Clinical Concepts 3 - Immunity
A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? A) AIDS B) DAF C) CVID D) SCID
A) AIDS
Which is usually the most important consideration in the decision to initiate antiretroviral therapy? A) CD4+ counts B) HIV RNA C) Western blotting assay D) ELISA
A) CD4+ counts
Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? A) Oral estrogen contraceptives B) An intrauterine device (IUD) C) A diaphragm D) The female condom
D) The female condom
Which of the following is the first barrier method that can be controlled by the woman? A) Female condom B) IUD C) Diaphragm D) Birth control pills
A) Female condom
Place the following in the sequence of the progression of HIV/AIDS on a cellular level. 1)The HIV virus is uncoded. 2)HIV attaches to the receptors on the CD4+ cell. 3)DNA synthesis occurs by reverse transcription. 4)Transcription of the DNA to form a single-strand messenger RNA. A) 1,2,3,4 B) 2,1,3,4 C) 3,4,1,2, D) 4,3,1,2
B) 2,1,3,4
A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse demonstrates a need for a review of transmission routes by identifying which body fluid as a means of transmission? A) Urine B) Semen C) Blood D) Breast milk
A) Urine
What is the most common mode of transmission of HIV? A) Vaginal and anal intercourse B) Mother to newborn via perinatal transmission C) Blood transfusion D) Infection from shared needles Occupational exposure
A) Vaginal and anal intercourse
A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate? A) "Your child does not have AIDS but this condition puts your child at risk for it later in life." B) "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." C) "Although AIDS is an immune deficiency, your child's condition is different from AIDS." D) "We need to do some more testing before we will know if your child's condition is AIDS."
C) "Although AIDS is an immune deficiency, your child's condition is different from AIDS."
A nurse practitioner is explaining the current methods of detection of HIV to a community group. In explaining the definitive method of detection, which statement is most accurate? A) The gold standard in testing is the enzyme-linked immunosorbent assay. B) The most sensitive and specific test is the Western blot analysis. C) The saliva test has been found to be more accurate than blood tests. D) Electrophoresis of white blood cell samples will indicate the presence or absence of HIV.
B) The most sensitive and specific test is the Western blot analysis.
What is the priority intervention for a nurse caring for a client with wasting syndrome from HIV? A) Promote nutritional intake B) Provide moisturizing skin care C) Administer antidiarrheal medications D) Monitor daily weight
A) Promote nutritional intake
Where does the auto immune reaction that causes rheumatoid arthritis originate? A) Bone B) Ligaments C) Synovial fluid D) Muscle
C) Synovial fluid
The nurse is instructing a male client about safer sexual behaviors. Which client statement indicates a need for additional instruction? A) "I will apply baby oil to lubricate the condom." B) "I should use a new condom each time I have sex." C) "My partner and I should avoid manual-anal intercourse." D) "After having sex, I should hold onto the condom when pulling out."
A) "I will apply baby oil to lubricate the condom."
When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? A) Antibodies to HIV are not present in his blood. B) He has not been infected with HIV. C) He is immune to HIV. D) Antibodies to HIV are present in his blood.
A) Antibodies to HIV are not present in his blood.
A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response? A) Avoid residue, lactose, fat, and caffeine. B) Encourage large, high-fat meals. C) Reduce food intake. D) Increase the intake of iron and zinc.
A) Avoid residue, lactose, fat, and caffeine.
The nurse is assessing clients at a clinic. Which signs indicate primary HIV infection? A) CD4 lymph: above 800 cells/mm³, fever, sore throat, muscle aches, rash B) CD4 lymph: below 200 cells/mm³, Pneumocystis jirovecii pneumonia C) CD4 lymph: above 1000 cells/mm³, no enlarged lymph nodes D) CD4 lymph: below 600 cells/mm³, no obvious symptoms
A) CD4 lymph: above 800 cells/mm³, fever, sore throat, muscle aches, rash
A client received 2 units of packed red blood cells while in the hospital with rectal bleeding. Three days after discharge, the client experienced an allergic response and began to itch and break out with hives. What type of reaction does the nurse understand could be occurring? A) Delayed hypersensitivity response B) Anaphylactic reaction C) Sensitization D) An immediate hypersensitivity response
A) Delayed hypersensitivity response
HIV is considered to be a retrovirus because: A) it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA). B) it converts to a primitive form of virus when duplicated. C) it carries a genetic marker for a previously discovered virus that was a source of an epidemic in an earlier time period. D) it reproduces at a rapid rate.
A) it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).
A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement about safer sex practices for persons with HIV is accurate? A) If the client and her sexual partners are HIV-positive, unprotected sex is permitted. B) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. C) Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended to prevent HIV transmission. D) The intrauterine device is recommended for a client with HIV.
B) A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse.
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? A) Sign a refusal of blood transfusion form so the client will not receive the transfusion. B) Bank autologous blood. C) Ask people to donate blood. D) Using volume expanders in case blood is needed.
B) Bank autologous blood.
A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next? A) ELISA B) Western Blot C) T4/T8 ratio D) Polymerase chain reaction
B) Western Blot
A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? A) distal sensory polyneuropathy (DSP) B) candidiasis C) AIDS dementia complex (ADC) D) cytomegalovirus (CMV)
C) AIDS dementia complex (ADC)
A nurse is working in a support group for clients with acquired immunodeficiency syndrome (AIDS). Which point is most important for the nurse to stress? A) Avoiding the use of recreational drugs and alcohol B) Refraining from telling anyone about the diagnosis C) Following safer-sex practices D) Telling potential sex partners about the diagnosis, as required by law
C) Following safer-sex practices
Typical symptoms seen in the latent period of HIV infection include which of the following? A) Skin lesions B) Gastrointestinal problems C) No signs or symptoms D) Night sweats
C) No signs or symptoms
Ataxia refers to A) vascular lesions caused by dilated blood vessels. B) inability to understand spoken words. C) uncoordinated muscle movement. D) difficulty swallowing.
C) uncoordinated muscle movement.
Which leukocytes arrive at the inflammation site? A) Basophils B) Eosinophils C) Monocytes D) Neutrophils
D) Neutrophils
What is the main effect of HIV infection? A) Poor natural killer cell function B) Poor B-cell function C) Poor suppressor T-cell function D) Poor helper T-cell function
D) Poor helper T-cell function
True or False The most definitive indicator of rheumatoid arthritis is the rheumatoid factor which is present in 100% of all diagnosed patients.
False 70-80%
True or False Immunity refers to the body's nonspecific protective response to an invading foreign agent or organism.
False Immunity refers to the body's specific, not nonspecific, protective response to an invading foreign agent or organism.
Fill in the blank Patients with SLE are likely to manifest a ______________ rash across the bridge of the nose and cheeks.
Malar or butterfly shaped
The school nurse is preparing a lecture on HIV/AIDS for a health class of high school students. The nurse would know to include what information about the transmission of AIDS in her lecture? Select all that apply. A) AIDS is transmitted through the bite of an insect. B) AIDS is transmitted through sexual contact. C) AIDS is transmitted through blood-to-blood contact. D) AIDS is transmitted from the mother to her unborn baby. E) AIDS is transmitted through nonsexual household contact.
B) AIDS is transmitted through sexual contact. C) AIDS is transmitted through blood-to-blood contact. D) AIDS is transmitted from the mother to her unborn baby.
A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what? A) HIV infection B) Opportunistic infection C) Autoimmune infection D) Suppression infection
B) Opportunistic infection
A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? A) Distal sensory polyneuropathy (DSP) B) Candidiasis C) HIV encephalopathy D) Cytomegalovirus (CMV)
C) HIV encephalopathy
True or False A hallmark of rheumatologic disease is autoimmunity, where the body mistakenly recognizes it's own tissue as a foreign pathogen.
True
True or False Alkylating agents and purine analogues are the first line of pharmacologic therapy for people with SLE because of their effect on overall immune function.
True
True or False Autoimmune disorders are more common in women than men.
True
True or False Risk factors for osteoarthritis and it's progression include older age, female gender, and obesity.
True
What are the three distinct characteristics of the pathophysiology of rheumatic diseases? Select all that apply A) Inflammation B) autoimmunity C) immobility D) Pain E) degradation
A) Inflammation B) autoimmunity E) degradation
The nurse accidentally has been stuck with a needle that was used to administer an intramuscular injection to a client who has AIDS. Which statements related to this event are most accurate? Select all that apply. A) The stage of illness of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. B) The viral load of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. C) The depth of the needle puncture of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. D) The amount of blood on the needle of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. E) The age of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client.
A) The stage of illness of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. B) The viral load of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. C) The depth of the needle puncture of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client. D) The amount of blood on the needle of the client diagnosed with AIDS impacts the risk of transmission of HIV to the nurse from the client.
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? A) Anorexia B) Chronic diarrhea C) Nausea and vomiting D) Oral candida
B) Chronic diarrhea
A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis? A) An opportunistic Epstein-Barr virus underlies the man's KS. B) He is likely to have lesions on his skin, mouth, or GI tract. C) Intense pain was probably his first manifestation of KS D) Heterosexual contact most likely underlies his HIV and subsequent KS.
B) He is likely to have lesions on his skin, mouth, or GI tract.
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as containing the genetic viral material? A) Deoxyribonucleic acid (DNA) B) Ribonucleic acid (RNA) C) Viral core D) Glycoprotein envelope
B) Ribonucleic acid (RNA)
An infant has been born to a client who is HIV positive. What is the infant's most likely prognosis for developing AIDS? A) The infant will most likely have AIDS by his or her first birthday. B) The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV. C) The infant's immune system may or may not be able to eradicate HIV during the first few months of life. D) The infant's immune system possesses high immunoglobulin levels due to passive immunity and will not likely develop HIV.
B) The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV.
A client has been diagnosed with HIV and has been placed on antiretroviral therapy. What does the nurse inform the client will be required for determining the progression of the disease as well as guiding drug therapy? A) The client will be required to stop the medication for 2 weeks and then have laboratory studies drawn to determine if the antiretroviral therapy has cured the disease. B) Viral load and T4-cell counts will be performed every 2 to 3 months. C) More antiretroviral medication will be added every 2 to 3 months. D) The Western blot test will be monitored every 6 months to see if the virus is still present.
B) Viral load and T4-cell counts will be performed every 2 to 3 months.
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: A) p24 antigen test for confirmation of diagnosis. B) Western blot test for confirmation of diagnosis. C) polymerase chain reaction test for confirmation of diagnosis. D) T4-cell count for confirmation of diagnosis.
B) Western blot test for confirmation of diagnosis.
Which client has the highest risk of contracting an opportunistic infection? A) A client who recently contracted HIV with a viral load of 1 million copies/mL B) A client who has had HIV for 30 years and has a CD4+ count of 1000 cells/μL C) A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL D) A client who has had HIV for 10 years and has a platelet count of 200/mL
C) A client who has had HIV for 3 years and has a CD4+ count of 50 cells/μL
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? A) Limit interactions with people who are not HIV infected. B) Limit interactions with people who are already HIV infected. C) Follow the same sexual precautions as someone who has been diagnosed with AIDS. D) Quit their job and get admitted to a hospital or a cancer treatment center.
C) Follow the same sexual precautions as someone who has been diagnosed with AIDS.
A client taking fosamprenavir reports "getting fat." What is the nurse's best action? A) Have the client increase exercise. B) Assess the client's diet. C) Teach the client about medication side effects. D) Arrange for a psychological counseling.
C) Teach the client about medication side effects.
A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which statement is appropriate direction from the student's nursing instructor? A) Wear gloves, gown, and mask when in contact with the client. B) Have the client wear a mask when transporting him from one area of the hospital to another. C) Wear gloves if there is a chance you will come in contact with the client's blood or body fluids. D) No precautions are needed.
C) Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? A) Obtain counseling. B) Call the lab to draw the nurse's blood. C) Fill out a risk management report. D) Report the incident to the supervisor.
D) Report the incident to the supervisor.