Sherpath HIV, Integumentary, Infection

A health care provider advises against prescribing an antibiotic to a patient with a severe cold, sore throat, and runny nose. The patient states, "I really think that an antibiotic would make me feel better soon." How does the nurse respond? A. "An antibiotic is ineffective against a cold or flu." B. "Do you have any previously prescribed antibiotic at your home? If so, you can take that." C. "Your symptoms aren't severe enough to treat with antibiotics." D. "I will review a list of antibiotics; I will ask your health care provider to prescribe one of them.

Answer: A Rationale: A cold, sore throat, and runny nose are symptoms of cold and flu (a viral infection), and antibiotics are ineffective in treating viral infections. The nurse should inform the patient about the use of antibiotics, not tell the patient to use the rest of a previously prescribed antibiotic from home. Telling the patient that the rationale for the health care provider's decision is that the symptoms aren't severe enough is not accurate. The nurse should not ask the health care provider to prescribe antibiotics.

Which patient may have the highest risk for developing malignant melanoma? A. A fair-skinned woman who uses a tanning booth regularly B. An African American patient with a family history of cancer C. A patient who required phototherapy as an infant for the treatment of hyperbilirubinemia D. A Hispanic male with a history of psoriasis and eczema who responded poorly to treatment

Answer: A Rationale: Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

Which information would the nurse provide the patient with human immunodeficiency virus (HIV) who asks about factors determining progression to acquired immunodeficiency syndrome (AIDS)? Select all that apply. A. Progression of HIV can be assessed by your viral load. B. Your CD4 + T-cell count is one of several factors identified. C. Changes in your red blood cell count identifies progression of HIV. D. Testing for presence of the hepatitis B virus (HBV) assists in identifying progression. E. Your immunoglobulin M (IgM) antibody levels identify progression of HIV to AID

Answer: A, B Rationale: The progression of HIV infection to AIDS is monitored by CD4 + T-cell counts, viral load, opportunistic infections, and wasting syndrome. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4 + T-cell count is obtained to monitor the progression of HIV infection and response to treatment. The normal range for CD4 + T cells is 800 to 1200 cells/μL. The red blood cell count indicates presence or absence of anemia. The tests for HBV and hepatitis C virus (HCV) are extremely important in identifying co-infection as these infections are more serious to the patient with HIV, but they do not indicate progression of the HIV. IgM antibody levels are nonspecific and do not indicate the progress of AIDS

The nurse is educating a patient about ways to decrease the risk of antibiotic-resistant infection. Which instructions does the nurse include in the teaching? Select all that apply. A. Perform frequent handwashing. B. Follow directions as prescribed. C. Complete the full course of antibiotics. D. Request antibiotics for faster resolution of the flu. E. Retain leftover antibiotics for future use if needed.

Answer: A, B, C Rationale: Handwashing is frequently the most important way to prevent any kind of infection, and the caregivers should be encouraged to follow this practice. Antibiotics should not be stopped just because the symptoms have subsided. The antibiotic course should be completed as prescribed. Antibiotics should be taken as directed by the health care provider. Not following the instructions or skipping the doses can lead to resistance of the bacteria toward the antibiotic. Antibiotics are not effective against colds and flus; therefore, respect the health care provider's decision not to prescribe antibiotics when not needed. Leftover antibiotics should not be kept for later use because they may not be effective for the particular disease in the future and may lose their effectiveness.

Which self-management measures would the nurse teach a patient with human immunodeficiency virus (HIV) to prevent developing a resistance to antibiotics and infections? Select all that apply. A. Advise the patient to avoid skipping antibiotic doses. B. Advise the patient to wash hands properly and regularly. C. Advise the patient to save unfinished antibiotics for later use. D. Advise the patient to avoid requesting an antibiotic for flu or colds. E. Advise the patient to take antibiotics only until the patient feels better.

Answer: A, B, D Rationale: Antibiotics are effective against bacterial infections but not viruses, which cause colds and influenza. Therefore, antibiotics should not be requested for colds or influenza. Handwashing is the most important thing to do to prevent infection. The patient should not skip antibiotic doses because doing so can lead to developing resistance. A person should never stop taking antibiotics when feeling better. If an antibiotic is stopped early, the hardiest bacteria survive and multiply. Eventually, the patient could develop an infection resistant to many antibiotics. Another important instruction is never to have leftover antibiotics

1. Which patient statements indicate understanding of nursing instructions regarding skin care management? Select all that apply. A. "Avoid extreme temperatures. B. "Apply moisturizers even at night." C. Wash my hands and legs frequently with soap." D. "Change my position regularly while at rest." E. "I will not use the foot lift on my recliner.

Answer: A, B, D Rationale: Good skin care management is essential to prevent fluid loss. The patient should limit the use of soap to prevent the skin from drying. The nurse should advise the patient to either take precautions or to avoid extreme temperatures in order to avoid dehydration of the skin. Regular skin care by applying moisturizers and changing positions while at rest help to maintain skin hydration and may prevent skin breakdown. Elevation of extremities promotes venous return, so the patient would elevate the feet when in a recliner.

Which information would the nurse emphasize while teaching a patient ways to avoid exposure to hepatitis B infection? Select all that apply. A. Use disposable needles and syringes. B. Avoid sharing toothbrushes and razors. C. Avoid eating food prepared in unhygienic ways. D. Avoid touching or coming in contact with people with hepatitis B. E. Avoid unsafe sex with multiple partners, and always use condoms.

Answer: A, B, E Rationale: Hepatitis B spreads through sexual contact and through blood. Sharing razors or toothbrushes with an infected person may introduce infection in another person's body. Similarly, a needle used by an infected person can spread the infection. Hepatitis B also spreads via sexual exposure with an infected person. Using a condom gives some protection against the spread of infection. Hepatitis B doesn't spread through water and food. Hepatitis B doesn't spread with general casual contact with people.

Which instructions would the nurse include when teaching preexposure prophylaxis (PrEP) to a group of adults at high risk of sexually acquired human immunodeficiency virus (HIV) infection? Select all that apply. A. Safe sex practices B. Regular HIV testing C. Frequent hand washing D. Discreet use of antibiotics E. Risk reduction counselin

Answer: A, B, E Rationale: PrEP refers to strategies that aim to prevent HIV infection in adults at high risk of developing sexually acquired HIV infection. The strategies include safe sex practice, regular HIV testing for screening and early detection, and risk reduction counseling. Frequent hand washing helps to prevent transmission of infection in general, but not specifically sexually acquired HIV infection. Discreet use of antibiotics is helpful in preventing antibiotic-resistant infections, but not specifically HIV infection.

When discussing human immunodeficiency virus (HIV) infection with a patient, which statements would the nurse use? Select all that apply. A. "Untreated HIV infection has a predictable pattern of progression." B. "Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS)." C. "Untreated HIV infection usually remains in the early chronic stage for one year or less." D. "The interval between untreated HIV infection and a diagnosis of AIDS is about five years." E. "Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection."

Answer: A, B, E Rationale: The typical course of untreated HIV infection follows a predictable pattern. Late chronic HIV infection is known as AIDS. The most common infection associated with the symptomatic phase of HIV infection is oropharyngeal candidiasis. The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years. Untreated HIV infection usually remains in the early chronic stage for about 8 years.

The nurse recognizes that there is an increased number of patients that require inpatient care due to an antibiotic-resistant infection. Which actions by heath care providers may have contributed to this problem? Select all that apply. A. Prescribing antibiotics for viral infections B. Performing cultures prior to initiating antibiotic therapy C. Prescribing inadequate drug regimens to treat infections D. Prescribing antibiotics based on need rather than on patient insistence E. Prescribing broad-spectrum antibiotics when only first-line antibiotics are needed

Answer: A, C, E Rationale: Antibiotics should be used to treat infections caused by bacteria only because they are ineffective for viral infections. Health care providers (HCPs) that prescribe inadequate drug regimens depending on the bacteria involved also lead to development of antibiotic-resistance. HCPs have contributed to the development of antibiotic-resistant infections by prescribing broad-spectrum antibiotics when first-line medications should be used. Performing cultures prior to initiating antibiotic therapy helps HCPs identify the bacteria and prescribe the appropriate first-line medication. Prescribing antibiotics based on need is an effective strategy for treating patients while also preventing the rise of antibiotic-resistant infections

Which routes of transmission and infective periods would the nurse share with the patient who is human immunodeficiency virus (HIV) positive and pregnant? Select all that apply. A. HIV can be transmitted by breastfeeding. B. HIV can be transmitted by contact with vomitus. C. HIV can be transmitted by hugging and dry kissing. D. HIV can be transmitted lifelong once a person is HIV-positive. E. HIV can be transmitted even before it is detected on a screening test.

Answer: A, D, E Rationale: HIV can be transmitted through contact with infected blood, semen, vaginal secretions, or breast milk. Transmission of HIV occurs through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV-infected individuals can transmit HIV to others within a few days after becoming infected, even before it is detected on a screening test. The ability to transmit HIV continues for life. HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. The virus is not spread by tears, saliva, urine, emesis (vomiting), sputum, feces, sweat, respiratory droplets, or enteric routes.

A nurse obtained a blood sample with a syringe and large-bore needle from a patient with chronic human immunodeficiency virus (HIV) and a CD4 +T-cell count of 123/μL. Which factors may affect the transmission of HIV infection if the nurse sustained a needle stick from the contaminated needle? Select all that apply. A. Viral load of the patient B. Age of the injured nurse C. Age of the patient with HIV D. Immune status of the injured nurse E. Volume of blood exposed to nurse

Answer: A, D, E Rationale: Patients with a poor immune status are more susceptible to any kind of infection, including HIV. The concentration of the virus is an important variable. Other variables that influence the transmission are the volume of blood, virulence of the virus, and concentration of the organism in the blood. Large amounts of HIV can be found in the blood, and to a lesser extent in the semen, during the first six months of infection and again during the late stages. HIV-positive patients can transmit the infection at any age to a person of any age when the route of transmission is established. Therefore the age of the patient or nurse does not affect the transmission of HIV infection to the nurse

In accordance with Healthy People 2020 goals, which strategies are directed toward preventing the transmission of human immunodeficiency virus (HIV) and early detection of those infected? Select all that apply. A. Increased accessibility to HIV testing facilities B. Mandatory HIV testing as a routine part of health care C. Denial of sterile IV equipment to drug abusers D. Inclusion of voluntary HIV testing in routine prenatal care E. Advocacy for safer sex practices, including use of condoms

Answer: A, D, E Rationale: Strategies aimed at prevention and early detection of HIV include increasing accessibility to HIV testing facilities (e.g., drug and alcohol treatment centers and community-based organizations), offering voluntary HIV testing as part of routine prenatal care, and advocating for safer sex practices (including use of condoms). Mandated HIV testing may result in avoidance of routine health care. Taking measures to prevent drug abusers from sharing needles is imperative. Many needle/syringe exchange programs have decreased the incidence of HIV among IV drug abusers.

When monitoring the CD4 results of a patient with human immunodeficiency virus (HIV) infection, which CD4 count would prompt the nurse to monitor for clinical manifestations associated with immunity problems? A. The CD4 count is 1200. B. The CD4 count falls to 500. C. The CD4 count falls below 200. D. The CD4 count is greater than 500.

Answer: B Rationale: Immune problems start to occur when the count drops below 500 CD4 T cells. When the value drops below 200 CD4 T cells, severe immune problems will develop, and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 and 1200 CD4 T cells is normal for adults who do not have any immune dysfunction.

How is Breslow's measurement related to the prognosis of malignant melanoma? A. The larger the tumor, the worse is the prognosis. B. The deeper the tumor, the worse is the prognosis. C. The darker the tumor, the worse is the prognosis. D. The greater number of tumors, the worse is the prognosis.

Answer: B Rationale: Tumor thickness is an important prognostic factor for melanoma. The Breslow's measurement is used to assess the depth of the tumor in millimeters. The deeper the tumor, the worse will be the prognosis of melanoma. The size of the tumor, the color of the tumor, and an increase in the number of tumors are not determined using the Breslow's measurement.

Which disease condition is found more in fair-skinned patients than in patients with more pigmentation in their skin? A. Keloids B. Melanoma C. Nevus of ota D. Traction alopecia

Answer: B Rationale: Fair-skinned people are more prone to developing melanoma as compared to people with more pigment in their skin. People with darker skin have an increased amount of melanin pigment produced by the melanocytes. This increased melanin forms a natural sun shield for darker skin tones and results in a decreased incidence of skin cancer in these individuals. However, individuals with dark skin may have increased incidence of keloids, nevus of ota, and traction alopecia.

When teaching a patient with human immunodeficiency virus (HIV) about CD4 T cells, which statement would the nurse include? A. "HIV produces CD4 T cells, which will cause you to have more infections." B. "HIV destroys your CD4 T cells and depletes your immune system." C. "Your immune system is considered healthy when you have CD4 T cells D. "Immune problems begin when you have more than 500 CD4 T cells/uL."

Answer: B Rationale: HIV depletes the immune system by destroying CD4 T cells, which are an important part of the body's natural defense against infection. The human body produces CD4 T cells to fight the HIV virus; however, opportunistic infections will develop when CD4 T-cell counts diminish. A patient's immune system is considered healthy when CD4 T cell counts are above 500 cells/uL; however, a patient can have CD4 T cells in their blood and not be considered healthy if the CD4 T-cell count is below 500 cells/uL. Severe immune problems begin to emerge when there are fewer than 500 CD4 T cells/uL.

In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? A. Platelets B. T cells C. Red blood cells D. Immunoglobulins Answer:

Answer: B Rationale: In the early stages of HIV infection, T cells protect the body from infections. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4 + T cells. Platelets do not take part in providing immunity to the human body. They are required for clotting. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections

Which patient may have the poorest prognosis? A. A 60-year-old diagnosed with nodular ulcerative basal cell carcinoma B. A 59-year-old man who is being treated for stage IV malignant melanoma C. A 70-year-old woman who has been diagnosed with late squamous cell carcinoma (SCC) D. A 51-year-old woman whose biopsy has revealed superficial squamous cell carcinoma

Answer: B Rationale: Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late SCC has worse outcomes than superficial SCC, these are both exceeded in mortality by late-stage malignant melanoma.

Which type of skin cancer has a higher risk for metastasis and poor prognosis unless it is treated early? A. Myeloma B. Melanoma C. Basal cell carcinoma D. Squamous cell carcinoma

Answer: B Rationale: Malignant melanoma has a higher risk for metastasis than does basal cell or squamous cell carcinoma because of its invasiveness. There is a poor prognosis unless melanoma is diagnosed and treated early. Basal cell and squamous cell carcinoma are typically superficial, localized lesions that respond well to treatment. Myeloma is a hematologic malignancy, not a skin cancer.

27. A patient with a history of human immunodeficiency virus (HIV) is scheduled to receive antiretroviral drugs. Which statement by the patient reflects a correct understanding of the purpose of the medications? A. "Antiretroviral drugs can cure HIV infection." B. "These drugs work by decreasing the viral load." C. "Antiretroviral drugs will prevent opportunistic diseases." D. "These drugs work only in the initial replication stage of the virus."

Answer: B Rationale: The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4 + T-cell counts, and delay onset of HIV-related symptoms and opportuni Antiretroviral drugs do not cure HIV infection, nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle.

The patient with human immunodeficiency virus (HIV) does not want to take more than one prescribed antiretroviral medication at a time. Which explanation would the nurse provide the patient regarding combination antiretroviral therapy? A. Together, the medications will cure your HIV. B. Viral replication will be inhibited through use of the combinations. C. The combination medications will decrease your CD4 + T-cell counts. D. The combination therapy will prevent interaction with your other medications.

Answer: B Rationale: The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance, which is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4 + T-cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

A patient with acquired immunodeficiency syndrome (AIDS) has been on antiretroviral therapy (ART) for four weeks. Which findings would the nurse associate with positive drug therapy outcomes? Select all that apply. A. 80% drop in viral load B. 90% drop in viral load C. CD4 T-cell count above 14% D. CD4 T-cell count above 400 cells /µL E. 3-unit drop (99% reduction) in viral load on a log scale

Answer: B, C, E Rationale: Lab findings may help assess the response of the patient to treatment. A 90% or more drop in viral load and CD4 T-cell count above 14% indicate good response to treatment. A 3-unit drop in viral load, which corresponds to a 99% reduction in viral load, also indicates the patient is responding well to the treatment. A drop in viral load of less than 90% does not indicate a significant response to antiretroviral therapy after four weeks of therapy. A CD4 T-cell count above 500 to 600 cells/µL is considered a favorable response to antiretroviral therapy

Which cancers would the nurse discuss with the patient inquiring about the opportunistic carcinomas included in the diagnostic criteria for acquired immunodeficiency syndrome (AIDS)? Select all that apply. A. Melanoma B. Kaposi sarcoma C. Burkitt's lymphoma D. Hodgkin's lymphoma E. Invasive cervical cancer

Answer: B, C, E Rationale: Opportunistic cancers are cancers that develop due to a dysfunctional immune system and are otherwise not found in healthy people. The opportunistic cancers in AIDS patients are invasive cervical cancer, Kaposi sarcoma (KS), Burkitt's lymphoma, immunoblastic lymphoma, and primary lymphoma of the brain. Kaposi sarcoma is caused by human herpesvirus 8. Burkitt's lymphoma is cancer of the lymphatic system. Melanoma is a skin cancer not associated with AIDS. Hodgkin's lymphoma represents one of the most common non-AIDS-defining cancers with an increasing incidence.

A newly diagnosed patient with human immunodeficiency virus (HIV) inquires as to the requirements for development of acquired immunodeficiency syndrome (AIDS). Which diagnostic criterion for AIDS would the nurse share with the patient? Select all that apply. A. The presence of HIV antibodies B. A CD4 + T-cell count below 200/µL C. The presence of an opportunistic infection D. A white blood cell (WBC) count below 5000/µL E. Presence of an opportunistic cancer F. Loss of 10% or more of ideal body mass

Answer: B, C, E, F Rationale: Diagnostic criteria for AIDS include a CD4 + T-cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or WBC count below 5000/µL may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

The nurse is providing discharge education for a patient with an infection who is prescribed antibiotic therapy. Which instructions does the nurse include? Select all that apply. A. "Stop taking the antibiotic when you feel better." B. "Be sure to take your antibiotics as directed by the prescriber." C. "If a family member has leftover antibiotics, just use those to save money." D. "Be sure to take all antibiotic doses prescribed, even if you feel better." E. "Save any leftover antibiotics so you can take them anytime that you feel ill."

Answer: B, D Rationale: Patients should be advised to take antibiotics exactly as prescribed. For example, if the prescription indicates that the medication should be taken twice a day, the patient should follow those instructions exactly. Patients should be instructed to finish the entire antibiotic prescription even if they feel better. Otherwise, the stronger bacteria may survive, resulting in the development of an antibiotic-resistant infection. The patient should not stop taking them when he or she feels better and should finish the entire course as prescribed. The nurse should not recommend that a patient take another person's leftover antibiotics; this is not safe. The nurse should not advise the patient to save any leftover antibiotics to be taken anytime that the patient feels ill. The entire prescription should be taken. If the patient develops another infection, the patient will be prescribed an antibiotic that is specific to that type of infection.

Which opportunistic infections would the nurse monitor for clinical manifestations in the patient with acquired immunodeficiency syndrome (AIDS)? Select all that apply. A. Legionnaires' disease B. Candidiasis of bronchi C. Ebola hemorrhagic fever D. Toxoplasmosis of the brain E. Mycobacterium avium (MAC) complex

Answer: B, D, E Rationale: Candidiasis of bronchi, toxoplasmosis of the brain, and Mycobacterium avium complex are opportunistic infections in AIDS because the immune system is too weak to fight back. Candidiasis of the bronchi is a fungal infection caused by Candida albicans. The fungal infection rarely causes problems in healthy adults because they have strong immune systems but is common in people with human immunodeficiency virus (HIV) due to weakened immunity. Toxoplasmosis of the brain is a protozoal infection, and Mycobacterium avium complex is a bacterial infection. Ebola hemorrhagic fever is caused by Ebola virus, and Legionnaires' disease is caused by Legionella pneumophila; these are not opportunistic diseases. They are emerging infections that have recently increased in incidence.

Which purpose statements would the nurse use to fully explain antiretroviral therapy (ART) recently prescribed for a patient with human immunodeficiency virus (HIV)? Select all that apply. A. ART is designed to cure the HIV disease. B. ART will decrease the viral load in the blood. C. The goal is to stop the HIV disease from progressing. D. The medications prevent transmission of the HIV disease. E. Prescribed medications maintain or increase the CD4 cell counts. F. Therapy includes prevention of HIV-related opportunistic infection

Answer: B, D, E, F Rationale: The goals of drug therapy in HIV infection are to decrease the viral load, maintain or increase CD4 T-cell counts, prevent HIV-related symptoms and opportunistic infections, delay disease progression, and prevent HIV transmission. Curing the HIV disease is incorrect because there is currently no cure for the HIV disease. Stopping the HIV disease from progressing is incorrect because it cannot stop the progression of the HIV disease, but only delay the HIV disease progression

When interpreting laboratory diagnostics, which statement would the nurse identify as pathophysiology for the human immunodeficiency virus (HIV) infection? A. The HIV infection can replicate outside a living cell. B. The virus replicates going from DNA to RNA. C. The immune system is impaired from CD4 + T-cell destruction. D. Infection of monocytes occur, but antibodies quickly destroy these cells.

Answer: C

The nurse is providing care for a patient with a five-year history of human immunodeficiency virus (HIV). Which assessment finding indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4 + count D. A sudden increase in the patient's white blood cell (WBC) count

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

Which factor puts a light-skinned patient at a higher risk for skin cancer than a patient with darker skin? A. Less sun exposure B. More sun exposure C. Less melanin content in the skin D. Greater melanin content in the skin

Answer: C Rationale: Melanin provides natural protection to the skin against the harmful radiation of the sun. Therefore melanin plays a major role in preventing skin cancer. Dark-skinned patients have greater melanin content in their skin; they are less susceptible to skin cancer than light-skinned people. Light-skinned patients have less melanin. Differences in sun exposure between the two populations cannot be predicted.

Which type of carcinogen is associated with melanomas, squamous cell carcinomas, and basal cell carcinomas? A. Viral B. Chemical C. Ultraviolet radiation D. Inherited genetic mutation

Answer: C Rationale: Melanomas, squamous cell carcinomas, and basal cell carcinoma are types of skin cancer, which are associated with ultraviolet radiation. Viral carcinomas are associated with oncogenic viruses. Inherited genetic mutations are passed on from a parent. Chemical carcinogens are cancer-causing agents capable of producing cell alterations.

The nurse provides discharge education for a patient who receives a new prescription for an antibiotic. Which statement by the patient indicates a need for further teaching? A. "I will not skip doses of the antibiotic." B. "I will take the medicine until it is finished." C. "I will stop taking the antibiotic when my symptoms are better." D. "I will not share this antibiotic with other members of my family.

Answer: C Rationale: Patients should not stop taking antibiotics when symptoms are better but should take them for the full duration of prescribed therapy. Patients can contribute to developing antibiotic resistance by skipping doses, not taking antibiotics for the full duration of prescribed therapy, or saving unused antibiotics "in case I need them later." Antibiotics should not be shared with other family members.

The nurse discusses emerging infections with a group of community leaders and includes which examples? Select all that apply. A. Pertussis B. Tuberculosis C. West Nile fever D. H1N1 (swine) flu E. Human immunodeficiency virus (HIV) infection

Answer: C, D, E Rationale: An emerging infection is an infectious disease that recently has increased in incidence or that threatens to increase in the immediate future. Examples of emerging infections include HIV infection and acquired immunodeficiency syndrome (AIDS), West Nile fever, and H1N1 (swine) flu. Pertussis and tuberculosis are examples of reemerging infections. Reemerging infections arise when infective agents return when certain conditions are right

Chronic exposure to ultraviolet (UV) rays has which effects on the skin that increase the risk for skin cancer? Select all that apply. A. Increases blood flow to the skin B. Decreases the water content of the skin C. Causes an error in the skin's genetic code D. Causes degeneration of elastic fibers in skin tissue E. Decreases the skin's ability to repair cellular damage

Answer: C, E Rationale: Chronic exposure to the sun decreases the skin's capacity to repair cellular damage, which could predispose an individual to skin cancer. UV radiation damages DNA, causing an error in the genetic code and resulting in abnormal skin cells. Increased blood flow to the skin does not cause skin cancer. Increased blood flow is manifested as increase in skin temperature and reddening of skin. Decrease in the water content of the skin and degeneration of elastic fibers are brought about by aging and do not predispose an individual to cancer

Which assessment findings would the nurse recognize as diagnostic of acquired immunodeficiency syndrome (AIDS) in the patient diagnosed with human immunodeficiency virus (HIV) approximately 12 years ago? Select all that apply. A. Typhoid fever B. Hepatitis A infection C. Esophageal candidiasis D. Pulmonary cryptococcosis E. CD4 count less than 200 cells/µL

Answer: C, E Rationale: To diagnose AIDS, the patient should have an opportunistic infection, such as esophageal candidiasis, or the CD4 count should be less than 200 cells/µL of blood. Typhoid fever is not a diagnostic parameter for diagnosis of AIDS. Hepatitis A infection is not diagnostic of AIDS because it is not an opportunistic infection. Extrapulmonary cryptococcosis is diagnostic of AIDS, but pulmonary cryptococcosis is not.

A patient with human immunodeficiency virus (HIV) is hospitalized. The patient's assessment findings include a CD4 + T-cell count of 150 cells/μL and a 12% loss of ideal body mass. Which diagnosis does the nurse suspect? A. Kaposi sarcoma B. Cytomegalovirus (CMV) C. Pneumocystis jiroveci pneumonia (PCP) D. Acquired immunodeficiency syndrome (AIDS)

Answer: D Rationale: A patient with HIV is diagnosed with AIDS when the CD4 + T-cell count drops below 200 or the patient develops wasting syndrome, which is the loss of 10% or more of ideal body mass. Kaposi sarcoma, CMV, and PCP are all opportunistic infections or cancers that may develop in an HIV patient and lead to a diagnosis of AIDS.

A patient, with a recent history of 10% body mass loss and herpes simplex with chronic ulcers, has a CD4 + cell count of <200 cells/µL and is diagnosed with Burkitt's lymphoma. Which infection would the nurse associate these clinical manifestations? A. Parvovirus B. Varicella-zoster C. Adenovirus D. Human immunodeficiency virus

Answer: D Rationale: In human immunodeficiency virus infection, the CD4 + T-cell count drops below 200 cells/µL due to the destruction of the white blood cells. As a result, immunity decreases. Due to the decreased immunity, opportunistic infections, such as herpes simplex and Burkitt's lymphoma, may occur. Because of the ongoing infectious processes, the body goes into a state of catabolism, resulting in significant weight loss. Parvovirus produces gastroenteritis. Varicella-zoster virus causes chickenpox and shingles. Adenoviruses cause upper respiratory tract infections and pneumonia

The nurse is teaching a student nurse about treatment for sepsis. Which response by the student indicates a need for further teaching? A. "We should provide broad-spectrum antibiotics." B. "Antibiotics should be administered in one hour." C. "Blood cultures must be drawn before the administration of antibiotics." D. "Antibiotics should be delayed until the causative organism is known."

Answer: D Rationale: More specific antibiotics may be ordered once the organism has been identified, but administration of antibiotics should not be delayed. Broad-spectrum antibiotics are given first. Antibiotics are an important early component of therapy and should be started in the first hour. The nurse should obtain blood cultures before antibiotics are started.

For which type of infection would a postoperative patient who developed a fever, abdominal pain, and diarrhea despite being on long-term antibiotics be evaluated? A. Wound infection B. Urinary infection C. Respiratory infection D. Clostridium difficile infection

Answer: D Rationale: Prolonged use of antibiotics increases the risk of Clostridium difficile infection by damaging the normal flora of the intestine. The infection is manifested as fever, diarrhea, and abdominal pain. Wound infection, urinary infection, and respiratory infection may present with fever, but these infections rarely present with diarrhea and abdominal pain