely related to: 1. Diabetes-like symptoms caused by pancreatic infiltration by HIV virus 2. Allergic reaction to the non-nucleoside reverse-transcriptase inhibitor medications 3. Nonadherence with the antiviral medication regimen 4. Hyperglycemia caused by the protease inhibitor

4 Rationale: Protease inhibitors have been associated with hyperglycemia, new-onset diabetes, abrupt exacerbation of existing diabetes, and diabetic ketoacidosis. This usually occurs after 2 months of use. Polydipsia, polyuria, and polyphagia are symptoms attributed to the hyperglycemia, rather than an allergic reaction. These symptoms are not an indication of nonadherence to the antiviral regimen, although nonadherence can be attributed to many factors, including the complexity of the treatment regimen.

The nurse is reviewing with a certified nursing assistant (CNA) the care for a child who is diagnosed with acquired immunodeficiency syndrome (AIDS) and has developed P. jiroveci pneumonia (PJP, PCP). Which of the following precautions would the nurse review with the CNA? 1. Strict handwashing 2. Airborne precautions 3. Contact precautions 4. Standard precautions

4 Rationale: The CDC recommends standard precautions for all clients; this is particularly important for the client with AIDS. Although strict handwashing is not an incorrect response, this should be performed when caring for all clients and is a part of standard precautions. Airborne precautions are not indicated for clients with opportunistic infections such as P. jirovecipneumonia (PJP, PCP). Protective isolation is indicated for clients who are severely immunocompromised

A client comes into the clinic with complaints of general malaise, increased lethargy, and headaches. An enzyme immunoassay (EIA) is positive for serum antibodies associated with the human immunodeficiency virus (HIV). What will be important for the nurse to discuss with the client? 1. The Western blot test will be done to determine the stage of HIV antibody reproduction. 2. It will be at least 5 years before possible conversion to acquired immune deficiency syndrome (AIDS). 3. Blood must be drawn to determine the level of the CD4+ T helper cells. 4. The test was positive; however, it must be repeated to verify the results.

4 Rationale: The EIA test was positive; however, it must be repeated. If the EIA is positive a second time, then more specific testing (Western Blot or immunofluorescence assay [IFA]) will be done before a diagnosis of HIV can be confirmed. The CD4+ T helper cells are monitored after the diagnosis to determine the client's response to the virus. Viral loads are done after the client is confirmed positive for HIV; it is not done for testing purposes.

The nurse is following up after therapy plans were discussed by the physician with the client who is considering antiviral therapy for the treatment after confirmation of a positive status for the human immunodeficiency virus (HIV) test. The client asks the nurse how long the therapy will last. The nurse bases a response on the understanding that therapy lasts: 1. Only 1 year 2. A minimum of 5 years 3. No longer than 10 years 4. A lifetime

4 Rationale: The antiretroviral treatment for HIV is a lifelong regimen of medications. As an advocate for the client, the nurse should explain this to the client and be certain that he is fully aware of this fact before treatment is initiated, because the drug therapy is complex and costly and may be toxic. The treatment does not cure the client but promotes an increase in CDT-4 cell count and a decrease in the viral load.

A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse prepare for this patient? a. Administration of immunosuppressant medications b. Insertion of an arteriovenous graft for hemodialysis c. Placement of the patient on the transplant waiting list d. A blood draw for human leukocyte antigen (HLA) matching

ANS: A Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is potentially reversible, there is no indication that the patient will require another transplant or hemodialysis. There is no indication for repeat HLA testing.

A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

The nurse teaches a patient about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions? a. "After a couple of years, it is likely that I will be able to stop taking the cyclosporine." b. "If I develop an acute rejection episode, I will need to have other types of drugs given IV." c. "I need to be monitored closely because I have a greater chance of developing malignant tumors." d. "The drugs are given in combination because they inhibit different ways the kidney can be rejected."

ANS: A Cyclosporine, a calcineurin inhibitor, will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

A patient is being evaluated for possible atopic dermatitis. The nurse expects elevation of which laboratory value? a. IgE b. IgA c. Basophils d. Neutrophils

ANS: A Serum IgE is elevated in an allergic response (type 1 hypersensitivity disorders). The eosinophil level will be elevated rather than neutrophil or basophil counts. IgA is located in body secretions and would not be tested when evaluating a patient who has symptoms of atopic dermatitis.

Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

ANS: A The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range

To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load testing b. Enzyme immunoassay c. Rapid HIV antibody testing d. Immunofluorescence assay

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.

A patient who has received allergen testing using the cutaneous scratch method has developed itching and swelling at the skin site. Which action should the nurse take first? a. Administer epinephrine. b. Apply topical hydrocortisone. c. Monitor the patient for lower extremity edema. d. Ask the patient about exposure to any new lotions or soaps.

ANS: A The initial symptoms of anaphylaxis are itching and edema at the site of the exposure. Hypotension, tachycardia, dilated pupils, and wheezes occur later. Rapid administration of epinephrine when excessive itching or swelling at the skin site is observed can prevent the progression to anaphylaxis. Topical hydrocortisone would not deter an anaphylactic reaction. Exposure to lotions and soaps does not address the immediate concern of a possible anaphylactic reaction. The nurse should not wait and observe for edema. The nurse should act immediately in order to prevent progression to anaphylaxis.

An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a. Many medications have interactions with antiretroviral drugs. b. Less frequent CD4+ level monitoring is needed in older adults. c. Hospice care is available for patients with terminal HIV infection. d. Progression of HIV infection occurs more rapidly in older patients.

ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patient's skin rash? a. The donor T cells are attacking the patient's skin cells. b. The patient's antibodies are rejecting the donor bone marrow. c. The patient is experiencing a delayed hypersensitivity reaction. d. The patient will need treatment to prevent hyperacute rejection.

ANS: A The patient's history and symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T cells attack the patient's tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older people d. Incidence of cancer-stimulating infections in older individuals

ANS: A The primary impact of aging on immune function is on T cells, which are important for immune surveillance and tumor immunity. Antibody function is not affected as much by aging. Poor nutrition can also contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care (select all that apply)? a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? a. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. c. Unused antibiotics that are more than a year old should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.

ANS: A, B, E All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza

The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.

ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.

The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which screening should the nurse include in the teaching plan for this patient? a. Screening for allergies b. Screening for malignancy c. Antibody deficiency screening d. Screening for autoimmune disorders

ANS: B Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by B lymphocytes and humoral immunity.

The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV). Which medication is most important to administer at the right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

ANS: B It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day.

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, "I am very nervous about making my baby sick." Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

ANS: B Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.

An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer? a. Corticosteroids b. Gamma globulin c. Hepatitis B vaccine d. Fresh frozen plasma

ANS: B The patient should first receive antibodies for hepatitis B from injection of gamma globulin. The hepatitis B vaccination series should be started to provide active immunity. Fresh frozen plasma and corticosteroids will not be effective in preventing hepatitis B in the patient

The nurse teaches a patient diagnosed with systemic lupus erythematosus (SLE) about plasmapheresis. What instructions about plasmapheresis should the nurse include in the teaching plan? a. Plasmapheresis will eliminate eosinophils and basophils from blood. b. Plasmapheresis will remove antibody-antigen complexes from circulation. c. Plasmapheresis will prevent foreign antibodies from damaging various body tissues. d. Plasmapheresis will decrease the damage to organs caused by attacking T lymphocytes.

ANS: B Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and complement from blood. T lymphocytes, foreign antibodies, eosinophils, and basophils do not directly contribute to the tissue damage in SLE.

Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected patient has a CD4+ cell count of 800/µL and an undetectable viral load. What is the priority nursing intervention at this time? a. Teach about the effects of antiretroviral agents. b. Encourage adequate nutrition, exercise, and sleep. c. Discuss likelihood of increased opportunistic infections. d. Monitor for symptoms of acquired immunodeficiency syndrome (AIDS).

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

A patient who is anxious and has difficulty breathing seeks treatment after being stung by a wasp. What is the nurse's priority action? a. Have the patient lie down. b. Assess the patient's airway. c. Administer high-flow oxygen. d. Remove the stinger from the site.

ANS: B The initial action with any patient with difficulty breathing is to assess and maintain the airway. The other actions also are part of the emergency management protocol for anaphylaxis, but the priority is airway maintenance.

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile (select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

ANS: B, C Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.

A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What instructions will the nurse give to the patient? a. Review foods that are higher in protein. b. Teach about the benefits of daily exercise. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.

ANS: C A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. Teach the patient about the medications available for treatment. 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. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

Which teaching should the nurse provide about intradermal skin testing to a patient with possible allergies? a. "Do not eat anything for about 6 hours before the testing." b. "Take an oral antihistamine about an hour before the testing." c. "Plan to wait in the clinic for 20 to 30 minutes after the testing." d. "Reaction to the testing will take about 48 to 72 hours to occur."

ANS: C Allergic reactions usually occur within minutes after injection of an allergen, and the patient will be monitored for at least 20 minutes for anaphylactic reactions after the testing. Medications that might modify the response, such as antihistamines, should be avoided before allergy testing. There is no reason to be NPO for skin testing. Results with intradermal testing occur within minutes.

The health care provider asks the nurse whether a patient's angioedema has responded to prescribed therapies. Which assessment should the nurse perform? a. Ask the patient about any clear nasal discharge. b. Obtain the patient's blood pressure and heart rate. c. Check for swelling of the patient's lips and tongue. d. Assess the patient's extremities for wheal and flare lesions.

ANS: C Angioedema is characterized by swelling of the eyelids, lips, and tongue. Wheal and flare lesions, clear nasal drainage, and hypotension and tachycardia are characteristic of other allergic reactions.

Immediately after the nurse administers an intracutaneous injection of an allergen on the forearm, a patient complains of itching at the site and of weakness and dizziness. What action should the nurse take first? a. Remind the patient to remain calm. b. Administer subcutaneous epinephrine. c. Apply a tourniquet above the injection site. d. Rub a local antiinflammatory cream on the site.

ANS: C Application of a tourniquet will decrease systemic circulation of the allergen and should be the first reaction. A local antiinflammatory cream may be applied to the site of a cutaneous test if the itching persists. Epinephrine will be needed if the allergic reaction progresses to anaphylaxis. The nurse should assist the patient to remain calm, but this is not an adequate initial nursing action.

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings. Which statement, if made by the patient, would indicate a need for additional teaching? a. "I need to find another way to earn extra money." b. "I will get a prescription for epinephrine and learn to self-inject it." c. "I will plan to take oral antihistamines daily before going to work." d. "I should wear a Medic-Alert bracelet indicating my allergy to bee stings."

ANS: C Because the patient is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the patient's hypersensitivity reaction. The other patient statements indicate a good understanding of management of the problem

The nurse, who is reviewing a clinic patient's medical record, notes that the patient missed the previous appointment for weekly immunotherapy. Which action by the nurse is most appropriate? a. Schedule an additional dose that week. b. Administer the usual dosage of the allergen. c. Consult with the health care provider about giving a lower allergen dose. d. Re-evaluate the patient's sensitivity to the allergen with a repeat skin test.

ANS: C Because there is an increased risk for adverse reactions after a patient misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection. A skin test is used to identify the allergen and would not be used at this time. An additional dose for the week may increase the risk for a reaction.

A new mother expresses concern about her baby developing allergies and asks what the health care provider meant by "passive immunity." Which example should the nurse use to explain this type of immunity? a. Early immunization b. Bone marrow donation c. Breastfeeding her infant d. Exposure to communicable diseases

ANS: C Colostrum provides passive immunity through antibodies from the mother. These antibodies protect the infant for a few months. However, memory cells are not retained, so the protection is not permanent. Active immunity is acquired by being immunized with vaccinations or having an infection. It requires that the infant has an immune response after exposure to an antigen. Cell-mediated immunity is acquired through T lymphocytes and is a form of active immunity.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/L. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? a. "The patient meets the criteria for a diagnosis of an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

ANS: C Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.

The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.

ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.

A nurse has obtained donor tissue typing information about a patient who is waiting for a kidney transplant. Which results should be reported to the transplant surgeon? a. Patient is Rh positive and donor is Rh negative b. Six antigen matches are present in HLA typing c. Results of patient-donor cross matching are positive d. Panel of reactive antibodies (PRA) percentage is low

ANS: C Positive crossmatching is an absolute contraindication to kidney transplantation, since a hyperacute rejection will occur after the transplant. The other information indicates that the tissue match between the patient and potential donor is acceptable

The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information should the nurse assign as the highest priority? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions

ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.

Which patient should the nurse assess first? a. Patient with urticaria after receiving an IV antibiotic b. Patient who has graft-versus-host disease and severe diarrhea c. Patient who is sneezing after having subcutaneous immunotherapy d. Patient with multiple chemical sensitivities who has muscle stiffness

ANS: C Sneezing after subcutaneous immunotherapy may indicate impending anaphylaxis and assessment and emergency measures should be initiated. The other patients also have findings that need assessment and intervention by the nurse, but do not have evidence of life-threatening complications.

Which statement by a patient would alert the nurse to a possible immunodeficiency disorder? a. "I take one baby aspirin every day to prevent stroke." b. "I usually eat eggs or meat for at least 2 meals a day." c. "I had my spleen removed many years ago after a car accident." d. "I had a chest x-ray 6 months ago when I had walking pneumonia."

ANS: C Splenectomy increases the risk for septicemia from bacterial infections. The patient's protein intake is good and should improve immune function. Daily aspirin use does not affect immune function. A chest x-ray does not have enough radiation to suppress immune function.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock

While obtaining a health history from a patient, the nurse learns that the patient has a history of allergic rhinitis and multiple food allergies. Which action by the nurse is most appropriate? a. Encourage the patient to carry an epinephrine kit in case a type IV allergic reaction to latex develops. b. Advise the patient to use oil-based hand creams to decrease contact with natural proteins in latex gloves. c. Document the patient's allergy history and be alert for any clinical manifestations of a type I latex allergy. d. Recommend that the patient use vinyl gloves instead of latex gloves in preventing blood-borne pathogen contact.

ANS: C The patient's allergy history and occupation indicate a risk of developing a latex allergy. The nurse should be prepared to manage any symptoms that may occur. Epinephrine is not an appropriate treatment for contact dermatitis that is caused by a type IV allergic reaction to latex. Oil-based creams will increase the exposure to latex from latex gloves. Vinyl gloves are appropriate to use when exposure to body fluids is unlikely.

The charge nurse is assigning rooms for new admissions. Which patient would be the most appropriate roommate for a patient who has acute rejection of an organ transplant? a. A patient who has viral pneumonia b. A patient with second-degree burns c. A patient who is recovering from an anaphylactic reaction to a bee sting d. A patient with graft-versus-host disease after a recent bone marrow transplant

ANS: C Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient who had an anaphylactic reaction.

A patient who is receiving immunotherapy has just received an allergen injection. Which assessment finding is most important to communicate to the health care provider? a. The patient's IgG level is increased. b. The injection site is red and swollen. c. The patient's allergy symptoms have not improved. d. There is a 2-cm wheal at the site of the allergen injection.

ANS: D A local reaction larger than quarter size may indicate that a decrease in the allergen dose is needed. An increase in IgG indicates that the therapy is effective. Redness and swelling at the site are not unusual. Because immunotherapy usually takes 1 to 2 years to achieve an effect, an improvement in the patient's symptoms is not expected after a few months

The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT.

The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis

ANS: D CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count.

A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/µL. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.

An older adult patient has a prescription for cyclosporine following a kidney transplant. Which information in the patient's health history has the most implications for planning patient teaching about the medication at this time? a. The patient restricts salt to treat prehypertension. b. The patient drinks 3 to 4 quarts of fluids every day. c. The patient has many concerns about the effects of cyclosporine. d. The patient has a glass of grapefruit juice every day for breakfast.

ANS: D Grapefruit juice can increase the toxicity of cyclosporine. The patient should be taught to avoid grapefruit juice. High fluid intake will not affect cyclosporine levels or renal function. Cyclosporine may cause hypertension, and the patient's many concerns should be addressed, but these are not potentially life-threatening problems.

A clinic patient is experiencing an allergic reaction to an unknown allergen. Which action is most appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Perform a focused physical assessment. b. Obtain the health history from the patient. c. Teach the patient about the various diagnostic studies. d. Administer skin testing by the cutaneous scratch method.

ANS: D LPN/LVNs are educated and licensed to administer medications under the supervision of an RN. RN-level education and the scope of practice include assessment of health history, focused physical assessment, and patient teaching.

A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

ANS: D More assessment of the patient's psychosocial status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.

The nurse is caring for a patient undergoing plasmapheresis. The nurse should assess the patient for which clinical manifestation? a. Shortness of breath b. High blood pressure c. Transfusion reaction d. Numbness and tingling

ANS: D Numbness and tingling may occur as the result of the hypocalcemia caused by the citrate used to prevent coagulation. The other clinical manifestations are not associated with plasmapheresis.

Which nursing action will be most useful in assisting a college student to adhere to a newly prescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.

A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex infection. Which outcome would be appropriate for the nurse to include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.

ANS: D The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection