LUPUS / HIV

The nurse is assessing a client with cutaneous lupus erythematosus. Which intervention should be implemented? 1. Use astringent lotion on the face and skin. 2. Inspect the skin weekly for open areas or rashes. 3. Dry the skin thoroughly by patting. 4. Apply anti-itch medication between the toes.

.ANS : 3 1. Moisturizing lotions, not astringents, are applied. Astringent lotions have an alcohol base, which is drying to the client's skin. 2. The skin should be inspected daily for any breakdown or rashes. 3. The skin should be washed with mild soap, rinsed, and patted dry. Rubbing can cause abrasions and skin breakdown. 4. The stem does not tell the test taker the client is itching, and SLE does not have itching as a symptom. Lotions are not usually applied between the toes because this fosters the development of a fungal infection between the toes.

The nurse provides home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instruction?1."I should take hot baths because they are relaxing."2."I should sit whenever possible to conserve my energy."3."I should avoid long periods of rest because it causes joint stiffness."4."I should do some exercises, such as walking, when I am not fatigued."

1."I should take hot baths because they are relaxing." Rationale:To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness

The nurse is performing an assessment on a female client who complains of fatigue, weakness, muscle and joint pain, anorexia, and photosensitivity. Systemic lupus erythematosus (SLE) is suspected. What should the nurse further assess for that also is indicative of SLE?1.Ascites2.Emboli3.Facial rash4.Two hemoglobin S genes

3.Facial rash

A 25-year-old woman with a history of systemic lupus erythematosus was admitted with a severe viral respiratory tract infection and diffuse petechiae. Based on these data, it is most important that the nurse further evaluate the client's recent: 1. quality and quantity of food intake. 2. type and amount of fluid intake. 3. extent of weakness and fatigue. 4. length and amount of menstrual flow.

4. A recent viral infection in a female client between the ages of 20 and 30 with a history of systemic lupus erythematosus and an insidious onset of diffuse petechiae are hallmarks of idiopathic thrombocytopenic purpura. It is important to ask whether the client's recent menses have been lengthened or are heavier. Determining her ability to clot can help determine her risk of increased bleeding tendency until a platelet count is drawn. Petechiae are not caused by poor nutrition. Because of poor food and fluid intake or weakness and fatigue, the client may have gotten bruises from falling or bumping into things, but not petechiae.

When teaching a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is: 1. premarital serologic screening. 2. prophylactic treatment of exposed people. 3. laboratory screening of pregnant women. 4. ongoing sex education about preventive behaviors

4. Education to prevent behaviors that cause HIV transmission is the primary method of controlling HIV infection. Behaviors that place people at risk for HIV infection include unprotected sexual intercourse and sharing of needles for IV drug injection. Educating clients about using condoms during sexual relations is a priority in controlling HIV transmission.

A nurse is planning care for a 25-year-old female client who has just been diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse, "How could this have happened?" The nurse responds to the question based on the most frequent mode of HIV transmission, which is: 1. hugging an HIV-positive sexual partner without using barrier precautions. 2. inhaling cocaine. 3. sharing food utensils with an HIV-positive person without proper cleaning of the utensils. 4. having sexual intercourse with an HIV-positive person without using a condom.

4. HIV infection is transmitted through blood and body fluids, particularly vaginal and seminal fluids. A blood transfusion is one way the disease can be contracted. Other modes of transmission are sexual intercourse with an infected partner and sharing IV needles with an infected person. Women now have the highest rate of newly diagnosed HIV infection. Many of these women have contracted HIV from unprotected sex with male partners. HIV cannot be transmitted by hugging, inhaling cocaine, or sharing utensils.

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching?A. "I will need to isolate any tissues I use so as not to infect my family."B. "I will notify all of my sexual partners so they can get tested for HIV."C. "Unprotected sexual contact is the most common mode of transmission."D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family."HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

A nurse is teaching a client who has SLE about self-care. Which of the following statementsby the client indicates an understanding of the teaching?A. "I should limit my time to10 minutes in the tanning bed."B. "I will apply powder to any skin rash."C."I should use a mild hair shampoo."D."I will inspect my skin once a month for rashes."

A. A client who has SLE should avoid the use of tanning beds, as well as prolonged sun exposure. B. A client who has SLE should apply steroid-based creams to skin rashes, not a powder. C. CORRECT: A client who has SLE should use a mild hair shampoo that does not irritate the scalp. D. A client who has SLE should inspect her skin daily for any open areas or rashes.

A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate? (Select all that apply.) A. Positive ANA titer B. Increased hemoglobin C. 2+ urine protein D. Increased serum C3 and C4 E. Elevated BUN

A. CORRECT: A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibodies produced against the client's own DNA. B. Pancytopenia, rather than an elevated hemoglobin, is an expected finding in a client who has SLE. C. CORRECT: Increased urine protein is an expected finding due to kidney injury as a result of SLE. D. The client who has SLE is expected to have a decreased level of serum C3 and C4. E. CORRECT: Elevated BUN is an expected finding due to kidney injury in a client who has SLE.

A nurse is assessing a client for HIV. Which of the following are risk factors associated with this virus?(Select all that apply.)A. Perinatal exposureB. PregnancyC. Monogamous sex partnerD. Older adult womanE. Occupational exposure

A. CORRECT: Perinatal exposure is a risk factor associated with HIV. Women who are pregnant shouldtake cautionary measures to prevent HIV exposure.B. INCORRECT: Women who are pregnant should be tested for HIV, but pregnancy is not a risk factorassociated with this virus.C. INCORRECT: Having a monogamous sex partner is not a risk factor associated with the HIV virus.D. CORRECT: Being an older adult woman is a risk factor associated with the HIV virus due vaginaldryness and the thinning of the vaginal wall.E. CORRECT: Occupational exposure, such as being a health care worker, is a risk factor associatedwith the HIV virus.

A nurse working in an outpatient clinic is assessing a client who reports night sweats and fatigue. He stateshe has had a cough along with nausea and diarrhea. His temperature is 38.1° C (100.6° F) orally. The client isafraid he has HIV. Which of the following actions should the nurse take? (Select all that apply.)A. Perform a physical assessment.B. Determine when current symptoms began.C. Teach the client about HIV transmission.D. Draw blood for HIV testing.E. Obtain a sexual history.

A. CORRECT: The nurse should perform a physical assessment to gather data about the client'scondition. This is an appropriate action by the nurse.B. CORRECT: The nurse should gather more data to determine whether the clinical manifestationsare acute or chronic. This is an appropriate action by the nurse.C. INCORRECT: Teaching the client about HIV transmission is not an appropriate action by the nurseat this time. This is not a priority action for the nurse to include at this time.D. INCORRECT: Drawing blood for HIV testing is not an appropriate action by nurse at this time. Thisis not a priority action for the nurse to include at this time.E. CORRECT: The nurse should obtain a sexual history to determine how the virus was transmitted.This is an appropriate action by the nurse.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows?A. Delaying disease progressionB. Preventing disease transmissionC. Helping to cure the HIV infectionD. Enabling an increase in self-care activities

A. Delaying disease progressionThese health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities

The home care nurse provides instructions to a client with systemic lupus erythematosus (SLE) about home care measures. Which statements by the client indicate the need for further instruction? Select all that apply.1."I need to sit whenever possible."2."I need to be sure to eat a balanced diet."3."I need to take a hot bath every evening."4."I need to rest for long periods of time every day."5."I should engage in moderate low-impact exercise when I am not tired."

ANS 3."I need to take a hot bath every evening." 4."I need to rest for long periods of time every day." Rationale:Systemic lupus erythematosus is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Hot baths may exacerbate the fatigue. To help reduce fatigue in the client with SLE, the nurse should instruct the client to sit whenever possible, avoid hot baths, engage in moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed not to rest for long periods because it promotes joint stiffness.

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 subclavianIV site.

ANS : 1 *1. The client has a malnutrition syndrome.The nurse assesses the body and whatthe client has been able to eat.*2. Standard Precautions are used for clientsdiagnosed with AIDS, the same as forevery other client.3. The nurse should check the orders but notbefore assessing the client.4. The client will probably be placed on totalparenteral nutrition and will need to betaught these things, but this is not the firstaction.

The nurse is counseling the client who has SLE. The client tells the nurse that she plans to become pregnant in the next year. Which response by the nurse is correct? 1. "It is best to plan for your pregnancy when you have been in remission for 6 months." 2. "Having systemic lupus erythematosus will not impact your pregnancy in any way." 3. "Your chances of having an infant with congenital malformations are increased with SLE." 4. "You will need to be scheduled for a cesarean delivery to prevent disease transmission."

ANS : 1 1. Planning for pregnancy with SLE when in remission for 6 months is correct. Pregnancy planned during periods of inactive or stable disease often results in giving birth to a healthy full-term baby without increased risks of pregnancy complications. 2. Exacerbations of SLE can occur during pregnancy and impact pregnancy outcomes.

The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions are most important for the nurse to include? Select all that apply. 1. Use a sunscreen of SPF 30 or greater when in the sunlight. 2. Notify the HCP immediately when developing a low-grade fever. 3. Some dyspnea is expected and does not need immediate attention. 4. The hands and feet may change color if exposed to cold or heat. 5. Explain the client can be cured with continued therapy

ANS : 1,2,4 1. Sunlight or UV light exposure has been shown to initiate an exacerbation of SLE, so the client should be taught to protect the skin when in the sun. 2. A fever may be the first indication of an exacerbation of SLE. 3. Dyspnea is not expected and could signal respiratory involvement. 4. Raynaud's phenomenon is a condition in which the digits of the hands and feet turn red, blue, or white in response to heat or cold and stress. It occurs with some immune inflammatory processes. 5. SLE is a chronic disease and there is no known cure.

Which interventions should the nurse discuss with the female client who is positive for human immunodeficiency virus (HIV)? Select all that apply. 1. Recommend the client not to engage in unprotected sexual activity. 2. Instruct the client not to inform past sexual partners of HIV status. 3. Tell the client to not donate blood, organs, or tissues. 4. Suggest the client not get pregnant. 5. Explain the client does not have to tell healthcare personnel of HIV status

ANS : 1.3.4.5 1. HIV is transmitted via sexual activity. 2. HIV is transmitted via sexual activity, and the client may have been HIV positive for up to a year and not aware of it, so all past sexual partners should be informed of the HIV status. 3. Blood donations are screened and excluded for this virus, as are organs/tissues from a client with HIV, because the virus can be transmitted to clients receiving the organ or tissue. 4. HIV can be transmitted to the fetus from the pregnant woman with HIV. 5. The client should tell the HCP, especially dentists, about the HIV status, but the client does not have to tell health-care personnel about the HIV status. Health-care personnel should always follow Standard Precautions.

The nurse is developing a care plan for a client diagnosed with SLE. Which goal is priority for this client? 1. The client will maintain reproductive ability. 2. The client will verbalize feelings of bodyimage changes. 3. The client will have no deterioration of organ function. 4. The client's skin will remain intact and have no irritation

ANS : 3 . 1. SLE is frequently diagnosed in young women and reproduction is a concern for these clients, but it is not the most important goal. 2. The client's body image is important, but this is not the most important. 3. SLE can invade and destroy any body system or organ. Maintaining organ function is the primary goal of SLE treatment. 4. Measures are taken to prevent breakdown, but skin breakdown is not life threatening.

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.

ANS : 3 1. The client may be in the primary infectionstage when the body has not had time todevelop antibodies to the HIV virus.2. Repeated exposure to HIV increases therisk of infection, but it only takes oneexposure to develop an infection.*3. The primary phase of infection rangesfrom being asymptomatic to severeflu-like symptoms, but during thistime, the test may be negative althoughthe individual is infected with HIV.*4. The client may or may not have a differentvirus, but this is not the reason the testis negative.

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 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 vaccineb. Pneumococcal vaccinec. Influenza virus vaccined. Trimethoprim-sulfamethoxazolee. 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.

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

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.

The nurse is caring for a client who has been diagnosed with discoid lupus erythematosus. The nurse is collaborating with the client to set goals for the nursing plan of care. What is an appropriate goal for this client?A) Work through the stages of death and dying.B) Comply 100% of the time with a sun protection plan.C) Gain weight to within 10 pounds of normal for height.D) Report pain no higher than four on a scale of 1-10.

Answer: B Explanation: A) Discoid lupus erythematosus is an autoimmune disorder of the skin, so the client must protect against the sun to avoid skin cancers and other complications. It is not fatal, is not related to weight, and is rarely painful unless complications arise.

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 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/µLb. Patient whose rapid HIV-antibody test is positivec. Patient who has had 10 liquid stools in the last 24 hoursd. 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

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.

A client with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome confides that he is homosexual and his employer does not know his HIV status. Which response by the nurse is best? 1. "Would you like me to help you tell them?" 2. "The information you confide in me is confidential." 3. "I must share this information with your family." 4. "I must share this information with your employer."

Answer: 4 Rationale: If the client tests positive for HIV with the ELISA test, the test is repeated because of the potential for a false-positive result (e.g., from a recent influenza or hepatitis B vaccine) or a false-negative result if drawn too early after infection. If the test is positive a second time, the Western blot (a more specific test) is done to confirm the finding. The client is not diagnosed as HIV positive unless the Western blot is positive. Some laboratories also run the Western blot a second time with a new specimen before making a final determination.

The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which client statement indicates plan of care understanding?A) "I will take birth control pills while I am taking cytotoxic medications."B) "I do not need to contact the doctor if I develop a fever or rash."C) "I plan to go to the movies this weekend so that I get out of the house."D) "I can take ibuprofen as indicated for pain."

Answer: A Explanation: A) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin and ibuprofen can cause bleeding and should be taken with extreme care.

A nurse caring for a client with SLE on immunosuppressive therapy understands that careful teaching is required to make sure both clients and family members understand appropriate precautions against the threat of infection. Teaching points should include:Select all that apply. A) Avoid large crowds and situations that increase exposure to infection.B) Report difficulty breathing or cough to the physician if taking cyclophosphamide.C) Use ibuprofen instead of acetaminophen if fever develops.D) Women may develop heavy menstrual bleeding during therapy.

Answer: A, B Explanation: A) The nurse should teach the client and family regarding avoiding large crowds and situations that increase exposure to infection and to report difficulty breathing or cough. The client should report a fever if it develops, and ibuprofen should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy.

A client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client?Select all that apply.A) Avoid large crowds.B) Don't get a flu shot.C) Use contraception to prevent pregnancyD) Refrain from taking aspirin or ibuprofen.E) Report signs of infection to the physician.

Answer: A, C, D, E Explanation: A) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported.

A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE?Select all that apply.A) Use sunscreen with an SPF of 15 or greater.B) Remain indoors on sunny days.C) Avoid swimming in a pool or the ocean.D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m.E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Answer: A, DExplanation: A) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Following instruction for a patient with newly diagnosed systemic lupus erythematosus (SLE), the nurse determines that teaching about the disease has been effective when the patient says,a. "I should expect to have a low fever all the time with this disease."b. "I need to restrict my exposure to sunlight to prevent an acute onset of symptoms."c. "I should try to ignore my symptoms as much as possible and have a positive outlook."d. "I can expect a temporary improvement in my symptoms if I become pregnant."

Answer: B Rationale: Sun exposure is associated with SLE exacerbation, and patients should use sunscreen with an SPF of at least 15 and stay out of the sun between 11:00 AM and 3:00 PM. Low-grade fever may occur with an exacerbation but should not be expected all the time. A positive attitude may decrease the incidence of SLE exacerbations, but patients are taught to self-monitor for symptoms that might indicate changes in the disease process. Symptoms may worsen during pregnancy and especially during the postpartum period.

A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). The nurse understands that the primary concern with this drug is:A) Pulmonary fibrosis.B) Cushingoid effects.C) Retinal toxicity.D) Renal toxicity.

Answer: C Explanation: A) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil.

A female client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which is the best nurse response?A) "Conditions that cause hypotension can often exacerbate SLE."B) "GI upset is often associated with SLE exacerbation."C) "Pregnancy is often associated with an SLE exacerbation."D) "Fever is a known trigger for an SLE exacerbation."

Answer: C Explanation: A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE.

A patient with an acute exacerbation of systemic lupus erythematosus (SLE) is hospitalized with incapacitating fatigue, acute hand and wrist pain, and proteinuria. The health care provider prescribes prednisone (Deltasone) 40 mg twice daily. Which nursing action should be included in the plan of care?A. Institute seizure precautions.B. Reorient to time and place PRN.C. Monitor intake and output.D. Place on cardiac monitor.

Answer: C Rationale: Lupus nephritis is a common complication of SLE, and when the patient is taking corticosteroids, it is especially important to monitor renal function. There is no indication that the patient is experiencing any nervous system or cardiac problems with the SLE.

When preparing the newly diagnosed client with HIV and significant other for discharge, which explanation by the nurse accurately describes proper condom use?A) ''Condoms should be used when lesions on the penis are present.''B) ''Always position the condom with a space at the tip of an erect penis.''C) ''Make sure it fits loosely to allow for penile erection.''D) ''Use adequate lubrication such as petroleum jelly.''

B) B) ''Always position the condom with a space at the tip of an erect penis.''Rationale: This allows for the collection of semen at the tip of the condom.

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS?A. Presence of HIV antibodieB. CD4+ T cell count below 200/µLC. Presence of oral hairy leukoplakiaD. White blood cell count below 5000/µl

B. CD4+ T cell count below 200/µLDiagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive?A. Personal protective equipmentB. Combination antiretroviral therapyC. Counseling to report blood exposuresD. A negative evaluation by the manager

B. Combination antiretroviral therapyPostexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

A female patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease?A. "I'll try my best to stay out of the sun this summer."B. "I know that I have a high chance of getting arthritis."C. "I'm hoping surgery will be an option for me in the future."D. "I understand I'm going to be vulnerable to getting infections."

C. "I'm hoping surgery will be an option for me in the future."Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. SLE carries an increased risk of infection, sun damage, and arthritis.

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection?A. "The baby will probably be infected with HIV."B. "Only an abortion will keep your baby from having HIV."C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection.

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection."On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease?A. A new onset of polycythemiaB. Presence of mononucleosis-like symptomsC. A sharp decrease in the patient's CD4+ countD. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ countA decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

Transmission of HIV from an infected individual to another most commonly occurs as a result ofa. unprotected anal or vaginal sexual intercourse.b. low levels of virus in the blood and high levels of CD4+ T cells.c. transmission from mother to infant during labor and delivery and breastfeeding.d. sharing of drug-using equipment, including needles, syringes, pipes, and straws

Correct answer: a Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result?a. The patient has the virus present and can transmit the infection to others.b. The patient is not able to transmit the virus to others through sexual contact.c. The patient will be prescribed lower doses of antiretroviral medications for 2 months.d. The syndrome has been cured, and the patient will be able to discontinue all medications.

a. The patient has the virus present and can transmit the infection to others.In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/μL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.