Chapter 14: Infection
Which information about a patient population would be most useful to help the nurse plan for human immunodeficiency virus (HIV) testing needs? a. Age b. Lifestyle c. Symptoms d. Sexual orientation
a. Age
The nurse is caring for a patient living with asymptomatic chronic HIV infection (HIV). 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
a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine
An older adult who takes medications for coronary artery disease and hypertension is newly diagnosed with HIV infection and is starting antiretroviral therapy. Which information will the nurse include in patient teaching? a. Many drugs interact with antiretroviral medications. b. HIV infections progress more rapidly in older adults. c. Less frequent CD4+ level monitoring is needed in older adults. d. Hospice care is available for patients with terminal HIV infection.
a. Many drugs interact with antiretroviral medications.
A 78-year-old patient has developed an infection caused by Haemophilus influenzae. In addition to standard precautions, what should the nurse use to protect herself when working within 3 feet of the patient? a. Mask b. Gown c. Shoe covers d. Particulate respirator
a. Mask
To what is the increase in emerging and untreatable infections attributed (select all that apply)? a. Global travel and bioterrorism b. The evolution of infectious agents c. Use of antibiotics to treat viral infections d. Transmission of infectious agents from humans to animals e. An increased number of immunosuppressed and chronically ill people
a. Global travel and bioterrorism b. The evolution of infectious agents c. Use of antibiotics to treat viral infections e. An increased number of immunosuppressed and chronically ill people
In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission? a. Transmission to women or to men during heterosexual intercourse b. Hollow-bore needle used for vascular access or used for IM injection c. First 2 to 4 weeks of infection or 1 year after infection d. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy (ART) or HIV-infected mothers using no therapy e. A splash exposure of HIV-infected blood on skin with an open lesion or a needle-stick exposure to HIV-infected blood
a. Transmission to women or to men during heterosexual intercourse
Which strategy can the nurse teach the patient to eliminate the risk for HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking lamivudine (Epivir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact
a. Using sterile equipment to inject drugs
A diagnosis of AIDS is made when an HIV-infected patient has a. a CD4+ T cell count below 200/μL. b. a high level of HIV in the blood and saliva. c. lipodystrophy with metabolic abnormalities. d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.
a. a CD4+ T cell count below 200/μL.
Interventions to prevent health care-associated infections include (select all that apply) a. following hand-washing protocols. b. limiting visitors to persons over age 18. c. placing high-risk patients in private rooms. d. decontaminating equipment used for patient care. e. appropriately using personal protective equipment.
a. following hand-washing protocols. d. decontaminating equipment used for patient care. e. appropriately using personal protective equipment.
Emerging and reemerging infections affect health care by (select all that apply) a. reevaluating vaccine practices. b. revealing antimicrobial resistance. c. limiting antibiotics to those with life-threatening infection. d. challenging researchers to discover new antimicrobial therapies.
a. reevaluating vaccine practices. b. revealing antimicrobial resistance. d. challenging researchers to discover new antimicrobial therapies.
Transmission of HIV from an infected person to another most often occurs because of a. 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 eating utensils, dry kissing, hugging, using toilet seats, or shaking hands.
a. unprotected anal or vaginal sexual intercourse.
Which patient would benefit from education about HIV preexposure prophylaxis (PrEP)? a. A 23-yr-old woman living with HIV infection. b. A 52-yr-old recently single woman just diagnosed with chlamydia. c. A 33-yr-old hospice worker who received a needle stick injury 3 hours ago. d. A 60-yr-old male in a monogamous relationship with an HIV-uninfected partner.
b. A 52-yr-old recently single woman just diagnosed with chlamydia.
A patient with diarrhea has been diagnosed with Clostridium difficile. Along with standard precautions, which kind of transmission-based precautions will be used when the nurse is caring for this patient? a. Droplet precautions b. Contact precautions c. Isolation precautions d. Airborne precautions
b. Contact precautions
An 82-year-old male patient with cardiac disease who is in the intensive care unit (ICU) is beginning to have decreased cognitive function. What should the nurse first suspect as a potential cause of this change? a. Fatigue b. Infection c. ICU psychosis d. Medication allergy
b. Infection
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with morbid thoughts about dying." Which response by the nurse is appropriate? a. "Thinking about dying will not improve the course of AIDS." b. "Do you think that taking an antidepressant might be helpful?" c. "Can you tell me more about the thoughts that you are having?" d. "It is important to focus on the good things about your life now."
c. "Can you tell me more about the thoughts that you are having?"
A patient who uses injectable illegal drugs asks the nurse how to prevent acquired immunodeficiency syndrome (AIDS). Which response by the nurse is most accurate? a. "Clean drug injection equipment before each use." b. "Ask those who share equipment to be tested for HIV." c. "Consider participating in a needle-exchange program." d. "Avoid sexual intercourse when using injectable drugs."
c. "Consider participating in a needle-exchange program."
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 recommendation 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.
c. Discuss a change in antiretroviral therapy.
The "rapid" HIV antibody testing is performed on a patient at high risk for HIV infection. What should the nurse explain about this test? a. The test measures the activity of the HIV and reports viral loads as real numbers. b. This test is highly reliable, and in 5 minutes the patient will know if HIV infection is present. c. If the results are positive, another blood test and a return appointment for results will be necessary. d. This test detects drug-resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs.
c. If the results are positive, another blood test and a return appointment for results will be necessary.
Which characteristics describe Pneumocystis jiroveci infection, an opportunistic disease that can be associated with HIV? a. May cause fungal meningitis b. Diagnosed by lymph node biopsy c. Pneumonia with dry, nonproductive cough d. Viral retinitis, stomatitis, esophagitis, gastritis, or colitis
c. Pneumonia with dry, nonproductive cough
What is one of the most significant factors in determining when to start ART in a patient with HIV infection? a. Whether the patient has high levels of HIV antibodies b. Confirmation that the patient has contracted HIV infection c. The patient's readiness to commit to a complex, lifelong, uncomfortable drug regimen d. Whether the patient has a support system to help manage the treatment regimen and costs
c. The patient's readiness to commit to a complex, lifelong, uncomfortable drug regimen
What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. Set up a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that side effects of ART are bad but that they go away. d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.
d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.
Which finding supports the diagnosis of acquired immunodeficiency syndrome (AIDS) in the person with HIV? a. Flu-like symptoms b. Oral hairy leukoplakia c. CD4+ T cells 200-500/μL d. Cytomegalovirus retinitis
d. Cytomegalovirus retinitis
Name 3 of the antibiotic-resistant bacteria that are of current concern in North America: ____________________, ____________________, and ____________________.
methicillin-resistant Staphylococcus aureus (MRSA) vancomycin-resistant enterococci (VRE) vancomycin-resistant S. aureus (VRSA) carbapenem-resistant Enterobacteriaceae (CRE) penicillin-resistant Streptococcus pneumoniae (PRSP)
Which patient who has arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose rapid HIV-antibody test is positive. b. Patient whose latest CD4+ count has dropped to 250/µL. c. Patient who has had 10 liquid stools in the last 24 hours. d. Patient who has nausea from prescribed antiretroviral drugs.
c. Patient who has had 10 liquid stools in the last 24 hours.
According to the Center for Disease Control and Prevention (CDC) guidelines, which personal protective equipment will the nurse put on before assessing a patient who is on contact precautions for Clostridium difficile diarrhea? (Select all that apply.) a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection
b. Gown c. Gloves
Treatment with 2 nucleoside reverse transcriptase inhibitors (NRTIs) and an integrase inhibitor is prescribed for a patient with HIV infection. The patient asks why so many drugs are necessary for treatment. What should the nurse explain is the primary reason for combination therapy? a. Cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination. b. Combinations of antiretroviral drugs decrease the potential for developing antiretroviral-resistant HIV variants. c. Side effects of the drugs are reduced when smaller doses of 3 different drugs are used rather than large doses of 1 drug. d. When CD4+ T-cell counts are < 500/μL, a combination of drugs that have different actions is more effective in slowing HIV growth.
b. Combinations of antiretroviral drugs decrease the potential for developing antiretroviral-resistant HIV variants.
A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is most important for the nurse to do? a. Ask the patient to identify all sexual partners. b. Determine when the patient thinks exposure to HIV occurred. c. Explain that all test results must be repeated at least twice to be valid. d. Discuss prevention practices to prevent transmission of the HIV to others.
b. Determine when the patient thinks exposure to HIV occurred.
HIV antiretroviral drugs are used to a. cure acute HIV infection. b. decrease viral RNA levels. c. treat opportunistic diseases. d. decrease symptoms in terminal disease.
b. decrease viral RNA levels.
Indicate subsequently which event (from Question 9) of HIV infection of a cell is controlled by each drug. This would also be the mechanism of action of the drug. 1. Entry inhibitors 2. Reverse transcriptase inhibitors 3. Integrase inhibitors 4. Protease inhibitors
1. Inhibit entry into cell (steps 1 and 2 from Question 9) 2. Block development of HIV DNA chain and inhibit the action of reverse transcriptase enzyme (steps 3 and 4 from Question 9) 3. Bind with integrase enzyme and prevent HIV from incorporating its genetic material into the host cell (step 5 from Question 9) 4. Prevent protease enzyme from cutting of the long strands of viral RNA needed for viable virions (step 7 from Question 9)
A patient with human immunodeficiency virus (HIV) infection has developed Cryptosporidium parvum 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.
d. The patient will maintain intact perineal skin.
Priority Decision: A patient diagnosed with HIV 1 year ago has no symptoms of HIV- related illness and does not want to start ART at this time. What is the best nursing intervention for the patient at this stage of illness? a. Assist with end-of-life issues b. Provide care during acute exacerbations c. Provide physical care for chronic diseases d. Teach the patient about immune enhancement
d. Teach the patient about immune enhancement
Why do opportunistic diseases develop in a person with AIDS? a. They are side effects of drug treatment of AIDS. b. They are sexually transmitted to people during exposure to HIV. c. They are characteristic in people with stimulated B and T lymphocytes. d. These infections or tumors occur in a person with an incompetent immune system.
d. These infections or tumors occur in a person with an incompetent immune system.
Which opportunistic disease associated with AIDS is characterized by vascular lesions of the skin, mucous membranes, and viscera? a. Kaposi sarcoma b. Candida albicans c. Herpes simplex type 1 infection d. Varicella-zoster virus infection
a. Kaposi sarcoma
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
a. Viral load testing
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+ count of less than 200 cells/μL. 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 acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient will likely develop symptomatic HIV infection within 1 year." d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
d. "The patient has developed acquired immunodeficiency syndrome (AIDS)."
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 scheduled time? a. Nystatin tablet b. Oral acyclovir (Zovirax) c. Aerosolized pentamidine (NebuPent) d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
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. CD4+ cell count b. How the patient obtained HIV c. Patient's tolerance for potential medication side effects d. Patient's ability to follow a complex medication regimen
d. Patient's ability to follow a complex medication regimen
Which characteristic corresponds with the acute stage of HIV infection? a. Burkitt's lymphoma b. Temporary fall of CD4+ T cells c. Pneumocystis jiroveci pneumonia d. Fever, sore throat, and lymphadenopathy
d. Fever, sore throat, and lymphadenopathy
The nurse is advising a patient who was exposed 4 days ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen-antibody test has just been reported as negative for HIV. What information should the nurse give to this patient? a. "You will need to be retested in 2 weeks." b. "You do not need to fear infecting others." c. "We won't know for about 10 years if you have HIV infection." d. "With no symptoms and this negative test, you do not have HIV."
a. "You will need to be retested in 2 weeks."
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. Antibiotics may sometimes be prescribed to prevent infection. b. Continue taking antibiotics until all of the prescription is gone. 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.
a. Antibiotics may sometimes be prescribed to prevent infection. b. Continue taking antibiotics until all of the prescription is gone. e. Hand washing is effective in preventing many viral and bacterial infections.
Eight years after seroconversion, a patient with human immunodeficiency virus infection has a CD4+ cell count of 800/µL and an undetectable viral load. What should be included in the plan of care at this time? a. Encourage adequate nutrition, exercise, and sleep. b. Teach about the side effects of antiretroviral agents. c. Explain opportunistic infections and antibiotic prophylaxis. d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
a. Encourage adequate nutrition, exercise, and sleep.
Place the following events of HIV infection of a cell in sequence from 1 (first) to 7 (last). _______ a. The release of reverse transcriptase converts HIV ribonucleic acid (RNA) into a single strand of DNA. _______ b. Viral DNA is spliced into cell genome using the enzyme integrase. _______ c. HIV binds with CD4+ T cell protein receptors on the outside of the cell (fusion). _______ d. Viral DNA directs the cell to replicate infected daughter cells and makes more HIV. _______ e. Viral RNA enters the host CD4+ T cell. _______ f. Long strands of viral RNA are cut in the presence of protease and released before CD4+ T cell destruction. _______ g. Single-stranded viral DNA replicates into double-stranded DNA.
a. 3; b. 5; c. 1; d. 6; e. 2; f. 7; g. 4
What is a primary reason that the normal immune response does not contain HIV infection? a. CD4+ T cells become infected with HIV and are destroyed. b. The virus inactivates B cells, preventing the production of HIV antibodies. c. Natural killer cells are destroyed by the virus before the immune system can be activated. d. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues.
a. CD4+ T cells become infected with HIV and are destroyed.
Priority Decision: A patient with advanced AIDS has a nursing diagnosis of confusion because of neurologic changes. In planning care for the patient, what should the nurse set as the highest priority? a. Maintain a safe patient environment b. Provide a quiet, nonstressful environment to avoid overstimulation c. Use memory cues, such as calendars and clocks, to promote orientation d. Provide written instructions of directions to promote understanding and orientation
a. Maintain a safe patient environment
A pregnant woman with 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 it is an early stage of HIV infection, the infant will not contract HIV. d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
b. Most infants born to HIV-positive mothers are not infected with the virus.
The registered nurse (RN) is caring for a patient who is living with HIV and admitted with tuberculosis. Which task can the RN delegate to unlicensed assistive personnel (UAP)? a. Teach the patient how to dispose of tissues with respiratory secretions. b. Stock the patient's room with 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.
b. Stock the patient's room with the necessary personal protective equipment.
After teaching a patient with HIV infection about using antiretroviral drugs, the nurse recognizes that further teaching is needed when the patient says a. "I should never skip doses of my medication, even if I develop side effects." b. "By taking my HIV medications I will be able to lower by CD4 + cell count." c. "I should not use any over-the-counter drugs without checking with my health care provider (HCP)." d. "If I develop a headache with nausea and vomiting, I should report it to my HCP."
b. "By taking my HIV medications I will be able to lower by CD4 + cell count."
Which statements about metabolic side effects of ART are true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid problems include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are harder to treat in HIV-infected patients.
b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid problems include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol.
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Tell the patient a secondary infection is present. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
c. Explain to the patient that this is an expected finding.
Which nursing action will be most useful in assisting a young adult 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. Help the patient develop a schedule to decide when the drugs should be taken. d. Encourage the patient to join a support group for adults who are HIV positive.
c. Help the patient develop a schedule to decide when the drugs should be taken.
Which exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Bite to the arm that does not result in open skin b. Splash into the eyes while emptying a bedpan containing stool c. Needle stick with a needle and syringe used for a venipuncture d. Contamination of open skin lesions with patient vaginal secretions
c. Needle stick with a needle and syringe used for a venipuncture
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.
c. Prevention of HIV transmission between sexual partners.
A patient informed of a positive rapid screening 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. Inform the patient about the available treatments. b. Teach the patient how to manage a possible drug regimen. c. Remind the patient to return for retesting to verify the results. d. Ask the patient to identify those persons who had intimate contact.
c. Remind the patient to return for retesting to verify the results.
Opportunistic diseases in HIV infection a. are usually benign. b. are generally slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.
c. occur in the presence of immunosuppression.
During HIV infection a. reverse transcriptase helps HIV fuse with the CD4+ T cell. b. HIV RNA uses the CD4+ T cell's mitochondria to replicate. c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.
c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.
The nurse is caring for a patient who is living with human immunodeficiency virus (HIV) and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient reports feeling "constantly tired." b. The patient reports having no side effects from the medications. c. The patient is unable to explain the effects of atorvastatin (Lipitor). d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
The nurse realizes that the patient understands the teaching about decreasing the risk for antibiotic-resistant infection when the patient makes which statement? a. "I know I should take the antibiotic for 1 day after I feel better." b. "I want an antibiotic ordered for my cold so that I can feel better sooner." c. "I always save some pills because I get the illness again after I first feel better." d. "I will follow the directions for taking the antibiotic so that I will get over this infection."
d. "I will follow the directions for taking the antibiotic so that I will get over this infection."
What are the recommended measures to prevent the transmission of health care- associated infections (HAIs) (select all that apply)? a. Empty bedpans as soon as possible. b. Limit fresh flowers in patient rooms. c. Remove urinals from bedside tables. d. Use of personal protective equipment. e. Wash hands or use alcohol-based sanitizer. f. Make sure patients wear sandals in the shower.
d. Use of personal protective equipment. e. Wash hands or use alcohol-based sanitizer.
Screening for HIV infection generally involves a. detecting CD8+ cytotoxic T cells in saliva. b. laboratory analysis of saliva to detect CD4+ T cells. c. analysis of lymph tissues for the presence of HIV RNA. d. laboratory analysis of blood to detect HIV antigen and/or antibody.
d. laboratory analysis of blood to detect HIV antigen and/or antibody.
Prophylactic measures that are routinely used as early as possible in HIV infection to prevent opportunistic and debilitating secondary problems include administration of a. isoniazid to prevent tuberculosis. b. zoster virus vaccination to prevent shingles. c. trimethoprim/sulfamethoxazole for toxoplasmosis. d. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B.
d. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B.