Lewis Chapter 14: Infection and HIV

A nurse is counseling a patient diagnosed with human immunodeficiency virus (HIV). The nurse understands that patients with HIV need vaccines to protect them from other infectious diseases. Which vaccines should the nurse advise the patient to take to comply with the recommended immunization schedule for a patient with HIV? Select all that apply. 1 Tetanus 2 Hepatitis B 3 Influenza 4 Pneumococcal vaccines 5 Measles-mumps-rubella (MMR) 6 Hepatitis C

1, 2, 3, 4 Patients with HIV should receive vaccination to avoid contracting other infectious diseases. They should get vaccinated against tetanus, influenza, hepatitis B, and pneumococcal infection. Vaccines with live pathogens such as MMR should be avoided, because these are contraindicated in people with a compromised immune system. Currently, there is no vaccine for preventing hepatitis C. Text Reference - p. 238

A woman infected with human immunodeficiency virus (HIV) delivers a baby with congenital anomalies. The patient was put on Atripla (tenofovir DF+emtricitabine+efavirenz) during pregnancy to control her infection. The nurse recognizes that what is the probable cause for the fetal malformations? 1 Adverse effects of efavirenz 2 Adverse effects of tenofovir DF 3 Adverse effects of emtricitabine 4 Immune deficiency due to HIV

1 The use of efavirenz in large doses in pregnant women may cause fetal anomalies. Tenofovir and emtricitabine are usually not associated with fetal malformations. Tenofovir and emtricitabine are used for preexposure prophylaxis. Immune deficiency due to HIV rarely causes fetal malformation. Text Reference - p. 238

The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities

1 These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities. Text Reference - p. 242

A public health nurse is teaching a group of people about preventing transmission of contagious infection. Which infections that are airborne and require transmission-based precautions should the nurse include in her teaching? Select all that apply. 1 Tuberculosis 2 Pertussis 3 Influenza 4 Rubeola 5 Cholera

1, 4 Transmission-based precautions include airborne precautions, droplet precautions, and contact precautions. Tuberculosis and rubeola are contagious diseases, and the organism can cause infection over long distances when suspended in the air. Therefore, airborne precautions are required to prevent transmission of infection. Droplet precautions are used to minimize contact with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Cholera is spread through contaminated water or food. Text Reference - p. 230

A nurse educator is teaching a group of nurses how to prevent health care-associated infections (HAI) in hospitals. Which bacteria are common culprits for the spread of health care-associated infections? Select all that apply. 1 Escherichia coli 2 Salmonella typhi 3 Clostridium botulinum 4 Staphylococcus aureus 5 Enterobacter aerogenes

1, 4, 5 Escherichia coli, Staphylococcus aureus, and Enterobacter aerogenes are the common culprits for health care-associated infections (HAI). These infections are acquired as a result of exposure to the microorganisms in a hospital setting. Surgical and immunocompromised patients are at increased risk of acquiring HAI. Salmonella typhi, which causes typhoid fever and Clostridium botulinum which causes food poisoning, are less common infections in hospitals. Text Reference - p. 230

ANS: A The current Center for Disease Control (CDC) policy is to offer routine testing for HIV to all individuals age 13 to 64. Although lifestyle, symptoms, and sexual orientation may suggest increased risk for HIV infection, the goal is to test all individuals in this age range.

11. Which information would be most important to help the nurse determine if the patient needs human immunodeficiency virus (HIV) testing? a. Patient age b. Patient lifestyle c. Patient symptoms d. Patient sexual orientation

ANS: D The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions also are useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.

13. Which nursing action will be most useful in assisting a college student 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. Encourage the patient to join a support group for students who are HIV positive. d. Check the patient's class schedule to help decide when the drugs should be taken.

A patient has human immunodeficiency virus (HIV) infection and wants to know about the measures which can help delay the progression of HIV disease. What should the attending nurse tell the patient? Select all that apply. 1 Encourage adequate rest. 2 Encourage a nutritious diet. 3 Inform the patient not to exercise. 4 Encourage adherence to the vaccination schedule. 5 Inform the patient that taking antiretroviral therapy (ART) alone is sufficient.

1, 2, 4 Useful interventions for HIV-infected patients that help delay the progression of disease include adequate rest, getting nutritional support, and keeping up to date with recommended vaccines. Exercising should be encouraged based on tolerance. Taking ART alone may not be sufficient, and treatment for other opportunistic infections may be required. HIV disease progression may be delayed by promoting a healthy immune system whether the patient chooses to use ART or not. Text Reference - p. 242

A nurse is instructed to take vitals and administer an intramuscular injection to a patient who has acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take in this case? Select all that apply. 1 Put on gloves. 2 Use a mask. 3 Put on a gown. 4 Wash the hands thoroughly. 5 Put on boots

1, 4 Even though this procedure does not involve more than minimal contact with blood, additional protection is required. The nurse should put on gloves after washing the hands thoroughly. A mask, gown, and boots must be used when splashes, sprays, spatters, or droplets of blood or other potentially infectious materials pose a hazard to the eyes, nose, or mouth and are not required in this case. Text Reference - p. 230

ANS: D The major manifestation of M. avium infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (pneumonia, dementia, influenza, etc.) associated with HIV infection.

14. A patient with human immunodeficiency virus (HIV) infection has developed Mycobacterium avium complex 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.

ANS: C A frequent first intervention for metabolic disorders is a change in antiretroviral therapy (ART). Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.

15. 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 instructions 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.

ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Elevated blood glucose and fatigue are common side effects of ART. The nurse should discuss medication side effects with the patient, but this is not as important as addressing the skipped doses of AZT.

18. The nurse cares for a patient who is human immunodeficiency virus (HIV) positive and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient's blood glucose level is 142 mg/dL. b. The patient complains of feeling "constantly tired." c. The patient is unable to state the side effects of the medications. d. The patient states, "Sometimes I miss a dose of zidovudine (AZT)."

The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? 1 Personal protective equipment 2 Combination antiretroviral therapy 3 Counseling to report blood exposures 4 A negative evaluation by the manager

2 Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first. Text Reference - p. 240

A mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunizations should the nurse provide this mother? 1 There is currently no need for those older vaccines. 2 There is a reemergence of some of the infections, such as pertussis. 3 There is no longer an immunization available for some of those diseases. 4 The only way to protect your child is to have the federally required vaccines.

2 Teaching the mother that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals. Text Reference - p. 227

A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the nurse reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."

2 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 opportunistic diseases. 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. Text Reference - p. 237

A 25-year-old male patient has been diagnosed with human immunodeficiency virus (HIV). The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? 1 Together they will cure HIV 2 Viral replication will be inhibited 3 They will decrease CD4+ T cell counts 4 It will prevent interaction with other drugs

2 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. Text Reference - p. 236

ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.

23. 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

ANS: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

3. A patient with a positive rapid antibody 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. Teach the patient about the medications available for treatment. b. Inform the patient how to protect sexual and needle-sharing partners. c. Remind the patient about the need to return for retesting to verify the results. d. Ask the patient to notify individuals who have had risky contact with the patient.

ANS: C Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.

7. A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? a. Driving is allowed when starting this medication. b. Report any bizarre dreams to the health care provider. c. Continue to use contraception while on this medication. d. Take this medication in the morning on an empty stomach.

ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART .

17. 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 hospital has seen a recent increase in the incidence of hospital care-associated infections (HAIs). Which measure should be prioritized in the response to this trend? 1 Use of gloves during patient contact 2 Frequent and thorough hand washing 3 Prophylactic, broad-spectrum antibiotics 4 Fitting and appropriate use of N95 masks

2 Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient. Text Reference - p. 230

Which virus causes dengue fever? 1 Ebola virus 2 Hantavirus 3 Flavivirus 4 West Nile virus

3 Flavivirus causes dengue fever. Ebola virus causes Ebola hemorrhagic fever. Hantavirus causes hemorrhagic fever associated with severe pulmonary syndrome. West Nile virus causes West Nile fever. Text Reference - p. 229

The nurse is caring for a patient with a skin infection. The patient's laboratory report reveals the presence of Staphylococcus aureus. The nurse recognizes that which medication will be beneficial? 1 Imipenem 2 Methicillin 3 Vancomycin 4 Ceftriaxone

3 Staphylococcus aureus is a gram-positive coccus bacterium that can cause skin infections. Vancomycin is a glycopeptide antibiotic that acts by inhibiting cell wall synthesis; the medication is effective against Staphylococcus aureus. Imipenem is a beta lactam antibiotic used against Klebsiella pneumoniae. Staphylococcus aureus is resistant to methicillin (a beta lactam antibiotic). Ceftriaxone is a third-generation cephalosporin that is ineffective against Staphylococcus aureus. Text Reference - p. 229

A nurse is caring for a patient with a diagnosis of acquired immunodeficiency syndrome (AIDS). What precautions should the nurse take for self-protection when administering IV injection to the patient? Select all that apply. 1 Mask 2 Gown 3 Gloves 4 Face shield 5 Hand hygiene

3, 5 Wearing gloves protects the nurse from potential contamination. Gloves are appropriate when there is a risk of the hands coming into contact with a patient's blood or body fluids. Hand hygiene is the most effective way to prevent the spread of microorganisms. Wearing a mask, gown, or face shield is necessary for procedures in which splashing of body fluids is anticipated or a risk. Text Reference - p. 230

The patient with cellulitis has a prescription to receive cefotetan 1.5 g intravenous piggyback (IVPB) q12h. The reconstituted vial contains 3000 mg per 20 mL. How many milliliters should be drawn up to add to the IVPB solution? 1 10 mL 2 20 mL 3 30 mL 4 40 mL

1 1.5 gram equals 1500 mg. Using ratio and proportion, multiply 3000 by x and multiply 1500 × 20 to yield 3000x = 30000. Divide 30,000 by 3000 to yield 10 mL. Text Reference - p. 230

A patient with a Staphylococcus aureus infection is prescribed vancomycin once daily for seven days. During a follow-up visit, the nurse suspects that the patient is at risk for developing resistance to the medication. Which statement by the patient supports the nurse's conclusion? 1 "I skipped the doses frequently." 2 "I took the mediation for nine days." 3 "I took the medication along with cold water." 4 "I increased the intake of sweet potatoes in my diet."

1 A patient on antibiotic therapy has a risk of developing resistance to therapy when he or she skips doses for the duration of therapy. The patient will develop resistance if he or she continues the therapy for too long; however, two extra days of antibiotic therapy will not lead to a development of resistance. Ingestion of medicine along with cold water does not causes resistance to medication. Vancomycin does not interact with foods that contain vitamin A (such as sweet potatoes). Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 229

A patient with acquired immunodeficiency syndrome (AIDS) comes into the clinic complaining of fatigue and knee pain. During the assessment, the nurse also notes that the patient is jaundiced. The nurse suspects that the patient is experiencing: 1 Hepatitis B virus (HBV) 2 Hepatitis C virus (HCV) 3 Cytomegalovirus (CMV) 4 Mycobacterium avium complex (MAC)

1 Although all of these are opportunistic infections that AIDS patients may acquire, HBV is correct here, because clinical manifestations consist of jaundice, fatigue, and joint pain. HCV is incorrect, because HCV clinical manifestations do not include joint pain. CMV is incorrect, because CMV is broken down into several specific categories that include retinitis, esophagitis, pneumonitis, and neurologic disease, in which none have the clinical manifestations of fatigue, jaundice, or joint pain. MAC is incorrect, because MAC clinical manifestations include gastroenteritis, watery diarrhea, and weight loss. Text Reference - p. 228

During an assessment, the nurse finds that a patient who is HIV-positive has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidiodes immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans

1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus, and the presence of thrush indicate Candida albicans. Infection by Coccidiodes immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans. Text Reference - p. 236

A nurse works in a long-term care unit. An elderly patient who has a continuous indwelling catheter seems to be confused and shows behavioral changes. On examination, the nurse finds the patient's body temperature to be normal. What does the change in cognition and behavior most likely indicate? 1 The patient has an infection. 2 The patient is developing dementia. 3 The patient is depressed. 4 The patient has a psychotic illness.

1 Patients living in long-term care facilities are at an increased risk of developing infections. The risk is higher in patients who have an indwelling catheter. Elderly patients may not have fever when they have an infection. Cognitive or behavioral changes are early indications of the presence of infection. Dementia is a slow and progressive disease, and does not have acute symptoms. Depression, until severe, does not manifest as cognitive and behavioral change. Whereas cognitive and behavioral changes may indicate a psychotic illness, other possibilities are more likely in this patient. Text Reference - p. 230

Which disease is caused by rhabdovirus? 1 Rabies 2 Measles 3 Encephalitis 4 Gastroenteritis

1 Rhabdovirus is a virus that causes rabies. Measles is caused by the virus rubeola. Both the West Nile virus and the arbovirus cause encephalitis. Viruses such as rotaviruses, respiratory syncytial virus, parvovirus, cytomegalovirus, echoviruses, and coxsackieviruses A and B cause gastroenteritis. Text Reference - p. 227

The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? 1 All patients regardless of diagnosis 2 Pediatric and gerontologic clients 3 Patients who are immunocompromised 4 Patients with a history of infectious diseases

1 Standard precautions are designed for care of all patients in hospitals and health care facilities. Text Reference - p. 231

The nurse is reviewing the prescriptions for four patients with bacterial infections. The nurse expects that which patient will be relieved from the bacterial infection quickly? 1 Patient A 2 Patient B 3 Patient C 4 Patient D

1 Staphylococcus epidermidis is a gram-positive bacterium. Patient A is receiving vancomycin, which is a glycopeptide antibiotic effective against gram-positive bacteria. Streptomycin is an aminoglycoside antibiotic that is effective against gram-negative bacteria; it will not be effective against Enterococcus faecium (which is gram-positive). Patient B should be given either penicillin G or ampicillin. Streptococcus pneumoniae is a gram-positive organism; penicillin G is a β-lactam antibiotic and is not effective against this bacterium. Patient C should receive either ceftriaxone or cefotaxime. Klebsiella pneumoniae is a gram-negative bacterium and is resistant to third-generation cephalosporins such as ceftazidime. Medications such as imipenem, cilastatin, and meropenem are effective against Klebsiella pneumoniae. Text Reference - p. 229

In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections? Select all that apply. 1 T lymphocytes 2 B lymphocytes 3 Platelets 4 Immunoglobulins 5 Red blood cells

1, 2 In the early stages of HIV infection, B cells and T cells protect the body from infections. B cells make HIV-specific antibodies that are effective in reducing viral loads in the blood. 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 mechanism. Immunoglobulins do not contribute in protection against HIV infection. Red blood cells do not play a role in protection from infections. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax. Text Reference - p. 233

A patient was admitted to the hospital with a ruptured abscess on the right thigh. Culture and sensitivity of the drainage showed methicillin-resistant Staphylococcus aureus (MRSA). What is true about MRSA? Select all that apply. 1 Community-acquired MRSA is more virulent than hospital-acquired MRSA. 2 Hospital-acquired MRSA is more virulent than community-acquired MRSA. 3 MRSA is a form of Staphlococcus aureus that does not respond to methicillin therapy. 4 MRSA is a form of Staphylococcus aureus that does not respond to penicillin-based therapy. 5 There is no cure for infections due to MRSA.

1, 3, 4 Community-acquired MRSA (CA-MRSA) is more virulent (able to cause disease or infection) compared with health care-associated MRSA (HA-MRSA). CA-MRSA has been known to cause rapidly forming skin infections and systemic diseases, including pneumonia and sepsis. Rates of CA-MRSA infections appear to be on the rise. MRSA is a form of Staphylococcus aureus that does not respond to methicillin- or penicillin-based therapies. The drug of choice for treating CA-MRSA is now believed to be vancomycin (Vancocin); HA-MRSA is susceptible to vancomycin. Newer drugs, such as linezolid (Zyvox) and daptomycin (Cubicin), are effective against both CA-MRSA and HA-MRSA. Linezolid is now felt to be the best drug for treating MRSA pneumonia. Text Reference - p. 229

During a follow-up appointment, the patient was notified by the health care provider that he or she has human immunodeficiency virus (HIV). The patient is extremely upset and does not understand how he or she could have gotten HIV. The nurse explains to the patient that HIV can be transmitted via which of the following? Select all that apply. 1 Blood 2 Emesis 3 Breast milk 4 Sharing utensils 5 Sexual intercourse

1, 3, 5 HIV can be transmitted as a result of contact with infected blood, semen, vaginal secretions, or breast milk. Therefore, it occurs through sexual intercourse, exposure to blood or blood products, and during pregnancy, delivery, or breastfeeding. HIV is not spread casually. Therefore, it cannot be spread just by sharing utensils or through emesis, as well as sweat, tears, saliva, or insect bites. Text Reference - p. 231

ANS: A After an initial positive EIA test, the EIA is repeated before more specific testing such as the Western blot is done. Viral cultures are not usually part of HIV testing. It is not appropriate for the nurse to predict the time frame for AIDS development. The Western blot tests for HIV antibodies, not for AIDS.

1. A patient who has vague symptoms of fatigue, headaches, and a positive test for human immunodeficiency virus (HIV) antibodies using an enzyme immunoassay (EIA) test. What instructions should the nurse give to this patient? a. "The EIA test will need to be repeated to verify the results." b. "A viral culture will be done to determine the progression of the disease." c. "It will probably be 10 or more years before you develop acquired immunodeficiency syndrome (AIDS)." d. "The Western blot test will be done to determine whether acquired immunodeficiency syndrome (AIDS) has developed."

ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are HIV positive, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.

1. The nurse cares for a patient infected with human immunodeficiency virus (HIV) who has just been diagnosed with asymptomatic chronic HIV infection. 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

ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.

10. The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would be most appropriate for the nurse to take? a. Instruct the patient to apply ice to the neck. b. Advise the patient that this is probably the flu. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient

The laboratory reports, including a culture and sensitivity test, of a patient with pneumonia reveal that the disease-causing microorganism is resistant to penicillin G. The nurse anticipates that which medication will be prescribed? 1 Cilastatin 2 Ceftriaxone 3 Vancomycin 4 Meropenem

2 Streptococcus pneumoniae causes pneumonia and is resistant to penicillin G. Ceftriaxone, or cefotaxime, is the preferred antibiotic. Cilastatin is beneficial for a patient with third-generation cephalosporin-resistant microbial infection. Vancomycin is beneficial to treat infections caused by methicillin-resistant microorganisms. Meropenem is beneficial to a patient infected with third-generation cephalosporin-resistant microorganisms. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 229

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock.

20. Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient with asymptomatic HIV infection is not a candidate for hospice. Progression of HIV is not affected by age, although it may be affected by chronic disease.

21. An older adult who takes medications for coronary artery disease has just been diagnosed with asymptomatic chronic human immunodeficiency virus (HIV) infection. Which information will the nurse include in patient teaching? a.Many medications have interactions with antiretroviral drugs. b.Less frequent CD4+ level monitoring is needed in older adults. c.Hospice care is available for patients with terminal HIV infection. d.Progression of HIV infection occurs more rapidly in older patients.

Which disease-causing fungus is responsible for thrush? 1 Trichophyton 2 Microsporum 3 Candida albicans 4 Aspergillus fumigatus

3 Candida albicans is a fungus that causes thrush. Trichophyton causes tinea pedis, or athlete's foot. Microsporum causes tinea capitis of the skin. Aspergillus fumigatus affects the ears and lungs. Test-Taking Tip: Identifying the content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 228

The patient has a new prescription to receive ceftazidime. The nurse would hold the medication and notify the health care provider if the patient reported a history of anaphylaxis to which class of medication? 1 Sulfa-containing medications 2 Nonsteroidal antiinflammatory drugs (NSAIDs) 3 Penicillins 4 Macrolides

3 Ceftazidime is a third-generation cephalosporin. In patients with anaphylaxis to penicillins, there is a 5% cross-sensitivity to cephalosporins. Before administration, the nurse should notify the provider of this known allergy. Ceftazidime will not interact with NSAIDs, sulfa, or macrolide antibiotics. Text Reference - p. 228

A woman who is three months pregnant finds out that she is human immunodeficiency virus (HIV)-positive on routine HIV testing. She wishes to continue her pregnancy. What information should be given to this patient? Select all that apply. 1 Inform her that the infant will not be infected. 2 Advise her to consider abortion. 3 Advise her to consider tubectomy after delivery. 4 Advise her that antiretroviral therapy (ART) can decrease the risk of transmission. 5 Advise her to follow a healthy lifestyle with nutritious food and regular exercise.

3, 4, 5

The nurse is comparing emerging and reemerging infections during an update class on health care. Which of these are examples of emerging infections? Select all that apply. 1 Pertussis 2 Tuberculosis 3 Human immunodeficiency virus (HIV) infection 4 West Nile fever 5 H1N1 (swine) flu

3, 4, 5 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. Text Reference - p. 229

The nurse assesses a patient who tests positive for HIV. Which finding would the nurse identify as the highest priority for follow-up? 1 Anorexia 2 Insomnia 3 Mood swings 4 Nonproductive cough

4 The patient who tests positive for HIV should be observed for the first sign of Pneumocystis jiroveci pneumonia, which is a dry, nonproductive cough. After evaluation of the nonproductive cough, follow-up care for anorexia, insomnia, and mood swings is secondary. Text Reference - p. 236

The nurse should assess a patient with acquired immunodeficiency syndrome (AIDS) for which most common symptoms? 1 Tremors and bradykinesia 2 Hematuria and abdominal pain 3 Persistent vomiting and headache 4 Low-grade fever and persistent diarrhea

4 The symptoms of acquired immunodeficiency syndrome (AIDS) are variable, but low-grade fever and persistent diarrhea are common. The symptoms listed in the other answer options are not specifically associated with AIDS. Text Reference - p. 235

The nurse understands that personal protective equipment helps to prevent the spread of infection and protects the health care professional from contracting infection. What would the nurse wear to prevent the spread of infection when disconnecting IV fluid tubing from the IV access port? 1 A cap 2 An isolation gown 3 Shoe covers 4 Gloves

4 When disconnecting IV fluid tubing, the nurse may come in contact with blood. Therefore, personal protective equipment such as gloves should be used. This also helps the nurse avoid an infection by not touching contaminated items or surfaces. Caps, gowns, and boots are not required when removing IV tubing. Text Reference - p. 230

Enterococcus faecalis is resistant to which medications? Select all that apply. 1 Ampicillin 2 Methicillin 3 Penicillin G 4 Vancomycin 5 Streptomycin

4, 5 The bacteria Enterococcus faecalis is resistant to the drugs vancomycin and streptomycin. Ampicillin is effective against Enterococcus faecalis. Staphylococcus aureus and Staphylococcus epidermidis are sensitive to methicillin. Penicillin G is effective for Enterococcus faecalis and resistant to Streptococcus pneumoniae. Text Reference - p. 229

ANS: D More assessment of the patient's psychosocial status is needed before taking any other action. The statements, "Thinking about dying will not improve the course of AIDS" and "It is important to focus on the good things in life" discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient. Although antidepressants may be helpful, the initial action should be further assessment of the patient's feelings.

4. A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best? a. "Thinking about dying will not improve the course of AIDS." b. "It is important to focus on the good things about your life now." c. "Do you think that taking an antidepressant might be helpful to you?" d. "Can you tell me more about the kind of thoughts that you are having?"

A human immunodeficiency virus (HIV)-infected patient tells the nurse that he or she is worried that he or she might have acquired immunodeficiency syndrome (AIDS). When is a diagnosis of AIDS in an HIV-infected patient confirmed? 1 The patient's CD4+ T cell count is below 200/μL. 2 The patient has flu-like symptoms. 3 Lipodystrophy with metabolic abnormalities is present. 4 Elevated platelet and white blood cell (WBC) counts are present.

1 AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/μL. Flu-like symptoms can be indicative of other diseases. Changes in WBC or platelet counts are not diagnostic criteria for AIDS (and WBC and platelet levels decrease, not increase). Changes in body shape because of lipodystrophy are not definitive diagnoses for AIDS. Text Reference - p. 235

A human immunodeficiency virus (HIV) patient on antiretroviral therapy comes into the clinic complaining that he or she is starting to feel like he or she did before starting the therapy. What should the nurse plan for? 1 Phenotype assay 2 Western Blot test 3 Standard antibody test 4 White blood cell count lab test

1 The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know if this is the reason why the antiretroviral therapy may not be working effectively. The Western Blot test is done to confirm that the patient has HIV. The standard antibody test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection. Text Reference - p. 235

A patient with pneumococcal pneumonia is prescribed ceftriaxone for 10 days. During a follow-up visit, the patient reports to the nurse, "I stopped the medication after taking it for five days because I felt better." What is the best nursing response? 1 Explain the importance of completing the planned medication therapy. 2 Instruct the patient to obtain a refill to continue the medication for another week. 3 Instruct the patient to save the remaining medication in case the symptoms reoccur. 4 Suggest that the patient give the leftover medications to the pharmacy.

1 Antibiotics should always be taken until the completion of planned therapy even if the symptoms subside. Skipping the medications or not completing the therapy may result in developing resistance to the organism. Antibiotics should not be used for more than the planned therapy. Organisms may develop resistance to antibiotics if used for a longer duration. Antibiotics will lose their effectiveness when stored for a longer time, and they can even be fatal. The nurse will not instruct the patient to save the remaining medication for future use. The patient should not give it back to the pharmacy, because this medication may not be appropriate for others and may contain inadequate doses that do not provide full treatment. Text Reference - p. 230

A female patient who is HIV positive is prescribed Efavirenz in large doses. What question should the nurse ask of the patient before administering the therapy to ensure drug safety? 1 "Are you pregnant?" 2 "Is your partner HIV positive?" 3 "Are you on your menses?" 4 "Have you ever had a blood transfusion?"

1 Efavirenz is an antiretroviral drug. Large doses could cause fetal anomalies; therefore, it is important to know if the patient is pregnant. Asking about the HIV status of the partner is unrelated to administration of the drug. The information about the patient's menses does not impact the antiretroviral therapy. A history of blood transfusion helps ascertain the mode of infection, but does not impact the drug therapy. Text Reference - p. 238

Based on laboratory reports of a patient, penicillin G is prescribed because the infection-causing bacterium is resistant to vancomycin, streptomycin, and gentamicin. The nurse identifies that which bacterial microorganism was observed in the laboratory report? 1 Enterococcus faecalis 2 Klebsiella pneumoniae 3 Staphylococcus epidermidis 4 Streptococcus pneumoniae

1 Enterococcus faecalis is a microorganism resistant to medications such as vancomycin, streptomycin, and gentamicin. Penicillin G is a β-lactam antibiotic effective in killing Enterococcus faecalis. Imipenem, cilastatin, and meropenem are effective in killing Klebsiella pneumoniae. Vancomycin kills Staphylococcus epidermidis. Ceftriaxone and cefotaxime are used to kill Streptococcus pneumoniae. Text Reference - p. 229

The laboratory report of a patient reveals the presence of Enterococcus faecium. The nurse anticipates that which medication will be prescribed? 1 Ampicillin 2 Imipenem 3 Vancomycin 4 Streptomycin

1 Enterococcus faecium causes urinary tract infections. Ampicillin is a beta-lactam antibiotic that kills the bacteria by blocking cell wall production and action of the cross-linking enzyme transpeptidase. Imipenem is a β-lactam antibiotic that is used to treat Klebsiella pneumonia infections. Enterococcus faecium is resistant to vancomycin (a glycopeptide) and streptomycin (an aminoglycoside). Text Reference - p. 229

When teaching a patient infected with human immunodeficiency virus (HIV) regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? 1 "I will need to isolate any tissues I use so as not to infect my family." 2 "I will notify all of my sexual partners so they can get tested for HIV." 3 "Unprotected sexual contact is the most common mode of transmission." 4 "I do not need to worry about spreading this virus to others by sweating at the gym."

1 HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat. The statements "I will notify all of my sexual partners so they can get tested for HIV," "Unprotected sexual contact is the most common mode of transmission," and "I do not need to worry about spreading this virus to others by sweating at the gym" show no need for further teaching. Text Reference - p. 232

A nurse, having identified nursing diagnoses for a patient who has tested positive for human immunodeficiency virus, determines that the highest risk is: 1 Hyperthermia 2 Social isolation 3 Impaired memory 4 Sexual dysfunction

1 Temperature increase is the highest priority for the nurse because Pneumocystis jiroveci pneumonia (PCP) is an indication of AIDS (acquired immunodeficiency syndrome). Early detection and treatment of PCP is directly related to a positive outcome. Temperature increase in an immunosuppressed patient is always a concern. Social isolation is a secondary risk of all persons who test positive for human immunodeficiency virus (HIV). Impaired memory and sexual dysfunction may develop as complications in patients with HIV disease, but these issues are not always present. Text Reference - p. 236

An 82-year-old woman is brought to her health care provider by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? 1 Urinalysis 2 Sputum culture 3 Red blood cell count 4 White blood cell count

1 The developments of urinary tract infections commonly contribute to atypical manifestations, such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection. Text Reference - p. 231

A patient diagnosed with a staph infection is started on vancomycin. About what should the nurse educate the patient to decrease resistance to the medications? Select all that apply. 1 "Make sure you take all of the medication as prescribed." 2 "Wash your hands frequently, so you do not spread the infection." 3 "You can skip doses, and double the dose at the next scheduled dose." 4 "It is okay to save unused doses for later if you do not use all of them." 5 "If you have a cold or the flu, this medication will help treat them as well."

1, 2 Ways to decrease resistance include not taking antibiotics unless prescribed, following the prescription directions, washing hands frequently, and finishing the medication. Ways that will contribute to resistance include skipping doses, saving unused doses for later, and taking the antibiotics for cold or flu. Test-Taking Tip: Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement. Text Reference - p. 230

What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection? Select all that apply. 1 Wash hands frequently 2 Take antibiotics as prescribed 3 Take the antibiotic until it is gone 4 Take antibiotics to prevent illnesses like colds 5 Save leftover antibiotics to take if needed later

1, 2, 3 To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, and finish the antibiotic. People should not request antibiotics for colds or flu, save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider. Text Reference - p. 230

Which fungal organisms cause skin infections? Select all that apply. 1 Trichophyton 2 Microsporum 3 Epidermophyton 4 Coccidioides immitis 5 Aspergillus fumigatus

1, 2, 3 Trichophyton, Microsporum, and Epidermophyton are fungal organisms that affect the skin. Coccidioides immitis affects the lungs. Aspergillus fumigatus affects the lungs and ears. Text Reference - p. 228

The nurse is caring for a patient who is being treated with antibiotics. The nurse recalls that what factors lead to antibiotic resistance? Select all that apply. 1 Skipping of doses 2 Saving unused antibiotics 3 Using narrow-spectrum antibiotics 4 Administering antibiotics for viral infections 5 Continuing antibiotic use beyond symptomatic relief

1, 2, 4 Various factors lead to bacterial resistance to antibiotics. Skipping doses leads to incomplete treatment and promotes antibiotic resistance. Saving unused antibiotic for future use may lead to inappropriate use related to the specific disease and may contribute to antibiotic resistance. Administering antibiotics for viral infections also promotes antibiotic resistance because antibiotics are ineffective against viruses. The use of broad-spectrum antibiotics, not the use of narrow-spectrum antibiotics, leads to the development of bacterial resistance. Antibiotics should be used for the prescribed duration irrespective of symptomatic relief. Text Reference - p. 229

A nurse is caring for a patient who is being treated with antibiotics. How would the nurse help the patient decrease the risk of contracting an antibiotic-resistant infection? Select all that apply. 1 Instruct the patient to finish the antibiotic course. 2 Advise the patient to wash hands frequently. 3 Suggest the patient take antibiotics for flu or cold. 4 Advise the patient not to take leftover antibiotics. 5 Instruct the patient to follow directions related to taking antibiotics.

1, 2, 4, 5 The prescribed course of the antibiotic should be completed to prevent the development of bacterial resistance. Hand washing prevents the spread of microorganisms. Leftover antibiotics may not be appropriate for specific illnesses and should not be taken. In addition, old antibiotics can lose their effectiveness or cause problems. The directions for antibiotics should be followed to avoid development of antibiotic resistance. Colds and the flu are caused by viruses, and antibiotics are ineffective against viruses. Text Reference - p. 230

The nurse provides education to a patient about decreasing the risk for antibiotic-resistant infections. What is appropriate to include in the teaching? Select all that apply. 1 "Finish your antibiotic course." 2 "Wash your hands frequently." 3 "Take antibiotics to prevent illness." 4 "Request an antibiotic for flu or colds." 5 "Follow directions when taking antibiotics."

1, 2, 5 The complete course for any antibiotic should be followed. Even if the patient starts feeling better, he or she should not stop taking the antibiotic because if the course is incomplete, the hardiest bacteria will survive and multiply. Washing hands frequently is the single most important thing to do to prevent infections. The patient should follow directions when taking antibiotics; failure to follow directions can lead to the development of antibiotic-resistant bacteria. Taking antibiotics to prevent illness increases the risk for developing antibiotic-resistant infection. Antibiotics are effective against bacterial infections, not viruses that cause flu or colds. Text Reference - p. 230

The nurse is discussing human immunodeficiency virus (HIV) infection with a patient and his or her family. Which statements accurately describe HIV infection? Select all that apply. 1 Untreated HIV infection has a predictable pattern of progression. 2 Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). 3 Untreated HIV infection usually remains in the early chronic stage for one year or less. 4 The interval between untreated HIV infection and a diagnosis of AIDS is about five years. 5 Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection.

1, 2, 5 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 eight years. Text Reference - p. 233

A nurse is teaching a group of patient caregivers ways to decrease the risk of antibiotic-resistant infection. Which instructions should the nurse include in the teaching? Select all that apply. 1 Wash your hands frequently. 2 Complete the full course of antibiotics. 3 Request antibiotics for faster resolution of flu. 4 Retain leftover antibiotics for future use if needed. 5 Follow directions as prescribed.

1, 2, 5 Washing hands frequently is 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 primary 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 flu; therefore, respect the primary 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. Text Reference - p. 230

One month after delivering a baby, a mother was infected with human immunodeficiency virus (HIV) due to intercourse with a stranger. She came to the hospital to seek medical advice and HIV testing. Enzyme immunoassay (EIA) and Western blot tests revealed that she was HIV-positive. What should be advised to the mother? Select all that apply. 1 Avoid breastfeeding. 2 Extract breast milk with a breast pump. 3 Have the baby immunized. 4 Get Bacille Calmette Guerin (BCG) vaccination (mother). 5 Baby will need antiretroviral drugs.

1, 3 Perinatal transmission from an HIV-infected mother to her infant can occur during pregnancy, delivery, or breastfeeding. In this case, the baby was born to a healthy mother, and, therefore, there are chances of baby getting infected through breast milk. Hence, breast milk should be avoided in this case. The baby needs regular immunization to protect against other infectious diseases. The baby does not need any antiretroviral drugs, because the mother got HIV infection after delivering the baby. Breast milk, even after extracting through a breast pump, should not be fed to the baby, because it can spread infection. The mother needs vaccines, but not live vaccines like BCG or measles-mumps-rubella (MMR). BCG and MMR should be avoided in people with HIV infection, because these patients have a compromised immune system. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. Text Reference - p. 231

A homosexual who was diagnosed with acquired immunodeficiency syndrome (AIDS) has come to a nurse to find out which tests would determine the prognosis of the syndrome. What should the nurse provide? Select all that apply. 1 Prognosis can be assessed by viral load. 2 Prognosis can be assessed by red blood cell count. 3 Prognosis can be assessed by CD4+ T-cell count. 4 Prognosis can be assessed by testing for hepatitis B virus (HBV) or hepatitis C virus (HCV). 5 Prognosis can be assessed by immunoglobulin M (IgM) antibody levels

1, 3 The progression of HIV infection is monitored by two important laboratory assessments: CD4+ T-cell counts and viral load. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4+ T-cell count is done 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 HCV indicate the infection with respective hepatitis virus. IgM antibody levels are nonspecific and do not indicate the progress of AIDS. Text Reference - p. 233

A senior nurse is teaching a nursing student about the infections caused by Mycobacteria. What are the diseases caused by Mycobacteria? Select all that apply. 1 Hansen's disease 2 Tetanus 3 Tuberculosis 4 Pneumonia 5 Toxic shock syndrome

1, 3, 4 Mycobacterium leprae causes leprosy, or Hansen's disease. Mycobacterium tuberculosis causes tuberculosis of the lungs via inhalation of infected droplets. Mycobacterium avium complex (MAC) or Mycobacterium kansasii causes recurrent pneumonia. Tetanus and toxic shock syndromes are not caused by Mycobacteria. Tetanus is caused by Clostridium tetani. Toxic shock syndrome is caused by Staphylococcus aureus. Text Reference - p. 229

As part of an awareness program for high school students on acquired immunodeficiency syndrome (AIDS), a public nurse is giving information about routes of transmission. What information should the nurse provide to students regarding the routes of transmission? Select all that apply. 1 A person can be infected by having intercourse with one stable partner. 2 A person can be infected by donating a pint of whole blood. 3 A person can be infected even if a condom is used each time there is sexual intercourse. 4 A person can be infected if sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies. 5 A person can get infected while hugging or shaking hands with a person infected with HIV.

1, 3, 4 The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. Equipment used in donation is disposable, and the donor does not come into contact with anyone else's blood. Hence, transmission cannot occur by donating blood. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 231

Health care workers should use personal protective equipment (PPE) to protect themselves from infections. What does PPE consist of according to the Occupational Safety and Health Administration (OSHA)? Select all that apply. 1 Gloves 2 Socks 3 Gown, boots, cap 4 Uniform 5 Face mask and eyeglasses

1, 3, 5 According to the OSHA guidelines, items required for PPE are gloves, clothing (gowns, aprons, caps, boots), and face protection (mask and glasses with solid side shields or a chin-length face shield). When removing personal protective equipment (PPE), the gown should be removed prior to the gloves; then hands should be washed. Socks and hospital uniforms do not belong to this category, because they do not protect against infections. Text Reference - p. 230

A patient with acquired immunodeficiency syndrome (AIDS) has come to the hospital without any improvement in condition in spite of antiretroviral therapy. On assessment, the nurse learns that the patient was noncompliant with the therapy. What are the next appropriate nursing actions? Select all that apply. 1 Assess the need for a change in the medication regimen. 2 Avoid discussing the patient's status with other people. 3 Instruct the patient to avoid adjusting dosages, even if the medications interfere with the patient's work schedule. 4 Determine if the patient experienced any adverse effects of the medications. 5 Determine whether the patient understands the need for treatment compliance.

1, 4, 5 Noncompliance to the treatment regimen is common in patients with HIV; therefore, the nurse should evaluate the factors that may lead to the noncompliance. If the noncompliance is caused by side effects, the side effects should be treated or the regimen should be changed. The nurse should determine if the patient experienced any adverse effects to the drugs. Sometimes patients will not comprehend the need for compliance to the antiretroviral therapy. Therefore, the nurse should educate the patient about the importance of compliance. The nurse should engage the patient's family and friends when teaching about the medications and the need for compliance. Sometimes compliance can be improved if the patient adjusts the medication according to a work schedule. Text Reference - p. 242

A human immunodeficiency virus (HIV) patient recently is started on antiretroviral therapy, but does not fully understand the purpose of the medication. The nurse would explain to the patient that the goals of the antiretroviral therapy are which of the following? Select all that apply. 1 To decrease the viral load 2 To cure the HIV disease 3 To stop the HIV disease from progressing 4 To prevent transmission of the HIV disease 5 To maintain or increase the CD4 cell counts 6 To prevent HIV-related opportunistic infections

1, 4, 5, 6 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. Text Reference - p. 237

ANS: B Participation in needle-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. It is difficult to make appropriate decisions about sexual activity when under the influence of drugs.

12. A patient who uses injectable illegal drugs asks the nurse about preventing acquired immunodeficiency syndrome (AIDS). Which response by the nurse is best? a. "Avoid sexual intercourse when using injectable drugs." b. "It is important to participate in a needle-exchange program." c. "You should ask those who share equipment to be tested for HIV." d. "I recommend cleaning drug injection equipment before each use."

The nurse understands that a patient with human immunodeficiency virus (HIV) starts to develop immune problems when his or her CD4 count: 1 drops below 200 2 drops below 500 3 is greater than 500 4 falls to between 800 to 1200

2 Immune problems start to occur when the count drops below 500 CD4 T cells. When it 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 to 1200 CD4 T cells is normal for adults who do not have any immune dysfunction. Text Reference - p. 233

ANS: B It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications should also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day

16. 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 right time? a. Oral acyclovir (Zovirax) b. Oral saquinavir (Invirase) c. Nystatin (Mycostatin) tablet d. Aerosolized pentamidine (NebuPent)

ANS: B The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection, when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.

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

The nurse expects that an antiviral medication will be prescribed for a patient with what diagnosis? 1 Infection 2 Poliomyelitis 3 Lyme disease 4 Blastomycosis

2 Poliomyelitis, also known as polio, or infantile paralysis, is caused by a poliovirus; therefore, antiviral medications should be prescribed to treat it. Lyme disease is caused by the bite of a tick infected with Borrelia burgdorferi; antibiotics should be prescribed for a patient with Lyme disease. Blastomycosis is caused by the fungus Blastomyces dermatitidis and is treated with antifungal medications. Tinea pedis is a skin disease caused by the fungus Trichophyton; antifungal medications should be prescribed. Text Reference - p. 227

A primary health care provider advises against prescribing an antibiotic to a patient with a severe cold, sore throat, and running nose. The patient tells the nurse, "I really want an antibiotic to make this cold go away." What is the best nursing response? 1 Provide a low-dose antibiotic 2 Inform the patient about the use of antibiotics 3 Request the pharmacy technician to provide an antibiotic 4 Communicate the patient request and ask the primary health care provider to prescribe an antibiotic

2 A cold, sore throat, and running 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. The nurse should not give antibiotics to the patient, because frequent use of antibiotics causes resistance. The nurse should not ask the pharmacy technician to provide antibiotics without the primary health care provider's prescription. The nurse should not ask the primary health care provider to prescribe antibiotics. Test-Taking Tip: A cold, sore throat, and running nose indicate a viral infection. Antibiotics are ineffective against viruses. Use this tip in answering this question. Text Reference - p. 230

The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? 1 Droplet precautions 2 Contact precautions 3 Air-borne precautions 4 Standard precautions

2 Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Air-borne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., tuberculosis, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above. Text Reference - p. 231

A patient currently taking emtricitabine, asks the nurse how this medication helps with the patient's human immunodeficiency virus (HIV) infection. The nurse would explain that it: 1 Prevents the binding of the HIV to cells, which prevents HIV entry into the cell. 2 Inserts DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. 3 Inhibits the action of the reverse transciptase enzyme, so that DNA is no longer converted to RNA. 4 Binds with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell.

2 Emtricitabine is classified as a nucleoside reverse transcriptase inhibitor (NRTI), and works by inserting DNA into the HIV DNA chain and blocks further development of the HIV DNA chain. Medications that prevent binding of the HIV to cells are classified as entry inhibitors. Drugs that inhibit the action of the reverse transciptase enzyme so that DNA is no longer converted to RNA, are classified as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Medications that bind with the integrase enzyme, which prevents HIV from incorporating its genetic material into the host cell, are classified as integrase inhibitors. Test-Taking Tip: Try putting questions and answers in your own words to test your understanding. Text Reference - p. 237

Which virus causes Burkitt's lymphoma? 1 Echoviruses 2 Epstein-Barr 3 Rotaviruses 4 West Nile virus

2 Epstein-Barr virus causes mononucleosis and Burkitt's lymphoma. Echoviruses cause upper-respiratory tract infection, gastroenteritis, and aseptic meningitis. Rotaviruses cause gastroenteritis. The West Nile virus causes flu-like symptoms, meningitis, and encephalitis. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 227

A patient is enzyme immunoassay (EIA)-antibody negative for HIV. The patient informs the nurse about recent sexual contact with multiple partners. What is the most appropriate nursing action? 1 Reassure the patient that HIV infection is unlikely. 2 Suggest HIV retesting at three weeks, six weeks, and three months. 3 Advise a more specific test, such as the Western blot. 4 Suggest getting a genotype and phenotype assay done.

2 If the patient is EIA-antibody negative for HIV and has a history of risky behavior, such as sexual contact with multiple partners, the nurse should advise the patient to get retested at three weeks, six weeks, and three months. In the initial stages of infection, the viral antibody may not be detectable; therefore repeated testing may be required. The nurse should inform the patient that absence of antibody does not indicate absence of HIV infection, and to confirm, further testing may be required. If the repeated tests are positive, then a more specific and confirmatory test like Western blot may be done. Genotype and phenotype assays are done not to detect presence of infection, but to determine whether a patient's HIV is resistant to drugs used for antiretroviral therapy. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 236

A health care provider advises a patient not to take leftover antibiotics. The patient later asks the nurse for the rationale behind the health care provider's advice. Which explanations should the nurse give? Select all that apply. 1 The risk of contamination of tablets is reduced. 2 Leftover antibiotics may be fatal for the patient. 3 Bacteria may develop resistance to the antibiotics. 4 The patient's illness may not be a bacterial infection. 5 Leftover antibiotic may not be appropriate for the patient.

2, 3, 4, 5 Leftover antibiotics may lose their effectiveness or sometimes may even be fatal. Inappropriate use of antibiotics may lead to the development of bacterial resistance. The patient may have a disease other than a bacterial infection, so antibiotics may not be helpful. Leftover antibiotics may not provide a sufficient dose to cure the infection or they may not be helpful for the particular type of infection. Usually tablets do not get contaminated. Text Reference - p. 230

A patient with AIDS has been put on antiretroviral therapy and has been taking the medications for four weeks. During the one-month follow-up visit, what findings will help the nurse identify whether the patient is responding to the treatment? Select all that apply. 1 80% drop in viral load 2 90% drop in viral load 3 CD4 T cell count above 14% 4 CD4 T cell count above 400 cells /µL 5 3-unit drop in viral load on a log scale

2, 3, 5 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 that 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 of therapy. A CD4 T cell count above 500 to 600 cells/µL is considered a favorable response to antiretroviral therapy. Text Reference - p. 241

A patient was given 500 mL of O-negative blood after proper cross-matching. Later, it was found that the blood donor was human immunodeficiency virus-(HIV) positive. After two weeks, the patient complained of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and diffuse rash. What could be the possible reason for these symptoms? Select all that apply. 1 Flu 2 Seroconversion 3 Mononucleosis 4 Acute HIV infection 5 Guillain-Barré syndrome

2, 4 In this case, the patient would have acquired HIV infection from the donor. A mononucleosis-like syndrome of fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash often accompanies seroconversion (when HIV-specific antibodies develop). These symptoms, called acute HIV infection, generally occur within two to four weeks after the initial infection and last for one to three weeks, although some symptoms may persist for several months. Many people, including health care providers, mistake acute HIV symptoms for a bad case of the flu. Some people also develop neurologic complications, such as aseptic meningitis, peripheral neuropathy, facial palsy, or Guillain-Barré syndrome. This patient has not yet developed neurologic symptoms. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in one to two minutes. Text Reference - p. 234

A patient who is taking penicillin for an upper respiratory infection asks the nurse why the entire five-day prescription must be taken even when the patient's symptoms are resolved. What explanations should the nurse provide? Select all that apply. 1 Taking the entire prescription reduces allergic reactions. 2 Taking the entire prescription may prevent the risk of drug resistance. 3 Taking the entire prescription allows time for therapeutic action. 4 Taking the entire prescription prevents the risk of survival and multiplication of the hardiest bacteria. 5 Taking the entire prescription reduces the side effects related to the drug.

2, 4 Not completing the prescribed duration of the penicillin prescription may lead to the development of bacterial resistance to penicillin among the surviving bacteria. In the initial stages, the bacteria that are susceptible to penicillin die off. The bacteria that escape the initial doses may require further penicillin administration to be killed; if the patient does not finish the prescription, those hardy bacteria may survive and multiply. Taking the entire prescription does not reduce allergic reactions. Penicillin is an antibiotic with fast killing activity, so allowing time for therapeutic action is not an issue. Penicillin usage for five days does not reduce the side effects related to the drug. Text Reference - p. 229

A patient is admitted to the emergency department with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations? Select all that apply. 1 Assessment of lung sounds 2 Assessment of sexual behavior 3 Assessment of living conditions 4 Assessment of drug and syringe use 5 Assessment of exposure to an ill person

2, 4 With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the human immunodeficiency virus (HIV) should be made or if the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for tuberculosis). The symptoms listed are not indicative of the person being around an acutely ill individual. Text Reference - p. 239

A nurse is asked to teach a human immunodeficiency virus (HIV)-positive patient about the measures to be taken to prevent resistance to antibiotics and infections. What information should the nurse give? Select all that apply. 1 Advise patient to only take antibiotics until the patient feels better. 2 Advise patient to avoid requesting an antibiotic for flu or colds. 3 Advise patient to save unfinished antibiotics for later use. 4 Advise patient to wash hands properly and regularly. 5 Advise patient to avoid skipping antibiotic doses.

2, 4, 5 Antibiotics are effective against bacterial infections but not viruses, which cause colds and flu. Therefore, antibiotics should not be requested for flu or colds. Hand washing is the single most important thing to do to prevent infection. The patient should not skip antibiotic doses, because doing so can lead to development of 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. It is also important to never have leftover antibiotics. Text Reference - p. 230

A patient with HIV infection has been diagnosed with acquired immunodeficiency syndrome (AIDS). Which opportunistic infections should the nurse be watchful for in the patient? Select all that apply. 1 Legionnaires' disease 2 Candidiasis of bronchi 3 Ebola hemorrhagic fever 4 Toxoplasmosis of the brain 5 Mycobacterium avium (MAC) complex

2, 4, 5 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. It rarely causes problems in healthy adults because they have strong immune systems, but is common in people with 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. Text Reference - p. 235

A nurse is caring for a patient diagnosed with acquired immunodeficiency syndrome (AIDS) who wants to know about the opportunistic carcinomas that are included in the diagnostic criteria of AIDS. Which opportunistic cancers should the nurse discuss with the patient? Select all that apply. 1 Melanoma 2 Kaposi sarcoma 3 Hodgkin's lymphoma 4 Burkitt's lymphoma 5 Invasive cervical cancer

2, 4, 5 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. Text Reference - p. 235

ANS: C Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.

2. 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+ T-cell count of less than 200 cells/mL. 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 an acute HIV infection." b. "The patient will be diagnosed with asymptomatic chronic HIV infection." c. "The patient has developed acquired immunodeficiency syndrome (AIDS)." d. "The patient will develop symptomatic chronic HIV infection in less than a year."

ANS: B, C Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.

2. According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection

ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.

22. The registered nurse (RN) caring for an HIV-positive patient admitted with tuberculosis can delegate which action to unlicensed assistive personnel (UAP)? a. Teach the patient about how to use tissues to dispose of respiratory secretions. b. Stock the patient's room with all 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.

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? 1 A new onset of polycythemia 2 Presence of mononucleosis-like symptoms 3 A sharp decrease in the patient's CD4+ count 4 A sudden increase in the patient's white blood cell (WBC) count

3 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. Text Reference - p. 234

The nurse assesses a patient with recently diagnosed human immunodeficiency virus disease who has been admitted to the hospital with a new diagnosis of acquired immunodeficiency syndrome (AIDS). What assessment finding is most diagnostic of AIDS? 1 Sleeping six to eight hours per night 2 Feelings of fatigue in the evening 3 Steady weight loss over the past several months 4 Feelings of profound helplessness and hopelessness

3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping six to eight hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss. Text Reference - p. 234

A patient who has a history of having multiple sexual partners underwent HIV testing through enzyme immunoassay (EIA). The test was negative. How should the nurse explain the test result to the patient? 1 The patient does not have HIV infection. 2 The test might give a false-negative report. 3 The test should be repeated at three weeks, six weeks, and three months. 4 The patient is HIV positive, but the viral load is not detectable.

3 An enzyme immunoassay (EIA) test for HIV is highly sensitive, but a negative result in a person with high risk behavior does not necessarily indicate an absence of HIV infection. The test should be repeated at three weeks, six weeks, and three months. The test is unlikely to give a false-negative result, so the nurse should not disclose this to the patient. The viral load may not be enough to be detected, but the nurse should not tell a patient who tested negative that he or she is HIV positive. Text Reference - p. 236

Which microorganism causes Lyme disease? 1 Hantavirus 2 West Nile virus 3 Borrelia burgdorferi 4 Campylobacter jejuni

3 Borrelia burgdorferi is a bacterium that causes Lyme disease. Hantavirus is a virus that causes hemorrhagic fever associated with severe pulmonary syndrome. West Nile virus is a virus that causes West Nile fever. Campylobacter jejuni is a bacterium that causes diarrhea. Text Reference - p. 228

A nurse is caring for older adults in a long-term care facility. For which early manifestation should the nurse monitor to detect infection in older adults? 1 High fever 2 Pain in the legs 3 Cognitive changes 4 Altered laboratory values

3 In older adults, infections usually have atypical manifestations such as cognitive and behavioral changes. Unlike young adults, older adults have lower core temperatures and decreased immune responses; therefore, they may not have fever as a hallmark sign of infection. Pain, fever, and altered laboratory changes may occur in due course of the disease. Text Reference - p. 230

Which piece of data is of highest priority for the nurse to verify to safely give a dose of cephalexin to a patient? 1 Normal white blood cell count 2 Patient is afebrile 3 No allergy to penicillin 4 Urine output is greater than 30 mL per hour

3 It is critically important to verify that the patient has no allergies to medication, specifically to cephalosporins or penicillins. There is a risk of cross-sensitivity to penicillins and cephalosporins in patients with a known penicillin allergy. An elevated white blood cell count and fever are common in the setting of infection being treated with this antibiotic. Urine output should be greater than 30 mL/hour; however, is not the priority assessment data. Text Reference - p. 230

Which bacteria cause urinary tract infections? 1 Helicobacter pylori 2 Streptococcus faecalis 3 Klebsiella-Enterobacter 4 Haemophilus influenzae

3 Klebsiella-Enterobacter causes urinary tract infections. Helicobacter pylori causes peptic ulcer disease and gastritis. Streptococcus faecalis causes genitourinary infection and infection of surgical wounds. Haemophilus influenza causes nasopharyngitis, meningitis, and pneumonia. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 227

Mycobacterium leprae is identified in a patient's blood culture, and the nurse recognizes that it can cause what condition? 1 Diphtheria 2 Meningitis 3 Hansen's disease 4 Acute osteomyelitis

3 Mycobacterium leprae is a bacterium that causes Hansen's disease (leprosy). Diphtheria is caused by Corynebacterium diphtheriae. Meningitis is caused by Haemophilus influenza, Neisseria meningitides, or Pseudomonas aeruginosa. Acute osteomyelitis is caused by the bacterium Staphylococcus aureus. Text Reference - p. 227

A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1 "The baby probably will be infected with HIV." 2 "Only an abortion will keep your baby from having HIV." 3 "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4 "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

3 On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism are two variables that influence whether transmission of HIV occurs. Volume, virulence, and concentration of the organism, as well as host immune status, are variables related to transmission via blood, semen, vaginal secretions, or breast milk. Text Reference - p. 240

The nurse is providing teaching for a patient who has a new prescription for an antibiotic. Which statement by the patient indicates a need for further teaching? 1 "I will not skip doses of the antibiotic." 2 "I will take the medicine until it is finished." 3 "I will stop taking the antibiotic when my symptoms are better." 4 "I will not share this antibiotic with other members of my family.

3 Patients can contribute to antibiotic resistance development 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. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. Text Reference - p. 230

A patient is admitted to the medical-surgical unit with a diagnosis of pertussis. The nurse plans to implement what necessary precaution? 1 Standard 2 Airborne 3 Droplet 4 Contact

3 Pertussis is a respiratory disease that is spread through the air at close contact, so droplet precautions must be in place to prevent the spread of the disease. Although standard precautions are used to reduce the risk and transmission of microorganisms, it is not the most accurate response. Airborne precautions are used to prevent the spread of infection of diseases that can go over long distances when suspended in the air, such as tuberculosis or rubeola. Contact precautions are used to prevent the spread of pathogens that are acquired from direct or indirect contact, such as methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE). Text Reference - p. 231

The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching? 1 "I can't contract HIV unless there's an opportunistic infection present." 2 "Using a condom with a spermicide will give 100% protection from HIV." 3 "Using a condom with a spermicide will reduce my risk of contracting HIV." 4 "Kaposi sarcoma is one of the first opportunistic infections to show up in someone with HIV."

3 Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse. An opportunistic infection does not have to be present, a condom with spermicide does not provide 100% protection, and Kapos sarcoma is not one of the first opportunistic infections to appear in someone infected with HIV. Text Reference - p. 240

A patient is on first-line therapy for a chronic bacterial infection. The health care provider has prescribed the full course of treatment for 10 days. The patient has skipped one tablet on the morning of the second day but took two tablets that night instead of one. After 7 days, the patient felt well and stopped taking tablets. What could be the possible causes for development of drug resistance in this patient? Select all that apply. 1 Diabetes 2 First-line antibiotics 3 Skipping the dose 4 Poor drug compliance 5 Associated viral infection

3, 4 Causes for drug resistance are using broad-spectrum or combination agents for infections that should be treated with first-line medications, administering antibiotics for viral infections, unnecessary antibiotic therapy, and using inadequate drug regimens. Patients can also contribute to resistance development by skipping doses and not taking antibiotics for the full duration of prescribed therapy. Viral infections and diabetes do not directly contribute to drug resistance. STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage. Text Reference - p. 229

The nurse is assessing a human immunodeficiency virus (HIV)-nfected patient who has been on antiretroviral therapy (ART) for eight months. Which statement about metabolic side effects of ART is true? Select all that apply. 1 Glucose levels often decrease because of insulin resistance. 2 These are a bothersome set of symptoms that are ultimately harmless. 3 ART-related body changes include central fat accumulation and peripheral wasting. 4 Lipid abnormalities include elevated triglyceride levels and decreases in high-density lipoproteins. 5 Bone disease may be improved with exercise, dietary changes, and calcium and vitamin D supplements

3, 4, 5 Some HIV-infected patients, especially those who have been infected and on ART for a long time, develop a set of metabolic disorders that include changes in body shape (i.e., fat deposits in the abdomen, upper back, and breasts, along with fat loss in the arms, legs, and face) caused by lipodystrophy, hyperlipidemia (i.e., elevated triglycerides and decreases in high-density lipoproteins), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease. These disorders are treated early to prevent complications. It is important to recognize and treat these problems early, especially because cardiovascular disease and lactic acidosis are potentially fatal complications. Text Reference - p. 23

A woman is afraid she may get human immunodeficiency virus (HIV) from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis? Select all that apply. 1 Take fluconazole 2 Take amphotericin B 3 Use condoms for risk-reducing sexual relations 4 Take emtricitabine and tenofovir regularly 5 Have regular HIV testing for herself and her husband

3, 4, 5 Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly have been shown to decrease the infection rate of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associated with HIV infection. Text Reference - p. 237

A woman who is three months pregnant finds out that she is human immunodeficiency virus (HIV)-positive on routine HIV testing. She wishes to continue her pregnancy. What information should be given to this patient? Select all that apply. 1 Inform her that the infant will not be infected. 2 Advise her to consider abortion. 3 Advise her to consider tubectomy after delivery. 4 Advise her that antiretroviral therapy (ART) can decrease the risk of transmission. 5 Advise her to follow a healthy lifestyle with nutritious food and regular exercise.

3, 4, 5 Women who are already infected with HIV should be asked about their reproductive desires. Those who choose not to have children should undergo family planning methods like tubectomy. The current standard of care is for all women who are pregnant or contemplating pregnancy to be counseled about HIV, routinely offered access to voluntary HIV-antibody testing, and, if infected, offered optimal ART. In this case, the possibility of maintaining the pregnancy and using ART to decrease the risk of transmission should be discussed. Abortion is not mandatory in such cases. If HIV-infected pregnant women are appropriately treated during pregnancy, the rate of perinatal transmission can be decreased from 25% to less than 2%, but it cannot be guaranteed that the infant will not be infected. The patient should eat a healthy and nutritious diet and do regular exercise to remain active and delay the progression of disease. Text Reference - p. 240

ANS: A, B, E All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection. Hand washing is generally considered the single most effective action in decreasin g infection transmission. Antibiotics are ineffective in treating viral infections such as influenza

3. 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. Continue taking antibiotics until all the medication is gone. b. Antibiotics may sometimes be prescribed to prevent infection. 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.

When reviewing the assessment data of a human immunodeficiency virus (HIV) patient, the nurse notes that the patient's CD4 cell count is below 200, and that the patient has lost more than 10% of his or her ideal body weight. The nurse suspects that the patient is experiencing: 1 Kaposi sarcoma 2 Cytomegalovirus (CMV) 3 Pneumocystis jiroveci pneumonia (PCP) 4 Acquired immunodeficiency syndrome (AIDS

4 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. Text Reference - p. 235

A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? 1 Shaking hands 2 Sharing a toilet seat 3 Eating from the same utensils 4 Having unprotected sex

4 AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes. Text Reference - p. 231

A human immunodeficiency virus (HIV) patient comes into the clinic for a follow-up appointment with a temperature of 102o F. Which statement would the nurse report immediately? 1 "I woke up this morning with a mild headache." 2 "I vomited once this morning." 3 "I started coughing up some clear mucous when I woke up this morning." 4 "I have a rash that appeared on my stomach this morning."

4 Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Headache, vomiting, and coughing are signs and symptoms the reporting of which can be delayed up to 24 hours. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 242

The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? 1 "I need to keep my appointments for follow-up laboratory work." 2 "I will call my health care provider if I am too sick to take these drugs." 3 "I won't take any new drugs or herbal products without checking with my health care provider first." 4 "Once my tests show that the virus has decreased, I cannot give HIV to another person."

4 Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first. Text Reference - p. 235 Topics

A primary health care provider prescribes a blood test for a patient who reports fever, chills, cough, and blood-tinged sputum. The blood reports indicate the presence of Yersinia pestis in the patient's blood sample. Which diagnosis does the nurse anticipate? 1 Diarrhea 2 Pertussis 3 Diphtheria 4 Pneumonic plague

4 Fever, chills, cough, and bloody sputum indicate that the patient has pneumonic plague. Yersinia pestis is the bacterium that causes plague. Giardia is a parasite that causes diarrhea. Bordetella pertussis is a bacterium that causes pertussis, a respiratory disease characterized by loud whooping inspiration. Corynebacterium diphtheriae causes diphtheria, which is characterized by localized skin or mucous membrane infection. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 229

A patient reports fever, chills, headache, and weakness. Upon physical examination, the nurse finds swollen lymph glands. The nurse suspects which infection? 1 Shingles 2 Pertussis 3 Tuberculosis 4 Bubonic plague

4 Fever, chills, headache, extreme weakness, and swollen lymph glands or lymph nodes indicate bubonic plague, which is a reemerging infection caused by Yersinia pestis. Shingles is a viral infection caused by Varicella zoster virus; symptoms include an erythematous maculopapular rash along the dermatomal planes, pain, and pruritus. Pertussis is a respiratory disease caused by the Bordetella pertussis bacterium and is characterized by loud whooping inspiration, cough, sneezing, and nasal discharge. Tuberculosis is characterized by productive cough, fever, night sweats, and weight loss, and it is caused by Mycobacterium tuberculosis. Text Reference - p. 229

A patient has an undetectable level of plasma human immunodeficiency virus (HIV) RNA after six months of antiretroviral therapy. The patient exclaims, "I'm so glad to be cured!" Which response by the nurse is most therapeutic and accurate? 1 "Oh,that is wonderful. I'm glad everything worked out so well for you." 2 "No, you're wrong. You're never going to be cured—this is a lifelong illness." 3 "You should be very pleased, and I think you should celebrate the good news." 4 "An undetectable level means that your therapy was successful but not that you were cured."

4 Human immunodeficiency virus antiretroviral therapy can reduce viral load, resulting in an undetectable serum level. This does not indicate a cure; rather, it indicates that the therapy is working and that the patient must continue to take the medication. Congratulating the patient, or telling him or her to celebrate, is inaccurate and incorrect; telling the patient that he or she is wrong and will never be cured is nontherapeutic. Text Reference - p. 243

The nurse reviews a plan of care for a patient who has sustained a deep laceration to an extremity. Which goal listed on the plan is inappropriate and should be questioned by the nurse? 1 The patient will be free of signs and symptoms of infection. 2 The patient will demonstrate how to change the sterile dressing on the laceration. 3 The patient will report any change in sensation of the extremity distal to the laceration. 4 The patient will stop taking the antibiotics after two days if he or she detects no signs of infection.

4 If antibiotics are prescribed, the patient should not stop them; rather, the entire course should be taken even if there are no signs of infection. Appropriate goals for this patient are to be free of signs and symptoms of infection, to maintain a dry and intact dressing, and to report changes in the distal extremity. Text Reference - p. 230

The laboratory reports of a patient indicate that the patient has a Klebsiella pneumoniae infection. The nurse anticipates that which medication will be prescribed? 1 Methicillin 2 Ceftriaxone 3 Ceftazidime 4 Meropenem

4 Klebsiella pneumoniae is a gram-negative bacterium that is sensitive to meropenem, which acts by inhibiting the bacterial cell wall synthesis. Methicillin is a penicillinase-resistant antibiotic that is not effective against Klebsiella pneumoniae. Ceftriaxone and ceftazidime are third-generation cephalosporins; they are not effective against Klebsiella pneumoniae. Text Reference - p. 229

A patient receiving long-term antiretroviral therapy (ART) for HIV has developed lipodystrophy, hyperlipidemia, insulin resistance, and bone disease. Which should be the first intervention? 1 Suggest dietary changes to lower lipid levels. 2 Promote weight loss through exercise. 3 Advocate use of calcium supplements. 4 Change antiretroviral medications.

4 Long-term therapy with antiretroviral drugs may lead to development of certain metabolic disorders, including lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, renal disease, and cardiovascular disease. Therefore, the first intervention should be to change the antiretroviral drug and start medications that have fewer side effects. Other interventions like dietary changes, weight loss through exercise, and taking calcium supplements are general measures and may not contribute directly to the reduction of side effects. Text Reference - p. 243

A patient with a bacterial infection is prescribed penicillin G. After reviewing the patient's laboratory report, the nurse anticipates a need for a medication change to either ceftriaxone or cefotaxime. Which microorganism did the nurse likely find in the report? 1 Enterococcus faecalis 2 Staphylococcus aureus 3 Staphylococcus epidermidis 4 Streptococcus pneumoniae

4 Penicillin G is a beta-lactam antibiotic that kills bacteria by blocking the cell wall production and the cross-linking enzyme transpeptidase. Streptococcus pneumoniae is a gram-positive bacterium and is resistant to penicillin G. Ceftriaxone or cefotaxime can be used to treat infections caused by Streptococcus pneumoniae, because these medications act by inhibiting the bacterial cell wall synthesis. Enterococcus faecalis is a gram-positive bacterium that is sensitive to penicillin G or ampicillin. Staphylococcus aureus is a gram-positive coccal bacterium that is sensitive to vancomycin. Ceftriaxone and cefotaxime are not effective in killing Staphylococcus epidermidis; this gram-positive bacterium is sensitive to vancomycin. Text Reference - p. 229

ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

5. A pregnant woman with a history of 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 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 therapy (ART).

ANS: A Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

6. Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Needle stick with a needle and syringe used to draw blood b. Splash into the eyes when emptying a bedpan containing stool c. Contamination of open skin lesions with patient vaginal secretions d. Needle stick injury with a suture needle during a surgical procedure

ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and the community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.

8. 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. HIV genotype and phenotype b. Patient's social support system c. Potential medication side effects d. Patient's ability to comply with ART schedule

ANS: D CMV retinitis is an acquired immunodeficiency syndrome (AIDS)-defining illness and indicates that the patient is appropriate for ART even though the HIV infection period is relatively short. An HIV-negative patient would not be offered ART. A patient with a CD4+ count in the normal range would not typically be started on ART. A patient who drinks alcohol heavily would be unlikely to be able to manage the complex drug regimen and would not be appropriate for ART despite the low CD4+ count.

9. The nurse will most likely prepare a medication teaching plan about antiretroviral therapy (ART) for which patient? a. Patient who is currently HIV negative but has unprotected sex with multiple partners b. Patient who was infected with HIV 15 years ago and now has a CD4+ count of 840/µL c. HIV-positive patient with a CD4+ count of 160/µL who drinks a fifth of whiskey daily d. Patient who tested positive for HIV 2 years ago and now has cytomegalovirus (CMV) retinitis