HIV

The nurse realizes that which of the following tests can be used to initially identify the presence of human immunodeficiency virus (HIV) antibodies in a client? 1. Enzyme-linked immunosorbent assay (ELISA) 2. Platelet count 3. Red blood cell count 4. Western blot

1. Enzyme-linked immunosorbent assay (ELISA)

Which of the following CD4+ count would be used to confirm the diagnosis of acquired immunodeficiency syndrome (AIDS)? 1. 155 cells/mcL 2. 255 cells/mcL 3. 455 cells/mcL 4. 755 cells/mcL

1. 155 cells/mcL

The nurse is instructing a client on the modes of transmitting the human immunodeficiency virus infection. Which of the following can transmit this infection? (Select all that apply.) 1.Blood 2.Breast milk 3.Emesis 4.Saliva 5.Semen 6.Sweat

1. Blood 2. Breast milk 3. Semen

A client diagnosed with human immunodeficiency virus infection is prescribed antiretroviral Group 1 medications. Which medications are included in Group 1? (Select all that apply.) 1.Enfuvirtide (Fuzeon) 2.Ziduvudine (AZT) 3.Didanosine (Videx) 4.Abacavir (Ziagen) 5.Ritonavir (Norvir) 6.Saquinavir (Fortovase)

2. Ziduvudine (AZT) 3. Didanosine (Videx) 4. Abacavir (Ziagen)

The nurse is caring for a client diagnosed with human immunodeficiency virus (HIV). Which of the following precautions is best in the care of the client? 1.Gloves and an N-95 mask 2.Gown, gloves, and mask if splashing with body fluids is likely 3.Gown, gloves, mask, and placement into a negative-pressure room 4.Only handwashing is needed

2.Gown, gloves, and mask if splashing with body fluids is likely

The nurse is teaching a small group of clients about human immunodeficiency virus (HIV) at a health clinic. Which of the following statements by a group member will need further clarification? 1.Condoms should be used during sexual contact. 2.Exposure can occur to a baby during pregnancy. 3.HIV-infected mothers can breastfeed their babies. 4.Needles should never be reused or shared.

3. HIV-infected mothers can breastfeed their babies.

The nurse, planning care for a client diagnosed with human immunodeficiency virus, realizes that the most common infection that occurs in clients with this health problem is: 1. cytomegalovirus infection. 2. Mycobacterium tuberculosis. 3. Pneumocystis carinii pneumonia. 4. Streptococcus pneumoniae.

3. Pneumocystis carinii pneumonia

A health care provider has accidentally been stuck with a used needle. The health care provider is going to be tested for human immunodeficiency virus (HIV). Which of the following would be the testing schedule for the health care provider? 1.Tested at 2 months, 4 months, and then at 6 months 2.Tested immediately and then again at 2 months 3.Tested immediately and then again at 6 months 4.Tested in 6 months and then again in 1 year

3. Tested immediately and then again at 6 months.

A client diagnosed with acquired immunodeficiency syndrome (AIDS) 6 years ago has a purple lesion located on the inner thigh. This lesion is most likely to be: 1.AIDS-related syndrome. 2.Burkitts lymphoma. 3.cachexia. 4.Kaposis sarcoma.

4. Kaposis sarcoma

The nurse is instructing a client on ways to reduce the risk of exposure to the human immunodeficiency virus. Which of the following activities would present the least risk of exposure to this virus? 1.Exposure to used needles 2.Multiple sex partners 3.Perinatal exposure 4.Teeth cleaning

4. Teeth cleaning

A client receiving treatment for human immunodeficiency virus infection is demonstrating signs of resistance to the medication. Which of the following does this suggest to the nurse? 1.The medication dosages need to be increased. 2.The client needs to be taken off all medication. 3.The client needs additional medication to treat side effects. 4.The client is not adhering to the prescribed medication schedule.

4. The client is not adhering to the prescribed medication schedule.

A pregnant client diagnosed with human immunodeficiency virus (HIV) is asking about her babys risk of infection. Which of the following does put the newborn at risk? 1.Bottle-feeding 2.Changing diapers 3.Kissing the baby 4.Vaginal birth

4. Vaginal birth Breastfeeding and vaginal birth put the newborn at risk for HIV. HIV cannot be transmitted by changing diapers (feces) or kissing the baby (saliva).

A client diagnosed with acquired immunodeficiency syndrome (AIDS) is sitting alone crying. Which of the following is an appropriate response for the nurse to give? 1.Everything will be okay. 2.Let me call your doctor about your depression. 3.Whats wrong now? 4.Would you like to talk?

4. Would you like to talk?

The physician explains to a patient that the frequent infections he has been experiencing are caused by insufficient production of antibodies and immune cells. The nurse is aware that the physician is describing what type of disorder? a. Immune deficiency b. Autoimmune disease c. Opportunistic infection d. Recurrent infection

A. Immune deficiency

The nurse recognizes a need for further instruction when the HIV-positive patient says: a. My life is over. HIV and AIDS are the same thing. b. I can delay having full-blown AIDS if I change my lifestyle. c. Drug protocols can keep me relatively healthy for many years. d. I am aware that unsafe sex is a risk factor I ignored.

A. My life is over. HIV and AIDS are the same thing.

The nurse is providing patient education to the patient newly diagnosed with HIV. When explaining sentinel infections to the patient, the nurse should include which infection? (Select all that apply.) a. Oral thrush b. Recurrent vaginal yeast infections c. Skin infections d. Tuberculosis e. Encephalopathy

A. Oral thrush B. Recurrent vaginal yeast infections C. Skin infections

The nurse is caring for an AIDS patient who has been experiencing fatigue, anorexia, weight loss, and occasional nausea/vomiting. Which nursing diagnosis is the priority for this patient? a. Fatigue b. Imbalanced nutrition: Less than body requirements c. Activity intolerance d. Ineffective health maintenance

B. Imbalanced nutrition: less than body requirements

The nurse is caring for an immune compromised patient who complains of itching and tingling from below the shoulder on the back around to the chest area, as well as burning and shooting pain, headache, and low-grade fever. The nurse is aware that this patient is most likely experiencing: a. hepatitis C. b. shingles. c. a bacterial infection. d. cryptococcosis

B. Shingles

An HIV patient has lost more than 10% of her weight along with having diarrhea for the last 30 days. The nurse knows that these are indications of: a. AIDS. b. wasting syndrome. c. an opportunistic infection. d. anorexia

B. wasting syndrome

The nurse is aware that Pneumocystis P. carinii (PCP) becomes a real threat when the immunosuppressed patients CD4 count drops to _____ cells/mm3. a. 200 b. 400 c. 600 d. 1000

A. 200

The nurse is working in a trauma unit and is accidentally stuck with an IV needle following venipuncture of the patient. What is the nurses first action? a. Immediately begin taking the two- or three-drug regimen. b. Report the stick to the charge nurse immediately so follow-up can be initiated. c. Wash the punctured area with soap and water. d. Complete an incident report so immediate testing of the patient and nurse can begin

C. Wash the punctured area with soap and water.

When oral thrush, recurrent vaginal yeast infections, or skin disorders appear in the HIV-positive patient, the nurse assesses this as: a. AIDS. b. invasion of primary pathogens. c. a sign of a failing immune system. d. retrovirus infection.

C. a sign of a failing immue system.

Ten years after seroconversion, an HIV-infected patient has a CD4+ cell count of 800/l and an undetectable viral load. What is the priority nursing intervention at this time? a. Monitor for symptoms of AIDS. b. Teach about the effects of antiretroviral agents. c. Encourage adequate nutrition, exercise, and sleep. d. Discuss likelihood of increased opportunistic infections.

C. encourage adequate nutrition, exercise, and sleep.

When assessing an individual who has been diagnosed with early chronic HIV infection and has a normal CD4+ count, the nurse will a. check neurologic orientation. b. ask about problems with diarrhea. c. palpate the regional lymph nodes. d. examine the oral mucosa for lesions.

C. palpate the regional lymph nodes.

The nurse clarifies that the HIV virus enters and alters the DNA of the _____ cell lymphocyte. a. B b. T c. CD4 d. killer T

CD4

The nurse describes the initial diagnostic test for HIV as the enzyme-linked immunosorbent assay (ELISA), which is performed to detect: a. human immunodeficiency virus. b. depleted phagocytes. c. numbers of T helper cells. d. HIV antibodies

D. HIV antibodies

The nurse is aware that more instruction is needed for the HIV-positive patient when she says: a. Latex condoms are the best. b. I could give my partner HIV without practicing safe sex. c. I should avoid pregnancy. d. Oral sex is safer and doesnt require a barrier.

D. Oral sex is safer and doesnt require a barrier.

In caring for the patient who is HIV positive, the nurse should: a. wear gown, gloves, and mask at all times. b. limit visitors. c. monitor intake of salt. d. use Standard Precautions.

D. Use standard precautions

The nurse speaking with a student about immunocompetence correctly defines it as occurring when: a.there has been an overwhelming allergic reaction. b.the immune system cannot differentiate between foreign cells and the bodys own cells. c.the individual is exposed to a disease from which he has no immunity. d.physiologic responses protect the body against invasion from microorganisms or toxins.

D. physiologic responses protect the body against invasion from microorganisms or toxins.

27. The nurse stresses that the primary emphasis on controlling HIV is __________.

Prevention

When caring for a patient who has just been diagnosed with early chronic HIV infection, which prophylactic measures will the nurse anticipate being included 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

A pregnant woman with a history of early chronic HIV infection is seen at the clinic. 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. Since she is at an early stage of HIV infection, the infant will not contract HIV. d. It is likely that her newborn will become infected with HIV unless she uses antiretroviral drug therapy (ART).

b. Most infants born to HIV-positive mothers are not infected with the virus.