Ch 19

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When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant other for discharge, which explanation by the nurse accurately describes proper condom use?

"Always position the condom with a space at the tip of an erect penis."

A client diagnosed with human immune deficiency virus is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). The client asks the nurse what will happen if the prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is the nurse's best response?

"Blood concentrations will be decreased, which will lead to increased viral replication."

Which interventions does the home health nurse teach to family members to reduce confusion in a client diagnosed with acquired immune deficiency syndrome (AIDS)-related dementia?

-Change the decorations in the home according to the season. -Put the bed close to the window. -Ask the client what time he or she prefers to shower or bathe. -Mark off the days of the calendar, leaving open the current date.

An HIV positive client with an acquired immune deficiency is seen in the clinic for re-evaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider?

Improved CD4+ T-cell count and reduced viral load

In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors?

"Have you had sex with men or women or both?"

The nurse is conducting a health assessment interview with a client diagnosed with human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address?

"I remember to take my antiretroviral drugs almost every day."

The home health nurse is making an initial home visit to a client currently living with family members after being hospitalized with pneumonia and newly diagnosed with acquired immune deficiency syndrome (AIDS). Which statement by the nurse best acknowledges the client's fear of discovery of his AIDS by his family?

"Is there somewhere private in the home where we can go and talk?"

Which statement made to the nurse by a health care worker assigned to care for a client with human immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the nurse?

"The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client."

The nurse is instructing an unlicensed health care worker on the care of a client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions?

"Washing my hands and putting on a gown and gloves is what I must do before starting care."

A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse?

"With this treatment, I probably cannot spread this virus to others."

The nurse presents a seminar on human immune deficiency virus (HIV) testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention regarding HIV testing?

-"I am 78 years old, and I was treated and cured of syphilis many years ago." -"Seven years ago, I was released from a penitentiary." -At 68, I am going to get married for the fourth time."

Which factors are possible transmission routes for human immune deficiency virus (HIV)?

-Breast-feeding -Anal intercourse -Oral sex

A client diagnosed with human immune deficiency virus is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions does the nurse recommend to the client?

Bathe daily using an antimicrobial soap.

The nurse is assigned to care for four clients. Which client does the nurse assess first?

Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature

A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client?

Fluconazole (Diflucan)

Which factor relates most directly to a diagnosis of primary immune deficiency?

Full-term infant surfactant deficiency

A client who is human immune deficiency virus (HIV) positive and has a CD4+ count of 15 has just been admitted with a fever and abdominal pain. Which health care provider request does the nurse implement first?

Obtain blood cultures from two sites.

In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority?

Potential for infection transmission related to recurring opportunistic infections

A client who is human immune deficiency virus positive is experiencing anorexia and diarrhea. Which nursing actions does the nurse delegate to a nursing assistant?

Provide oral care to the client before meals to enhance appetite.

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)?

The dietary worker hands the disposable meal trays to the LPN assigned to the client.

The nurse is providing care to a client with impaired oxygenation related to anemia. Which nursing intervention has the highest priority?

Transfuse ordered packed red blood cells.


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