Med Surg Week 4: HIV/AIDS, Transfusions

Statistics on AIDS: worldwide and US

-658,000 people have died from Aids -50,000 are diagnosed annually -2 million people per year are newly infected -in US: 1 million people living with AIDS

Stage 2 HIV

-CD4+ T-cell count between 200 and 499 cells/mm3 -CD4+ T-cell percentage of 14%-28% -No AIDS-defining illness

Which methods or items are means of transmitting HIV (Select all that apply) a. sex b. household utensils c. breast milk d. toilet facilities e. mosquitoes

A. C

A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client? A. Fluconazole (Diflucan) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Rifampin (Rifadin) D. Acyclovir (Zovirax)

A. Fluconazole (Diflucan)

What solution or solutions below are compatible with red blood cells? Select all that apply. A. Normal Saline B. Dextrose Solutions C. Any medications with normal saline D. No solutions are compatible with blood

A. Normal Saline Rationale: only normal saline is compatible with blood

When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant other for discharge, which explanation by the nurse accurately describes proper condom use? A. "Condoms should be used when lesions are present on the penis." B. "Always position the condom with a space at the tip of an erect penis." C. "Make sure it fits loosely to allow for penile erection." D. "Use adequate lubrication, such as petroleum jelly."

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

What type of precautions should the nurse take for a patient suspected of having TB as a result of HIV? A. universal b. airborne c. enteric d. protective isolation

B. Airborne

What is the most important means of preventing HIV spread? A. engineering B. education C. isolation D. counseling

B. Education

How does HIV virus enter cell?

Binding of viral envelope glycoprotein to receptors on CD4+ cells; called "docking"

Cryptosporidiosis is a form of intestinal infection in which diarrhea can amount to a loss of how many liters of fluid per day? A. 1-2 B. 3-5 c. 5-8 d. 15-20

D. 15-20 L

What blood type is known as the "universal donor"? A. Type A B. Type B C. Type AB D. Type O

D. Type O

which treatments are intended to boost the immune system? a. protease inhibitors b. hematopoietic growth factors c. lymphocyte transfusion d. interleukin-2 infusion

D. interleukin-2 infusion

Example of fast and slow HIV infection course

Fast: adults who receive transfusions of contaminated blood products Slow: adults who contract HIV from single sexual encounter

Acute hemolytic reaction prevention

Meticulously verify and document patient ID from sample collection to component infusion (e.g. visually compare label on sample collection and blood component with patient identification)

Sepsis Transfusion Reaction manifestations

Rapid onset of chills High fever Vomiting Diarrhea Marked hypotension Shock

Transfusion-related acute lung injury (TRALI) reaction cause

Reaction between transfused anti-leukocyte antibodies and recipient's leukocytes, causing pulmonary inflammation and capillary leak

Febrile non-hemolytic transfusion reaction prevention

-Consider leukocyte-reduced blood products (filtered, washed, or frozen) for patients with a history of two or more such reactions -Give acetaminophen or diphenhydramine (Benadryl) 3o min prior to infusion

Transfusion-related acute lung injury reaction (TRALI) management

-Draw blood for ABG and human leukocyte antigen (HLA) or antileukocyte antibodies -Provide O2 and administer corticosteroids as ordered -Initiate CPR if needed and provide ventilatory and BP support if needed

Transfusion-related acute lung injury (TRALI) reaction manifestations

-Fever -Chills -Hypotension -Hypoxemia -Respiratory failure -Noncardiogenic pulmonary edema -Leading cause of transfusion-related deaths -Arises 1-6 hours after infusion

Circulator overload reaction cause

-Fluid administered faster than the circulation can accomodate -People with cardiac or renal disease are at risk

Mild allergic transfusion reaction manifestations

-Flushing -Itching -Pruritus -Urticaria (hives)

Mild allergic transfusion reaction treatment

-Give antihistamine, corticosteroid, epinephrine, as ordered -If symptoms are mild and transient, transfusion may be restarted slowly with HCP's order -Do not restart transfusion if fever or pulmonary symptoms develop

Febrile non-hemolytic transfusion reaction treatment

-Give antipyretics as prescribed (acetaminophen) -Avoid aspirin in thrombocytopenic patients -Do not restart transfusion unless HCP orders

What is HAART?

-Highly active anti-retroviral therapy: 2-4 HIV meds used to slow progression of HIV, reduce viral load, etc. -Multiple drugs are used because they work on different mechanisms of the virus' life cycle -Causes less mutations by virus and is more effective -Stress importance of medication compliance! Must take 9/10 doses correctly for it to work optimally

Opportunistic infections

-Infection caused by organisms that are present as part of the normal environment and would be kept in check by normal immune function

Anaphylactic and severe allergic transfusion reaction management

-Initiate CPR if indicated -Administer O2 -Have epinephrine ready for injection -Antihistamines, corticosteroids, B2 agonists may also be prescribed -Do not restart transfusion

What are the effects of HIV on immune system cells?

-Lymphocytopenia -increased production of incomplete, nonfunctional antibodies -abnormally functioning macrophages

Sepsis Transfusion Reaction management

-Obtain culture of patient's blood -Treat septicemia as direction: antibiotics, IV fluids, vasopressors

Common HIV complications

-Opportunistic infections -Wasting syndrome -F&E Imbalance -HIV encephalopathy

Circulatory overload reaction management

-Place patient upright with feet in dependent position -Obtain CXR stat if ordered -Administer prescribed diuretics, O2, morphine -Phlebotomy may be indicated

Transfusion-related acute lung injury reaction (TRALI) prevention

-Provide leukocyte-reduced products -Identify donors who are implicated in TRALI reactions and do not allow them to donate

Which actions can the nurse delegate to the UAP who will be giving mouth care to a patient with HIV/AIDS (Select all that apply) a. offer mouth rinses with sodium bicarb and sterile water several times a day b. assess mouth for increased presence of lesions c. encourage the patient to drink plenty of fluids d. provide a soft bristled toothbrush e. administer oral analgesic gel

A, C, D

where can candidiasis occur in the body (Select all that apply) a. nose b. esophagus c. vagina d. mouth e. ears

B, C, D

According to the American Association of Blood Banks, what is the recommended hemoglobin level for a blood transfusion? A. 5-7 g/dL B. 7-8 g/dL C. 4-7 g/dL D. 9-10 g/dL

B. 7-8 g/dL Rationale: This is the recent recommendation for by the AABB (7-8 g/dL).

What blood type is known as the "universal recipient"? A. Type A B. Type B C. Type AB D. Type O

C. Type AB

What cells are targeted by HIV?

CD4 lymphocytes (T-helper cells)

What is often the first S/S of HIV/AIDS for women?

Chronic yeast infection or UTI

A patient who needs a unit of packed red blood cells is ordered by the physician to be premeditated with oral diphenhydramine and acetaminophen. You will administer these medications? A. 15 minutes before starting the transfusion B. Immediately after starting the transfusion C. Right before starting the transfusion D. 30 minutes before starting the transfusion

D. 30 minutes before starting the transfusion RaiFor ORAL medications you will administer the medications 30 minutes before starting the transfusion.

What is the clinical relevance about HIV's 12 step life cycle?

Different parts of the life cycle can be targeted by different drugs, leading to more effective treatment that produces less viral mutations

True or False: Genetic testing has no benefit in the treatment plan of a patient with HIV

False The HIV genotype test is used to determine whether any mutations exist in the strain of HIV that has infected the patient. This test is useful before starting antiretroviral therapy to learn whether the patient is infected with a resistant strain of HIV.

What is the most important body system to monitor for patient with HIV/AIDS?

Focused respiratory assessment-- patients have higher risk for pneumonias, TB, and other respiratory infections

Stages of HIV

Stage 0 Stage 1 Stage 2 Stage 3 Stage Unknown

Sepsis Transfusion Reaction cause

Transfusion of bacterially infected blood components

What is the leading cause of transfusion-related deaths?

Transfusion-related acute lung injury reaction (TRALI)

Role of reverse transcriptase in HIV infection

enzyme that converts HIV RNA into host DNA and alters the host immune system

What happens 2-4 weeks after HIV infection? ***

flu-like symptoms occur

HIV/AIDS RN Education

o Medication use and dosing o Importance of hand hygiene o Minimize travel o Avoid raw vegetables and meats o Avoid kitty litter (toxoplasmosis) o Keep home environment as clean as possible o Practice safe sex o Potential side effects of medications o NEED FOR FOLLOW UP LABS o SIGNS AND SYMPTOMS OF INFECTION o NEED FOR MEDICATION COMPLIANCE o Monitor CD4 + Viral Load Counts o Hygiene - home environment o Infection exposure

which malignancy is most common in patients with HIV/AIDS a. non-hodgkins B cell lymphoma b. anal cancer c. primary brain cancer d. kaposi's sarcoma

D. kaposi's sarcoma

Which is the most common route for a HCP to contract HIV A. blood B. bodily fluids C. mucous membranes D. needle sticks

D. needle sticks

Which statement regarding HIV/AIDS among older adults is true? A. the risk for HIV infection after exposure is minimal for older adults B. older men are more susceptible to HIV C. it is not necessary to assess an older adult for history of drug use D. older adults who participate in high-risk behaviors are susceptible to HIV

D. older adults who participate in high-risk behaviors are susceptible to HIV

HIV Diagnosis***

--Round ONE: Positive HIV antibody screening (4th gen Ab-Ag) OR a positive ELISA --If one of those are positive: confirmed by a positive Western blot or an indirect immunofluorescent test --Patient must also have a positive HIV nucleic acid, HIV p24 antigen, HIV isolation viral culture

Circulatory overload reaction prevention

-Adjust transfusion volume and flow rate based on patient size and clinical status. -Have blood bank divide future units into smaller aliquots for better spacing of fluid infused

Anaphylactic and severe allergic transfusion reaction manifestations

-Anxiety -Urticaria -Dyspnea -Wheezing -Progressing to cyanosis, bronchospasm, hypotension, shock, and possible cardiac arrest

Which labs should you monitor when patient is undergoing HAART?

-CBC, with special attention to WBC; may see increase in MCV -Liver tests: may see increase in ALT, AST, bilirubin -Lipid panel: may seen increase in cholesterol and triglycerides

What is the end result of the 2nd HIV stage?

-CD4 cells destroyed -viral load increases -dramatic loss of immunity

Stage 1 HIV

-CD4+ T-cell count of greater than 500 cells/mm3 (0.5 × 109/L) OR -CD4+ T-cell percentage of 29% or greater -No AIDS-defining illnesses

Stage 3 HIV (AIDS)***

-CD4+ T-cell count of less than 200/mm3 -CD4+ T-cell percentage less than 14% -A person with an AIDS-defining illness, regardless of CD4 count, also meets the criteria for stage 3

Effects of HIV infection

-CD4+ T-cells become "HIV factory" to make new viral particles daily -Gradually, CD4+ T-cell count falls, viral load rises -Immune systems weakens -Everyone with AIDS has HIV; not everyone with HIV has AIDS

Massive blood transfusion reaction cause

-Can occur with replacement of 10 or more RBC units within 24 hours -RBC transfusions do not contain clotting factors, albumin, and platelets

Hep B and C delayed transfusion rxn

-Cause: blood infected with virus -S/S: elevated liver enzymes (AST and ALT), anorexia, malaise, N/V. fever, dark urine, jaundice -Usually resolves in 4-6 weeks, although chronic carrier state can develop and result in permanent damage to liver -Hep C is similar to S/S above, but symptoms are usually less severe. Chronic liver disease and cirrhosis may develop -Prevention: detect viruses in donated blood via surface antigens (HBsAg) or anti-HCV antibody -Treatment: Symptomatically

Iron overload delayed reaction: cause, S/S, treatment

-Cause: excess iron is deposited into heart, liver, pancreas, and joints, causing dysfunction (occurs in patients receiving greater than 100 units for chronic anemia over time-- SCD, thalassemia) -S/S: HF, dysrhythmias, impaired thyroid and gonadal function, diabetes, arthritis, cirrhosis -Tx: treat symptomatically; chelating agents remove excess iron from body

Sepsis Transfusion Reaction prevention

-Collect, process, store, and transfused blood products according to blood banking standards -Complete the transfusion within 4 hr of starting time

Delayed transfusion reactions

-Delayed hemolytic -Hep B or C -Iron overload -Other (infections)

Antineoplastic medication

-Enhance immune response and inhibit bad cells from replication -ex: Interleukin (Interferon)

Massive blood transfusion reaction manifestations

-Hypothermia and cardiac dysrhythmias (from rapid infusion of large quantities of cold blood) -Citrate toxicity (from the use of citrate as a storage solution) -Hypocalcemia manifested as muscle tremors and ECG changes (citrate binds calcium) -Hyperkalemia manifested as muscle weakness, diarrhea, paresthesaias, paralysis of cardiac or respiratory muscles, or cardiac arrest (stored RBC leak potassium)

Acute hemolytic transfusion casue

-Infusion of ABO-incompatible whole blood, RBC, or components containing greater than 10 ml of RBC -Antibodies in the recipient's plasma attach to antigens on transfused RBC, causing RBC destruction (hemolysis)

Non-nucleoside reverse transcriptase inhibitors

-Inhibit viral replication in the cell -Ex: Delvirdine (Rescriptor) and Efavirenz (Sustiva)

Delayed hemolytic rxn: S/S, prevention, management

-S/S: fever, mild jaundice, decreased hgb -Occurs as early as 3 days or as late as several months post=transfusion as the result of destruction of transfused RBC by alloantibodies (recipient's antibodies) not detected during crossmatch -Prevention and treatment: No acute treatment is usually required, although hemolysis may be severe enough to warrant further transfusions

Mild allergic transfusion reaction cause

-Sensitivity to foreign plasma proteins -More common in people with hx of allergies

Febrile non-hemolytic transfusion reaction manifestations

-Sudden chills -Rigor -Fever (rise in temperature greater than 1 degree celsius) -Headache -Flushing -Anxiety -Vomiting -Muscle pain

Anaphylactic and severe allergic transfusion reaction pevention

-Transfuse extensively washed RBC products from which all plasma has been removed -Use blood from IgA-deficient donor -Use autologous components

Mild allergic transfusion reaction prevention

-Treat prophylactically with antihistamines or steroids -Consider washed RBCs and platelets

Acute hemolytic reaction management

-Treat shock and DIC if present -Draw blood samples for serologic testing slowly to avoid hemolysis from the procedure -Send urine specimen to the lab -Maintain BP with IV colloid solutions -Give diuretics as prescribed to maintain urine flow -Insert indwelling urinary catheter or measure voided amounts to monitor hourly urine output. Dialysis may be required if renal failure occurs. -Do not transfuse additional RBC-containing components until blood bank has provided newly crossmatched units

Massive blood transfusion reaction prevention

-Use blood-warming equipment -Infusion of 10% calcium gluconate (10mL with every 1L of citrated blood) -Because of dilution effect on coagulation due to massive RBC transfusion, platelets and plasma will also be administered

Acute hemolytic reaction manifestations

-Usually develops in first 15 min -Fever with or without chills -Low back, abdominal, chest, or flank pain -Flushing -Tachycardia -Dyspnea or tachypnea -Hypotension or vascular collapse -Hemoglobinuria / dark urine -Acute jaundice -Bleeding -Acute kidney injry -Shock, cardiac arrest, DIC -Death

Stage 0 HIV

-a patient who develops a first positive HIV test result within 6 months after a negative HIV test result -Changing the patient's status to stage 1, 2, or 3 does not occur until 6 months have elapsed since the stage 0 designation, even when CD4+ T-cell counts decrease or an AIDS-defining condition is present.

Which conditions cause severe pain in HIV and AIDS (Select all that apply) a. enlarged organs b. peripheral neuropathy c. tumors d. high fever e. dry skin

A, B, C

An HIV positive women who is pregnant asks if her baby is at risk for HIV. which points must the nurse be sure to include when teaching? (Select all that apply) A. HIV can cross the placenta B. infant can contract HIV with exposure to blood and vaginal secretions during birth C. once your baby is born, you should be able to breastfeed D. there is a risk for perinatal transmission of HIV from you to your child. because you are on drug therapy, that risk is about 8% E. consider oral contraceptives to protect yourself from other STDs

A, B, D

Which actions are useful in helping orient a patient (Select all that apply) a. repeating person, place, time b. using clocks and calendars c. using MMSE screening test d. having familiar items present e. providing uninterrupted time

A, B, D

what methods or agents are used to treat kaposi's sarcoma (Select all that apply) a. radiotherapy b. chemo c. antibiotics d. cryotherapy e. surgery

A, B, D

the nurse assesses a patient diagnosed with advanced AIDS for malnutrition. which findings does the nurse most likely assess (Select all that apply) a. pain b. anorexia c. urinary incontinence d. diarrhea e. vomiting

A, B, D, E

Which factors are possible transmission routes for human immune deficiency virus (HIV)? Select all that apply. A. Breast-feeding B. Anal intercourse C. Mosquito bites D. Toileting facilities E. Oral sex

A, B, E

Corticosteroids perform which actions (Select all that apply) a. block movement of neutrophils and monoctyes through cell membrane b. increase cell production in the bone marrow c. reduce number of circulating t cells, resulting in suppressed cell mediated immunity d. decrease ICP (intracranial pressure) e. constrict blood vessels

A, C, D

Where in the body can cytomegalovirus present with symptoms? (Select all that apply) a. eyes, causing visual impairment b. kidneys as glomerulonephritis c. respiratory tract causing pneumonia d. GI tract, causing diarrhea e. heart as cardiomyopathy

A, C, D

Which lab results will the nurse expect to decrease (Select all that apply) a. cd4+ b. cd8+ c. WBC d. lymphocytes e. HIV antibodies

A, C, D

which conditions may be the first signs of HIV in women? (Select all that apply) A. vaginal candidiasis B. bladder infections C. cervical caner D. PID E. mononucleosis

A, C, D

A patient presenting with toxicoplasmosis may have with s/s? (Select all that apply) A. speech difficulty B. Shortness of breath C. visual changes D. impaired gait E. mental status changes

A, C, D, E

Which opportunistic infections can be observed in AIDS (Select all that apply) A. toxicoplasmosis B. gastroenteritis C. TB D. candidiasis E. cytomegalovirus

A, C, D, E

A patient needs 2 units of packed red blood cells. The patient is typed and crossmatched. The patient has B+ blood. As the nurse you know the patient can receive what type of blood? Select all that apply: A. B- B. A+ C. O- D. B+ E. O+ F. A- G. AB+ H. AB-

A, C, D, E Rationale: The patient must receive blood from either a donor that has O or B blood. Since the patient is B+ (Rh factor is positive), they can receive both negative or positive blood. So, the patient can receive B-, B+, O-, and O+ blood.

The nurse presents a seminar on human immune deficiency virus (HIV) testing to a group of seniors and their caregivers in an assisted-living facility. Which responses fit the recommendations of the Centers for Disease Control and Prevention regarding HIV testing? Select all that apply. A. "I am 78 years old, and I was treated and cured of syphilis many years ago." B. "In 1986, I received a transfusion of platelets." C, "Seven years ago, I was released from a penitentiary." D "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." E. "At 68, I am going to get married for the fourth time."

A, C, E

Which practices are recommended to prevent transmission of HIV? (Select all that apply) A. latex condoms for genital and anal intercourse B. natural membrane condoms for genital and anal intercourse C. topical contraceptives D. antiviral meds E. latex barrier for genital and anal intercourse

A, E

The nurse who is about to begin a blood transfusion knows that blood cells start to deteriorate after a certain period of time. The nurse takes which actions in order to prevent a complication of the blood transfusion as it relates to deterioration of blood cells? Select all that apply. A. Checks the expiration date B. Inspects for the presence of clots C. Checks the blood group and type D. Checks the blood identification number E. Hangs the blood within the specified time frame per agency policy

A, E Rationale: The nurse notes the expiration date on the unit of blood to ensure that the blood is fresh. Blood cells begin to deteriorate over time, so safe storage usually is limited to 35 days. Careful notation of the expiration date by the nurse is an essential part of the verification process before hanging a unit of blood. The nurse also needs to hang the blood within the specified time frame after receiving it from the blood bank per agency policy to ensure that the blood being transfused is fresh. The blood bank keeps the blood regulated at a specific temperature, and therefore it must be infused within a specified time frame once received on the unit. The nurse also notes the blood identification (unit) number, blood group and type, and client's name, but this is not specifically related to the degradation of blood cells. The nurse also inspects the unit of blood for leaks, abnormal color, clots, and bubbles and returns the unit to the blood bank if clots are noted. Again, this is not related to the degradation of blood cells over time.

Your patient is having a transfusion reaction. You immediately stop the transfusion. Next you will: A. Notify the physician. B. Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. C. Collect urine sample. D. Send the blood tubing and bag to the blood bank.

B. Disconnect the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. Rationale: This question wants to know your NEXT nursing action. AFTER stopping the transfusion, the nurse will DISCONNECT the blood tubing from the IV site and replace it with a new IV tubing set-up and keep the vein open with normal saline 0.9%. This will limit any more blood from entering the patient's system. THEN the nurse will notify the MD and blood bank.

Which factor relates most directly to a diagnosis of primary immune deficiency? A. History of viral infection B. Full-term infant surfactant deficiency C. Contact with anthrax toxin D. Corticosteroid therapy

B. Full-term infant surfactant deficiency

Which groups are experiencing increased numbers of HIV infection? (Select all that apply) A. men having sex with other men B. IV drug users C. women having sex with men D. african americans E. hispanics

D, E

Following infusion of a unit of packed red blood cells, the client has developed new onset of tachycardia, bounding pulses, crackles, and wheezes. Which action should the nurse implement first? A. Maintain bed rest with legs elevated. B. Place the client in high Fowler's position. C. Increase the rate of infusion of intravenous fluids. D. Consult with the health care provider (HCP) regarding initiation of oxygen therapy.

B. Place the client in high Fowler's position. Rationale: New onset of tachycardia, bounding pulses, and crackles and wheezes posttransfusion is evidence of fluid overload, a complication associated with blood transfusions. Placing the client in a high Fowler's (upright) position will facilitate breathing. Measures that increase blood return to the heart, such as leg elevation and administration of IV fluids, should be avoided at this time. In addition, administration of fluids cannot be initiated without a prescription. Consulting with the HCP regarding administration of oxygen may be necessary, but positional changes take a short amount of time to do and should be initiated first.

A client who is human immune deficiency virus positive is experiencing anorexia and diarrhea. Which nursing actions does the nurse delegate to a nursing assistant? A. Collaborate with the client to select foods that are high in calories. B. Provide oral care to the client before meals to enhance appetite. C. Assess the perianal area every 8 hours for signs of skin breakdown. D. Discuss the need to avoid foods that are spicy or irritating.

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

A patient who has been diagnosed with acquired immunodeficiency syndrome (AIDS) develops an oral Candida infection. When teaching the patient, the healthcare provider will include which of the following instructions? A. Include plenty of citrus juices in your diet B. Select foods that are soft or pureed C. Include hot soups and beverages with each meal D. Rinse your mouth often with a commercial mouthwash

B. Select foods that are soft or pureed

The nurse is providing care to a client with impaired oxygenation related to anemia. Which nursing intervention has the highest priority? A. Administer antibiotics as prescribed. B. Transfuse ordered packed red blood cells. C. Teach pursed-lip breathing. D. Encourage increased fluid intake.

B. Transfuse ordered packed red blood cells.

HAART causes what effects? A. reversal of a patients antibody status B. decrease of the viral load C. increase of the viral load D. more delectable HIV

B. decrease of the viral load

which definition of immunodeficiency is accurate? A. disease/deficiency acquired as a result of viral infection, contact with toxin, or medical therapy B. deficient immune response as a result of impaired or missing immune components C. chronic infection with immunodeficiency virus D. disease/deficiency present since birth

B. deficient immune response as a result of impaired or missing immune components

Before starting a blood transfusion the nurse will perform a verification process with __________. This will include? A. any available personnel; physician's order, patient's identification, blood bank's information, expiration date of blood B. licensed personnel only (another RN); physician's order, patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, assess the bag of blood for damage or abnormal substances C. blood bank; patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, bag of blood for damage or abnormal substances D. licensed personnel only (another RN); blood compatibility, physician order, expiration date

B. licensed personnel only (another RN); physician's order, patient's identification, blood bank's information, patient's blood type and donor's type along with Rh factor, expiration date, assess the bag of blood for damage or abnormal substances Rationale: he nurse will verify with another licensed personnel (another RN) the physician's order, patient's identification and blood bank's information, patient's blood type and donor's type along with the Rh factor, expiration date, assess the bag for damage or abnormal substances BEFORE starting the transfusion.

The nurse is teaching a patient about preventing infection through sex. which statement indicates effective teaching? a. latex condom with spermicide proves the best protection b. mutually monogamous sex with a non infected partner will best prevent HIV c. contraceptive methods like implants and injections are recommended to prevent HIV transmission d. if my partner and i are both HIV positive, unprotected sex is permitted

B. mutually monogamous sex with a non infected partner will best prevent HIV

A patient is ordered to receive 2 units of packed red blood cells. The first unit was started at 1400 and ended at 1800. You send for the other bag of red blood cells. As the nurse you know it is priority to: A. obtain signed informed consent for the second unit of blood from the patient B. obtain a new y-tubing set for this unit of blood C. type and crossmatch the patient D. hang a new bag of dextrose to transfuse with the blood

B. obtain a new y-tubing set for this unit of blood The patient has already received 1 unit of blood and another unit is needed. It took 4 hours for the first unit to transfuse and the nurse needs to obtain new y-tubing for the next unit of blood. Y-tubing sets are only good for 4 hours. Some hospitals require new tubing sets with each unit transfusion or after 4 hours....always check your hospital's protocol.

The nurse is conducting a health assessment interview with a client diagnosed with human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address? A. "When I injected heroin, I was exposed to HIV." B. "I don't understand how the antiretroviral drugs work." C. "I remember to take my antiretroviral drugs almost every day." D. "My sex drive is weaker than it used to be since I started taking my antiretroviral medications."

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

The nurse is instructing an unlicensed health care worker on the care of a client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions? A. "I need to know my HIV status, so I must get tested before caring for any clients." B. "Putting on a gown and gloves will cover up the itchy sores on my elbows." C. "Washing my hands and putting on a gown and gloves is what I must do before starting care." D. "I will wash my hands before going into the room, and then will put on a gown and gloves only for direct contact with the client's genitals."

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

Your patient needs 1 unit of packed red blood cells. You've completed all the prep and the blood bank notifies you the patient's unit of blood is ready. You send for the blood and the transporter arrives with the unit at 1200. You know that you must start transfusing the blood within _________. A. 5 minutes B. 15 minutes C. 30 minutes D. 1 hour

C. 30 minutes

The nurse enters a client's room to assess the client, who began receiving a blood transfusion 45 minutes earlier, and notes that the client is flushed and dyspneic. On assessment, the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client most likely is experiencing which complication of blood transfusion therapy? A. Bacteremia B. Hypovolemia C. Circulatory overload D. Transfusion reaction

C. Circulatory overload Rationale: Circulatory overload is caused by the infusion of blood at a rate too rapid for the client to tolerate. With circulatory overload, crackles are present in addition to dyspnea. An allergic reaction, which is one type of blood transfusion reaction, would produce symptoms such as flushing, dyspnea, itching, and a generalized rash. Hypovolemia is not likely a complication of blood transfusion. With bacteremia, the client would have a fever, which is not part of the clinical picture presented

Before initiating the blood transfusion, you obtain the patient's baseline vital signs, which are: heart rate 100, blood pressure 115/72, respiratory rate 18, and temperature 100.8'F. Your next action is to: A. Administer the blood transfusion as ordered. B. Hold the blood transfusion and reassess vital signs in 1 hour. C. Notify the physician before starting the transfusion. D. Administer 200 mL of the blood and then reassess the patient's vital signs.

C. Notify the physician before starting the transfusion Rationale: The patient has an elevated temperature. Any temperature greater than 100'F (before the administration of the blood) the physician should be notified. In addition, transfusions must be started within 30 minutes of receiving the unit(s). Therefore, holding for 1 hour is against transfusion policy.

A client who is human immune deficiency virus (HIV) positive and has a CD4+ count of 15 has just been admitted with a fever and abdominal pain. Which health care provider request does the nurse implement first? A. Obtain a 12-lead electrocardiogram (ECG). B. Call for a portable chest x-ray. C. Obtain blood cultures from two sites. D. Give cefazolin (Kefzol) 500 mg IV.

C. Obtain blood cultures from two sites.

In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority? A. Loss of social contact related to misunderstanding of transmission of acquired secondary immune deficiency and the social stigma B. Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency C. Potential for infection transmission related to recurring opportunistic infections D. High risk for inadequate nutrition related to acquired secondary immune deficiency and Candida albicans

C. Potential for infection transmission related to recurring opportunistic infections

The nurse has just obtained a unit of blood from the blood bank to transfuse into a client as prescribed. Before preparing the blood for transfusion, the nurse looks for which member of the health care team to assist in checking the unit of blood? A. Phlebotomist B. Medical student C. RN D. Blood bank technician

C. RN Rationale: Depending on agency policy, two RNs or one RN and one licensed practical nurse (LPN) must check the label on the blood product together against the client's identification number, blood group, and complete name. This minimizes the risk of error in checking information on the blood bag and thereby minimizes the risk of harm or injury to the client. A blood bank technician verifies data with the nurse when the blood is obtained from the blood bank but does not verify information on the nursing unit or at the client's bedside. The other options are also incorrect.

The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should be taken next? A. Remove the intravenous (IV) line. B. Run a solution of 5% dextrose in water. C. Run normal saline at a keep-vein-open rate. D. Obtain a culture of the tip of the catheter device removed from the client.

C. Run normal saline at a keep-vein-open rate. Rationale: If the nurse suspects a transfusion reaction, the nurse stops the transfusion and infuses normal saline at a keep-vein-open rate pending further health care provider prescriptions. This maintains a patent IV access line and aids in maintaining the client's intravascular volume. The nurse would not remove the IV line because then there would be no IV access route. Obtaining a culture of the tip of the catheter device removed from the client is incorrect. First, the catheter should not be removed. Second, cultures are performed when infection, not transfusion reaction, is suspected. Normal saline is the solution of choice over solutions containing dextrose because saline does not cause red blood cells to clump.

Shingles results from VZV leaving the body by which route? a. mucous membrane b. pulmonary space c. body fluids and other tissues d. bone marrow

C. bodily fluids and other tissues

The patient with HIV/AIDS tells the nurse that food tastes funny and is difficult to swallow. What is the nurses priority action at this time? a. Check the patients gag reflex b. ask about blood cultures c. examine the patient's mouth and throat d. collaborate with the dietitian to provide a soft diet

C. examine the patient's mouth and throat

The HIV positive patient tells the nurse that his HIV negative partner will be using preexposure drugs (Truvada). Which statement indicates the need for additional teaching? A. my partner will need to be tested q3m B. this drug will decrease the chances of my partner becoming positive C. once we start using Truvada I will no longer need a condom D. my partner will need to be monitored for any side effects on this drug

C. once we start using Truvada I will no longer need a condom

The nurse has received a prescription to transfuse a client with a unit of packed red blood cells. Before explaining the procedure to the client, the nurse should ask which initial question? A. "Have you ever had a transfusion before?" B. "Why do you think that you need the transfusion?" C. "Have you ever gone into shock for any reason in the past?" D. "Do you know the complications and risks of a transfusion?"

A. "Have you ever had a transfusion before?" Rationale: Asking the client about personal experience with transfusion therapy provides a good starting point for client teaching about this procedure. Questioning about previous history of shock and knowledge of complications and risks of transfusion is not helpful because it may elicit a fearful response from the client. Although determining whether the client knows the reason for the transfusion is important, it is not an appropriate statement in terms of eliciting information from the client regarding an understanding of the need for the transfusion.

In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors? A. "Have you had sex with men or women or both?" B. "I hope you use condoms to protect your partners." C. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS." D. "You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."

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

A patient who has been diagnosed with acquired immunodeficiency syndrome (AIDS) has been prescribed a combination of the medications lopinavir and ritonavir. The patient asks why these two medications are given together. What is the best response by the healthcare provider? A. "Ritonavir helps increase the effectiveness of lopinavir." B. "This is a way of giving a lower dose of each of the medications." C. "Ritonavir helps decrease potential adverse effects of lopinavir." D. "By combining two medications together you won't have to take as many pills."

A. "Ritonavir helps increase the effectiveness of lopinavir."

A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse? A. "With this treatment, I probably cannot spread this virus to others." B. "This treatment does not kill the virus." C. "This medication prevents the virus from replicating in my body." D. "Research has shown the effectiveness of this therapy if I do not forget to take any doses."

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

The nurse is picking up a unit of packed red blood cells at the hospital blood bank. After putting the pen down, the nurse glances at the clock, which reads 1300. The nurse calculates that the transfusion must be started by which time? A. 1330 B. 1400 C. 1430 D. 1500

A. 1330 Rationale: Blood must be hung as soon as possible (within 30 minutes) after it is obtained from the blood bank. After that time, the blood temperature will be higher than 50°F (10°C), and the blood could be unsafe for use. For this reason, the remaining options are incorrect.

The nurse has a prescription to administer whole blood to a client who does not currently have an intravenous (IV) line inserted. When obtaining supplies to start the blood infusion, the nurse should select an angiocatheter of at least which size? A. 19 gauge B. 21 gauge C. 24 gauge D. 26 gauge

A. 19 gauge Rationale: Blood components are usually administered with at least a 19-gauge needle, cannula, or catheter. Larger sizes (e.g., 18- or 16-gauge) may be preferred if rapid transfusions are given. Smaller needles can be used for platelets, albumin, and clotting factor replacement.

As the nurse you know that there is a risk of a transfusion reaction during the administration of red blood cells. Which patient below it is at most RISK for a febrile (non-hemolytic) transfusion reaction? A. A 38 year old male who has received multiple blood transfusions in the past year. B. A 42 year old female who is immunocompromised. C. A 78 year old male who is B+ that just received AB+ blood during a transfusion. D. A 25 year old female who is AB+ and just received B+ blood.

A. A 38 year old male who has received multiple blood transfusions in the past year. Rationale: Afebrile transfusion reaction is where the recipient's WBCs are reacting with the donor's WBCs. This causes the body to build antibodies. It is most COMMON in patients who have received blood transfusions in the past. Option B is at risk for GvHD (graft versus host disease). Option C is wrong because this places the patient at risk for a hemolytic transfusion reaction (not febrile). The patient is receiving incompatible blood. However, option D is not the patient at MOST risk compared to option A. Note the patient is receiving compatible blood in this option.

A unit of platelets was just received from the blood bank for transfusion to an assigned client. The nurse should select tubing with which feature for the transfusion? A. An in-line filter B. At least 3 Y-ports C. Self-sealing valves D. Tinted to protect the blood from light

A. An in-line filter Rationale: The tubing used for platelet administration has an in-line filter. This helps ensure that any particles larger than the size of the filter are caught in the filter and are not infused into the client. Self-sealing valves and Y-ports are unnecessary. These features may be used to administer medication. No medication is infused through the intravenous (IV) line that the blood is infusing through. If the client needed medications as a result of a complication while receiving blood or for another reason, it would need to be administered via a different IV site and line. Platelets do not need to be protected from light.

A client requiring surgery is anxious about the possible need for a blood transfusion during or after the procedure. The nurse suggests to the client to take which actions to reduce the risk of possible transfusion complications? Select all that apply A. Ask a family member to donate blood ahead of time. B. Give an autologous blood donation before the surgery. C. Take iron supplements before surgery to boost hemoglobin levels. D. Request that any donated blood be screened twice by the blood bank. E.Take adequate amounts of vitamin C several days prior to the surgery date.

A. Ask a family member to donate blood ahead of time. B. Give an autologous blood donation before the surgery. Rationale: A donation of the client's own blood before a scheduled procedure is autologous. Donating autologous blood to be reinfused as needed during or after surgery reduces the risk of disease transmission and potential transfusion complications. The next most effective way is to ask a family member to donate blood before surgery. Blood banks do not provide extra screening on request. Preoperative iron supplements are helpful for iron deficiency anemia but are not helpful in replacing blood lost during the surgery. Vitamin C enhances iron absorption, but also is not helpful in replacing blood lost during surgery.

The nurse has discontinued a unit of blood that was infusing into a client because the client experienced a transfusion reaction. After documenting the incident appropriately, the nurse sends the blood bag and tubing to which department? A. Blood bank B. Infection control C. Risk management D. Environmental services

A. Blood bank Rationale: The nurse returns the blood transfusion bag containing any remaining blood to the blood bank. This allows the blood bank to complete any follow-up testing procedures needed once a transfusion reaction has been documented. The other options identify incorrect departments.

Which interventions does the home health nurse teach to family members to reduce confusion in a client diagnosed with acquired immune deficiency syndrome (AIDS)-related dementia? Select all that apply. A. Change the decorations in the home according to the season. B. Put the bed close to the window. C. Write out detailed instructions, and have the client read them over before performing a task. D. Ask the client what time he or she prefers to shower or bathe. E. Mark off the days of the calendar, leaving open the current date.

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

The nurse is assisting in monitoring a client who is receiving a transfusion of packed red blood cells (PRBCs). Before leaving the room, the nurse tells the client to immediately report which symptoms of a transfusion reaction? Select all that apply. A. Chills B. Fatigue C. Sleepiness D. Chest pain E. Lower back pain F. Difficulty breathing

A. Chills D. Chest pain E. Lower back pain F. Difficulty breathing Rationale: The nurse should instruct the client to immediately report signs of a transfusion reaction, which can include chest pain, lower back pain, chills, itching, rash, or difficulty breathing. These signs of transfusion reaction would require the nurse to stop the transfusion. Fatigue and sleepiness are unrelated to transfusion reaction.

An IV drug user who regularly shares needles is in the ER. What information does the nurse provide to decrease he patients risk of HIV through shared needles after each use? A. fill and flush syringe with clear water, fill with bleach and shake for 30-60 seconds and rinse with clear water B. fill and flush with water then soap and hot water, shake for 2 minutes and flush with cold water C. rinse needles with bleach and water solution and allow to air dry D. rinse needles after each use with rubbing alcohol and water, then rinse with water

A. Fill and flush syringe with clear water, then fill with bleach and shake for 30-60 seconds. Rinse with clear water.

A client has experienced high blood pressure and crackles in the lungs during previous blood transfusions. The client asks the nurse whether it is safe to receive another transfusion. The nurse explains that which medication most likely will be prescribed before the transfusion is begun? A. Furosemide B. Acetaminophen C. Diphenhydramine D. Acetylsalicylic acid

A. Furosemide Rationale: Fluid overload is one of the potential complications of a blood transfusion and is characterized by a variety of signs, including high blood pressure, fluid in the lungs manifesting as crackles, and distended jugular veins. This type of transfusion reaction is prevented by pretreating the client with a diuretic such as furosemide. Acetaminophen and aspirin are analgesics, which can also be used for analgesia. These medications may reduce fever as well but do not treat fluid overload.

A client receiving a transfusion of packed red blood cells (PRBCs) begins to vomit. The client's blood pressure is 90/50 mm Hg from a baseline of 125/78 mm Hg. The client's temperature is 100.8°F (38.2°C) orally from a baseline of 99.2°F (37.3°C) orally. The nurse determines that the client may be experiencing which complication of a blood transfusion? A. Septicemia B. Hyperkalemia C. Circulatory overload D. Delayed tranfusion reaction

A. Septicemia Rationale: Septicemia occurs with the transfusion of blood contaminated with microorganisms. Signs include chills, fever, vomiting, diarrhea, hypotension, and the development of shock. Hyperkalemia causes weakness, paresthesias, abdominal cramps, diarrhea, and dysrhythmias. Circulatory overload causes cough, dyspnea, chest pain, wheezing, tachycardia, and hypertension. A delayed transfusion reaction can occur days to years after a transfusion. Signs include fever, mild jaundice, and a decreased hematocrit level.

A patient started receiving their first unit of blood at 1000. It is now 1010 and the patient is reporting itching, chills, and a headache. In addition, the patient's temperature is now 99.8'F from 98'F. Your next nursing action is: A. Stop the transfusion B. Notify the physician C. Decrease the rate of the transfusion D. Reassure the patient that this is normal and will resolve in 30 minutes.

A. Stop the transfusion The patient is possibly having a transfusion reaction. FIRST, the nurse should STOP the transfusion and then disconnect the IV tubing at the access site and replace it with NEW tubing. In addition, have normal saline infusing to keep the vein open. THEN the nurse will notify the physician and blood bank.

Before a blood transfusion you educate the patient to immediately report which of the following signs and symptoms during the blood transfusion that could represent a transfusion reaction (select all that apply): A. Sweating B. Chills C. Hives D. Poikilothermia E. Tinnitus F. Headache G. Back pain H. Pruritus I. Paresthesia J. Shortness of Breath K. Nausea

A. Sweating B. Chills C. Hives F. Headache G. Back pain H. Pruritus J. SOB K. Nausea Rationale: As the nurse you want to educate the patient to report signs and symptoms associated with blood transfusion reactions, which would include: sweating, chills, hives, headache, back pain, pruritus (itching), shortness of breath, and nausea.

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. B. The social worker encourages the client to verbalize about stressors at home. C. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. D. The health care provider orders vital signs, including temperature, every 8 hours.

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

The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse should assess which priority item? A. Vital signs B. Skin color C. Urine output D. Latest hct level

A. Vital signs Rationale: A change in vital signs during the transfusion from baseline may indicate that a transfusion reaction is occurring. This is why the nurse assesses vital signs before the procedure and again after the first 15 minutes and thereafter per agency policy. The other options do not identify assessments that are a priority just before beginning a transfusion.

A patient with Pneumocystis jiroveci pneumonia usually presents with which symptom? A. dyspnea, tachypnea, persistent dry cough, fever b. cough with copious thick sputum, fever, and dyspnea c. chest pain and difficulty swallowing D. fever, persistent cough and vomiting

A. dyspnea, tachypnea, persistent dry cough, fever

A patient asks why it is essential that HAART meds be taken everyday at the same time. What is the nurses best response? a. missing or delaying doses of these drugs decreases blood concentrations needed to inhibit viral replication b. missing or delayed doses of these drugs decreases the risk of developing infections c. missing or delaying doses of these drugs decreases the effectiveness d. missing or delaying doses can decrease the risk of developing HIV resistant mutations

A. missing or delaying doses of these drugs decreases blood concentrations needed to inhibit viral replication

Which point are you sure to include when teaching a new RN to prevent HIV transmission from patients? A. wear gloves when in contact with patients mucous membrane or non-intact skin B. be sure to wear protective gear when providing any care to HIV positive patients C. always war a mask D. use PPE whether a patient is positive or not

A. wear gloves when in contact with patients mucous membrane or non-intact skin

how does HSV manifest itself in patients with HIV/AIDS (Select all that apply) a. maculopapular lesions that can spread b. chronic ulceration after vesicles rupture c. vesicles located in the perirectal, oral, and genital area d. numbness and tingling before vesicle forms e. itching localized to perianal area

B, C, D

HIV is most commonly transmitted by which routes? (Select all that apply) A. oral B. sexual C. parenteral D. airborne E. perinatal

B, C, E

Which statements are true about immunodeficiency? (Select all that apply) A. it causes a decrease in the patients risk for infection B. it may be acquired or congenital C. it occurs when a persons body cannot recognize antigens D. it is the same as autoimmunity E. it may cause varied reactions from mild, localized health problems to total immune system failure

B, C, E

Circulatory overload reaction manifestations

Cough, dyspnea, pulmonary congestion, adventitious breath sounds, headache, hypertension, tachycardia, distended neck veins

A CD4 T-cell count is measured in a client newly diagnosed with human immunodeficiency virus (HIV). In planning care, the nurse understands that which is accurate regarding the CD4 T-cell count? Select all that apply. A. Falls in response to a declining viral load B. Is a primary marker of immunocompetence C. Plays a role in the cell-mediated immune response D. Is a direct measure of the magnitude of HIV replication E. Guides decision making regarding timing of initiation of treatment

B, C, E Rationale: CD4 T-cells are a subgroup of lymphocytes that play an important role in the cell-mediated immune response; as such, CD4 T-cells are a primary marker of immunocompetence. Viral load is the direct measure of the magnitude of HIV replication. The CD4 T-cell count rises in response to a declining viral load. CD4 T-cell counts also guide decision making regarding initiation of treatment, when to change medications when treatment is failing, and the need for initiation of treatment against opportunistic infections.

which statements about HIV are accurate? (Select all that apply) A. may be acquired or congenital B. it is retrovirus C. it always progresses to AIDS D. it is a virus that attacks the immune system E. it is a parasite that forces cells to make copies of itself

B, D, E Retroviruses have an enzyme, called reverse transcriptase, that gives them the unique property of transcribing their RNA into DNA after entering a cell. The retroviral DNA can then integrate into the chromosomal DNA of the host cell, to be expressed there. HIV is a retrovirus.

A client diagnosed with human immune deficiency virus is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). The client asks the nurse what will happen if the prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is the nurse's best response? A. "This will not make any difference in the viral load." B. "Blood concentrations will be decreased, which will lead to increased viral replication." C. "If only one dose of medication is missed, this will not make a difference." D. "This will cause an increase in opportunistic infections."

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

Red blood cells are very for vital survival. Which statement below is NOT correct about red blood cells? A. "Red blood cells help carry oxygen throughout the body with the help of the protein hemoglobin." B. "Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems." C. "Red blood cells help remove carbon dioxide from the body." D. "Red blood cells are suspended in the blood's plasma."

B. "Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems." Rationale: Extreme loss of red blood cells leads to anemia which can cause a patient to experience shortness of breath (there is a decreased ability to carry oxygen throughout the body), tachycardia, fatigue, pale skin color etc. Suppressed immune system can be from LOW white blood cells, and clotting problems can be from LOW platelets.

The home health nurse is making an initial home visit to a client currently living with family members after being hospitalized with pneumonia and newly diagnosed with acquired immune deficiency syndrome (AIDS). Which statement by the nurse best acknowledges the client's fear of discovery of his AIDS by his family? A. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?" B. "Is there somewhere private in the home where we can go and talk?" C. "I hope that all of your family members know about your disease and how you need to be protected, because you have been so sick." D. "It is your duty to protect your family members from getting AIDS."

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

Which statement made to the nurse by a health care worker assigned to care for a client with human immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the nurse? A. "I told family members they need to wash their hands when they enter and leave the room." B. "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." C. "Yes, I understand the reasons why I have to wear gloves when I bathe the client." D. "The client's spouse told me she got HIV from a blood transfusion."

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

A client has a prescription to receive a unit of packed red blood cells. The nurse should obtain which intravenous (IV) solution from the IV storage area to hang with the blood product at the client's bedside? A. lactated ringers B. 0.9% NaCl C. 5% dextrose in 0.9% NaCl D. 5% dextrose in 0.45% NaCl

B. 0.9% NaCl Rationale: Sodium chloride 0.9% (normal saline) is a standard isotonic solution used to precede and follow infusion of blood products. Dextrose is not used because it could result in clumping and subsequent hemolysis of red blood cells (RBCs). Lactated Ringer's is not the solution of choice with this procedure

The patient with HIV/AIDS appears emaciated and has diarrhea, anorexia, mouth lesions, and persistent weight loss. What condition does the nurse suspect this patient is developing? a. AIDS dementia B. AIDS wasting syndrome C. AIDS GI opportunistic infection D. AIDS candidiasis opportunistic infection

B. AIDS wasting syndrome

A patient who has been receiving antiretroviral therapy (ART) to manage infection with human immunodeficiency virus (HIV) has an undetectable viral load. How would the healthcare provider interpret this information? A. HIV has been eliminated from the patient's blood B. ART has been effective in decreasing viral load C. More tests are needed to determine the effectiveness of ART D. ART can be discontinued for 3 months

B. ART has been effective in decreasing the viral load

A client diagnosed with human immune deficiency virus is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions does the nurse recommend to the client? A. Clean toothbrushes once a week. B. Bathe daily using an antimicrobial soap. C. Eat salad at least once a day. E. Wash dishes in cool water.

B. Bathe daily using an antimicrobial soap.

The nurse is told by a health care provider that a client in hypovolemic shock will require plasma expansion. The nurse should prepare which supplies for transfusion? A. Bag of platelets with filtered tubing B. Bottle of albumin with vented tubing C. Cryoprecipitate bag with vented tubing D. Infusion pump and bag of packed RBC

B. Bottle of albumin with vented tubing Albumin may be used as a plasma expander. Albumin is supplied in a bottle, and vented tubing is required for transfusion. Platelets are used when the client's platelet count is low. Cryoprecipitate is useful in treating bleeding from hemophilia or disseminated intravascular coagulopathy because it is rich in clotting factors. Cryoprecipitate is usually supplied in bags, so vented tubing is not required. Packed red blood cells replace erythrocytes and are not a plasma expander.

A client is receiving zalcitabine. The nurse should monitor the results of which study to determine the effectiveness of this medication? A. Western blot B. CD4+ cell count 3. Enzyme-linked immunosorbent assay (ELISA) 4. CBC count

B. CD4+ cell count Rationale: Zalcitabine slows the progression of acquired immunodeficiency syndrome (AIDS) by improving the CD4+ cell count. The Western blot and the ELISA are performed to diagnose the infection initially. A CBC count with differential may be done as part of ongoing monitoring of the status of the client with AIDS and to detect adverse effects of other medications.

The nurse is assigned to care for four clients. Which client does the nurse assess first? A. Client with human immune deficiency virus (HIV) and Kaposi's sarcoma who has increased swelling of a sarcoma lesion on the right arm B. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature C. Client who has been admitted to receive a monthly dose of serum immune globulin to treat Bruton's agammaglobulinemia D. Client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count

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

A donor has AB- blood. Which patient or patients below can receive this type of blood safely? A. A patient with O- blood. B. A patient with A- blood. C. A patient with B- blood. D. A patient with AB- blood.

D. A patient with AB- blood. Rationale: Donors with AB type blood can only donate to others who have the AB type blood, in this case AB- blood. However, they are the universal recipients in that they can receive blood for every blood type but can only donate to their same exact blood type.

A patient is receiving 1 unit of packed red blood cells. The unit of blood will be done at 1200. The patient is scheduled to have IV antibiotics at 1000. As the nurse you will: A. Stop the blood transfusion and administer the IV antibiotic, and when the antibiotic is done resume the blood transfusion. B. Administer the IV antibiotic via secondary tubing into the blood transfusion's y-tubing. C. Hold the antibiotic until the blood transfusion is done. D. Administer the IV antibiotic as scheduled in a second IV access site.

D. Administer the IV antibiotic as scheduled in a second IV access site. Rationale: If any IV medications will be needed while the blood is transfusing, the nurse will need to start another IV access site. The nurse would NEVER administer the IV antibiotic in the same tubing as the blood product or stop the transfusion. Remember blood is time sensitive and must be transfused within 4 hours. Also, holding the antibiotic is not correct because antibiotics are time sensitive as well and must be administered at the scheduled time to maintain blood levels.

The nurse enters the room of a client who began receiving a blood transfusion 45 minutes earlier to check on the client. The client is complaining of "itching all over" and has a generalized rash. The client's temperature has not changed from baseline and the lungs are clear to auscultation. Which complication of blood transfusion therapy should the nurse determine that this client is most likely experiencing? A. Bacteremia B. Fluid overload C. Hypovolemic shock D. Allergic transfusion reaction

D. Allergic transfusion reaction Rationale: The client is most likely experiencing an allergic transfusion reaction based on the clinical manifestation of pruritus. Bacteremia usually manifests with fever. With fluid overload, the client has the presence of crackles in the lungs in addition to dyspnea. Other clinical manifestations of fluid overload include hypertension, a bounding pulse, distended jugular veins, restlessness, and confusion. Hypovolemic shock is not likely a transfusion reaction because intravascular fluid is being administered.

The nurse has just received a prescription to transfuse a unit of packed red blood cells for an assigned client. What action should the nurse take next? A. Check a set of vital signs B. Order blood from the blood bank C. Obtain Y-site administration tubing D. Check to be sure that consent for the transfusion has been signed

D. Check to be sure that consent for the transfusion has been signed Rationale: After receiving a prescription for a blood transfusion, the first action the nurse should take should be to check to be sure that consent for the transfusion has been signed by the client. If the client has consented, the nurse should then check a set of vital signs to be sure there is no contraindication for a transfusion at that time, such as an elevation in temperature. If the vital signs are acceptable, the nurse can then gather supplies to administer the transfusion and order the blood from the blood bank.

A client has received a transfusion of platelets. The nurse evaluates that the client is benefiting most from this therapy if the client exhibits which finding? A. Increased hct B. Increased hgb C. Decline of elevated temp to normal D. Decreased oozing of blood from puncture sites and gums

D. Decreased oozing of blood from puncture sites and gums Platelets are necessary for proper blood clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture sites, wounds, and mucous membranes. Increased hemoglobin and hematocrit levels would occur when the client has received a transfusion of red blood cells. An elevated temperature would decline to normal after infusion of granulocytes because these cells were instrumental in fighting infection in the body.

The nurse is monitoring a client who is receiving a blood transfusion. After 30 minutes of the infusion, the client begins to have chills and back pain. His temperature is 100.1°F (37.8°C). What action should the nurse take first? A. Assess the client for other symptoms. B. Slow the blood transfusion and monitor the client's vital signs. C. Remind the client that these are expected reactions to a blood transfusion. D. Discontinue the infusion and start an infusion of normal saline using new tubing.

D. Discontinue the infusion and start an infusion of normal saline using new tubing. Rationale: Signs of a transfusion reaction include fever, chills, tachycardia, tachypnea, dyspnea, hives or skin rash, flushing, backache, and decreased blood pressure. If the client shows any symptoms of a blood transfusion reaction, the nurse needs to discontinue the infusion immediately and start an infusion of normal saline using new tubing connected to the hub of the intravenous insertion site. The nurse should stay with the client and monitor his or her condition while asking a colleague to notify the health care provider immediately.

A client with acquired immunodeficiency syndrome (AIDS) is receiving ganciclovir. The nurse should take which priority action in caring for this client? A. Monitor for signs of hyperglycemia. B. Administer the medication without food. C.Administer the medication with an antacid. D. Ensure that the client uses an electric razor for shaving.

D. Ensure that the client uses an electric razor for shaving. Rationale: Because ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects, the nurse monitors for signs and symptoms of bleeding and implements the same precautions as for a client receiving anticoagulant therapy. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach or without food and should not be taken with an antacid.

The healthcare provider is teaching a student about the disease process. Which of the following information should the healthcare provider include? A. HIV RNA is inserted into the host cell mitochondria B. The HIV virus divides quickly inside red blood cells C. HIV begins to phagocytize host immune cells D. HIV RNA is transcribed into DNA

D. HIV RNA is transcribed into DNA

An HIV positive client with an acquired immune deficiency is seen in the clinic for re-evaluation of the immune system's response to prescribed medication. Which test result does the nurse convey to the health care provider? A. Therapeutic highly active antiretroviral therapy (HAART) level B. Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot C. Positive Papanicolaou (Pap) test D. Improved CD4+ T-cell count and reduced viral load

D. Improved CD4+ T-cell count and reduced viral load

A client who has been receiving pentamidine intravenously now has a fever with a temperature of 102°F (38.9°C). Keeping in mind that the client has a diagnosis of acquired immunodeficiency syndrome (AIDS) and Pneumocystis jiroveci pneumonia, the nurse should interpret that this fever is most associated with which condition? A. Inadequate thermoregulation B. Insufficient medication dosing C. Toxic nervous system effects from the medication D. Infection caused by leukopenic effects of the medication

D. Infection caused by leukopenic effects of the medication Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. Adverse effects of pentamidine include leukopenia, thrombocytopenia, and anemia. The client should be routinely assessed for signs and symptoms of infection. The remaining options are inaccurate interpretations.

The nurse, listening to the morning report, learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which daily serum laboratory studies to assess the effectiveness of the transfusion? A. Hct B. Erythrocyte cont C. Hgb D. WBC count

D. WBC count Rationale: The client who has neutropenia may receive a transfusion of granulocytes, or WBCs. These clients often have severe infections and are unresponsive to antibiotic therapy. The nurse notes the results of follow-up WBC counts and differential to evaluate the effectiveness of the therapy. The nurse also continues to monitor the client for signs and symptoms of infection. Erythrocyte count and hemoglobin and hematocrit levels are determined after transfusion of packed red blood cells.

13. You're gathering supplies to start a blood transfusion. You will gather? A. PVC free tubing and dextrose B. Polyethylene-line tubing and 0.9% Normal Saline C. Y-tubing with in-line filter and dextrose D. Y-tubing with in-line and 0.9% Normal Saline

D. Y-tubing with in-line and 0.9% Normal Saline Rationale: This is the type of tubing and solution you will use to transfuse blood. Normal Saline is the ONLY solution used to transfuse blood!!

A client with severe blood loss resulting from multiple trauma requires rapid transfusion of several units of blood. The nurse asks another health team member to obtain which device for use during the transfusion procedure to help reduce the risk of cardiac dysrhythmias? A. infusion pump B. pulse ox C. cardiac monitor D. blood-warming device

D. blood-warming device Rationale: If several units of blood are to be administered rapidly, a blood warmer should be used. Rapid transfusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this, the nurse warms the blood with a blood-warming device. Pulse oximetry and cardiac monitoring equipment are useful for the early assessment of complications but do not reduce the occurrence of cardiac dysrhythmias. Electronic infusion devices are not helpful in this case because the infusion must be rapid, and infusion devices generally are used to control the flow rate. In addition, not all infusion devices are made to handle blood or blood products.

You've started the first unit of packed red blood cells on a patient. You stay with the patient during the first 15 minutes and: A. run the blood at 100 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. B. run the blood at 20 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. C. run the blood at 200 mL/min and then decrease the rate after 15 minutes, if tolerated by the patient. D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient.

D. run the blood at 2 mL/min and then increase the rate after 15 minutes, if tolerated by the patient. Rationale: The blood will be started on an infusion pump at 2 mL/min, and if the blood is tolerated by the patient, it will be increased AFTER 15 minutes. Remember the blood must be transfused within 2-4 hours....most bags are 250 to 300 mL. During the first 15 minutes is when the patient is most likely to have a transfusion reaction. Running the blood slowly during the first 15 minutes allows the patient to receive the LEAST amount of blood possible if a reaction does occur.

Anaphylactic and severe allergic transfusion reaction cause

Sensitivity to donor plasma proteins infusion or IgA proteins to IgA-deficient recipient who has developed IgA antibody

What precautions should you initiate with an HIV patient?

Standard precautions: hand hygiene, safe sharps, etc. etc. If your'e expected to come into contact with open skin or bodily fluids, you should take extra precautions, such as: gloves, goggles, mask, etc.

Stage Unknown HIV

any patient with a confirmed HIV infection but no information regarding CD4+ T-cell counts, CD4+ T-cell percentages, and AIDS-defining illnesses is available

S/S of HIV infection***

· Fever/chills · Anorexia · Nausea · Weight loss · Weakness · Fatigue · Headaches · Night Sweats · Muscular Aches

As the nurse is talking to the patient, the patient comments that he doesn't know why he must live with such a horrible disease, and states that he knows he will die soon. What is the appropriate nursing response?

· Therapeutic communication · Active listening · Patient encouraged to openly express feelings about the disease · If the patient expresses SI, it is the responsibility of the nurse to notify healthcare reporter

Risk factors for HIV

· Unprotected Sex · Multiple partners · Occupational exposure ----Healthcare workers ----Garbage men ----Environmental workers in hospitals that dispose of sharps/biohazard · Perinatal exposure · IV drug use · Increase susceptibility with age

Nucleoside reverse transcriptase inhibitors

-Interferes with ability of virus to convert RNA to DNA -ex: Zidovudine (Retrovir)

HIV is transmitted via

Blood and bodily fluids most often semen and vaginal secretions, but also found in feces, urine, tears, saliva, CSF, cervical cells, lymph nodes corneal tissue, and brain tissue

Which type of tubing is indicated for administration of blood products?

In-line filter The tubing used for blood administration has an in-line filter. The filter helps to ensure that any particles larger than the size of the filter are caught in the filter and are not infused into the client.

It is important to remember that antiretroviral therapy only _______ and does not ______

Only inhibits viral replication and does not kill the virus

Febrile non-hemolytic transfusion reaction cause

Sensitization to donor WBCs (most common), platelets, or plasma proteins

What is the most important V/S to monitor in HIV/AIDS patients?**

Temperature d/t increased risk for infection

Massive blood transfusion reaction management

When patients receive massive transfusions or blood products, monitor clotting status and electrolyte levels

A person with HIV can transmit at any stage of the disease, but in what condition is transmission most likely?

When the person has a high viral load (large amount of viruses per volume blood)

A patient with HIV is receiving meds to reduce viral load and improve cd4+ counts. which term accurately describes this HIV drug regimen? a. interferon treatment b. antiviremia c. ELISA administration d. HAART

d. HAART

Nursing interventions for AIDS patients

· Assess risk factors · I & O · Daily Weights (cachexia / muscle wasting) · Nutritional support · Monitor electrolytes · Skin assess & care: open sores, bruising · Pain assess & care · Vital Signs: Especially note temperature d/t increased risk for infection · Focused Respiratory & Neuro assess (Higher risk for pneumonia, TB; HIV-associated dementia) · Rest periods · O2 PRN for supportive care

The nurse is caring for a client who is receiving a blood transfusion and is complaining of a cough. The nurse checks the client's vital signs, which include temperature of 97.2°F (36.2°C), pulse of 108 beats per minute, blood pressure of 152/76 mm Hg, respiratory rate of 24 breaths per minute, and an oxygen saturation level of 95% on room air. The client denies pain at this time. Based on this information, what initial action should the nurse take? A. Collect a urine sample for analysis. B. Place the client in an upright position. C. Compare current data to baseline data. D. Slow the rate of the blood transfusion.

C. Compare current data to baseline data. Rationale: For the client receiving a blood transfusion, the nurse should monitor for potential complications of a transfusion. One of the complications is circulatory overload. Signs and symptoms of circulatory overload include cough, dyspnea, chest pain, wheezing on auscultation of the lungs, headache, hypertension, tachycardia and a bounding pulse, and distended neck veins. Based on the data in the question, the nurse should compare current data to baseline data. The nurse should also further assess the client for other signs and symptoms of circulatory overload. If the nurse still suspects this complication after comparing to baseline data, the nurse should then place the client in an upright position with the feet in a dependent position and slow the rate of the infusion. Collection of a urine sample should occur if the nurse suspects a transfusion reaction, such as a hemolytic reaction.

The nurse overhears a health care provider (HCP) stating that a client diagnosed with disseminated intravascular coagulation (DIC) requires a transfusion. Which blood product should the nurse anticipate that the HCP will write a prescription for? A. Albumin B. Platelets C. Cryoprecipitate D. Packed RBCs

C. Cryoprecipitate Rationale: Cryoprecipitate is useful in treating bleeding from hemophilia or DIC because it is rich in clotting factors. Albumin may be used as a plasma expander in hypovolemia with or without shock. Platelets are used when the client's platelet count is low. Packed red blood cells replace erythrocytes, not fibrinogen.

One unit of packed red blood cells has been prescribed for a client with severe anemia. The client has received multiple transfusions in the past, and it is documented that the client has experienced urticaria-type reactions from the transfusions. The nurse anticipates that which medication will be prescribed before administration of the red blood cells to prevent this type of reaction? A. Ibuprofen B. Acetaminophen C. Diphenhydramine D. Acetylsalicylic acid

C. Diphenhydramine Rationale: An urticaria-type reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction is prevented by pretreating the client with an antihistamine such as diphenhydramine (Benadryl). The remaining medications would not prevent an urticaria-type reaction. Acetaminophen may be prescribed before the administration to assist in preventing an elevated temperature.

A client is brought to the emergency department having experienced blood loss related to an arterial laceration. Which blood component should the nurse expect the health care provider to prescribe? A. platelets B granulocytes C. FFP D. packed RBC

C. FFP Rationale: Fresh-frozen plasma is often used for volume expansion as a result of fluid and blood loss. It is rich in clotting factors and can be thawed quickly and transfused quickly. Platelets are used to treat thrombocytopenia and platelet dysfunction. Granulocytes may be used to treat a client with sepsis or a neutropenic client with an infection that is unresponsive to antibiotics. Packed red blood cells are a blood product used to replace erythrocytes.

You're providing care to a 36 year old male. The patient experienced abdominal trauma and recently received 2 units of packed red blood cells. You're assessing the patient's morning lab results. Which lab result below demonstrates that the blood transfusion was successful? A. Hemoglobin level 7 g/dL B. Platelets 300,000 µl C. Hemoglobin level 15 g/dL D. Prothrombin Time 12.5 seconds

C. Hemoglobin level 15g/dL Rationale: Hemoglobin levels are used to assess the effectiveness of a blood transfusion. A normal Hgb level for a MALE is 14 to 18 g/dL. For a FEMALE, the level is 12 to 16 g/dL.

A patient with O+ blood received A+ blood. The patient is at risk for? A. Febrile transfusion reaction B. None: O+ and A+ are compatible blood types C. Hemolytic transfusion reaction D. Allergic transfusion reaction

C. Hemolytic transfusion reaction Rationale: O+ and A+ are NOT compatible blood types. Patients with O+ can only receive blood from others with O blood. This patient is at risk for a hemolytic reaction. This is where the immune system is killing the donors RBCs. The antibodies in the recipient's blood match the antigens on the donor's blood cells....the patient has been mistyped!!

A diagnosis of AIDS requires that the adult be HIV positive and have either:

o a CD4+ T-cell count of less than 200 cells/mm3 (0.2 × 109/L) OR o less than 14% (even if the total CD4+ count is above 200 cells/mm3[ 0.2 × 109/L]) OR o an opportunistic infection (regardless of CD4 numbers)

Primary stage of HIV

-Infection, flu like symptoms 2-4 weeks later (!!!) -rapid rise in HIV viral load -increase CD8 cells -decrease CD4 cells -flu like symptoms decline -decrease viral load -Lymphadenopathy persists throughout disease process

Protease Inhibitors

-Inhibit enzyme needed for virus to replicate -ex: Amprenavir (agenerase), Nefinavir (Viracept)

What is true about discrepancies in speed of HIV disease progression as well as the severity of symptoms experienced?

-It can range from months to years depending on route of transmission -S/S can be worse depending on how you were exposed

AIDS

-Last phase of HIV -Life-threatening syndrome characterized by opportunistic infections -Without treatment death will occur in 2-5 years -the infection itself leads to death

Other factors that influence timing of HIV progression and severity of symptoms

-frequency to exposure -low nutrition status -presence of other STIs -stress -(higher risk / faster onset)

Entry/infusion inhibitors do

-Prevent entry of HIV into cell -Given SQ (rotate sites) -Ex: Enfurvirtide (Fuzeon)

Second phase of HIV infection: chronic asymptomatic infection **

-asymptomatic 10+ years*** -over time, loss of immunity occurs -this phase can be clinically prolonged by antiretroviral therapy -this phase can be silent -the patient is making anti-HIV antibodies, but they still have HIV; it won't go away -over time, indiviudal begins actual replication of virus via altered genetic machinery that occurs when reverse transcriptase puts HIV DNA into nucleus -CD4 cells destroyed, viral load decreases, dramatic loss of immunity

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing interventions would be helpful in managing this symptom? Select all that apply. A. Keep liquids at the bedside. B. Place a towel over the pillowcase. C. Make sure the pillow has a plastic cover. D. Keep a change of bed linens nearby in case they are needed. E. Administer an antipyretic after the client has a spike in temperature.

A, B, C, D For clients with AIDS who experience night fever and night sweats, the nurse may offer the client an antipyretic of choice before the client goes to sleep rather than waiting until the client spikes a temperature. Keeping a change of bed linens and night clothes nearby for use also is helpful. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if diaphoresis is profuse. The client should have liquids at the bedside to drink.

A patient tells the nurse that she has recently engaged in unprotected sexual intercourse. The nurse recognizes that which symptom(s) may be consistent with an acute infection, following infection with HIV? (Select all that apply) A. Fever B. Chills C. Headache D. Night sweats E. Muscular aches

A, B, C, D, E

which descriptions are characteristic of a non progressor? (Select all that apply) A. has been infected for 10 years B. is asymptomatic C. has no CD4+ or t-lymphocytes D. is immunocompetent E. are functional antibodies

A, B, D

A 30 year-old man with HIV is admitted the acute care unit. Which assessment findings does the nurse recognize that may indicate that the patient currently has AIDS? Select all that apply A. Kaposi's sarcoma B. HIV-positive status C. Wasting syndrome D. Esophageal candidiasis E. Persistent generalized lymphadenopathy

A, C, D

The nurse is assigned to care for a client with acquired immunodeficiency syndrome (AIDS) suspected of having Kaposi's sarcoma. The nurse should prepare the client for which test to confirm this diagnosis? A. Biopsy B. Blood culture C. CT D. MRI

A. Biopsy Rationale: Kaposi's sarcoma is the most common AIDS-related malignancy. It manifests as small purplish brown, raised lesions if they occur on the skin. Dyspnea occurs if they occur in the lungs. Lymph node swelling occurs if they are located in the lymph nodes. Kaposi's sarcoma also can occur in the gastrointestinal (GI) tract and manifests as an altered bowel pattern, including diarrhea or constipation. Chest x-ray, bronchoscopy, upper GI exam, colonoscopy, and computed tomography scan may be used to aid the diagnosis, but whether Kaposi's sarcoma manifests as a skin lesion or in the lungs or GI tract, the diagnosis is confirmed with a biopsy.

The nurse works with high-risk clients in an urban outpatient setting. Which groups should be tested for human immunodeficiency virus (HIV)? Select all that apply. A. Injection drug abusers B. Prostitutes and their clients C. People with sexually transmitted infections (STIs) D. People who have had frequent episodes of pneumonia E. People who recently received a blood transfusion for a surgical procedure

A. Injection drug abusers B. Prostitutes and their clients C. People with sexually transmitted infections (STIs) Rationale: Injection drug abusers, those engaged in prostitution, and people with STIs are high-risk groups that should be tested for HIV per the Centers for Disease Control and Prevention's recommendations. Those who have had frequent episodes of pneumonia and those who recently received a blood transfusion for a surgical procedure are not at risk for HIV unless another compounding factor places them at risk. However, if a blood transfusion was received between 1978 and 1985, the client should be tested.

The healthcare provider is assessing the skin of a patient who is at risk for becoming infected with the human immunodeficiency virus (HIV). Which of the following findings requires immediate follow-up by the healthcare provider? A Purplish-red raised lesions B. Numerous moles on the chest and back C. Ecchymoses on the legs D. Patches of dry, flaky skin

A. Purple-ish red raised lesions

A client with acquired immunodeficiency syndrome (AIDS) has a respiratory infection from Pneumocystis jiroveci and has been experiencing difficulty breathing and resultant problems with gas exchange. Which finding indicates that the expected outcome of care has yet to be achieved? A. The client limits fluid intake. B. The client has clear breath sounds. C. The client expectorates secretions easily. D. The client is free of complaints of shortness of breath.

A. The client limits fluid intake Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. The status of the client with a problem concerning gas exchange would be evaluated against the standard outcome criteria for a P. jiroveci infection. These would include options 2, 3, and 4 where breath sounds are clear, the nurse notes that secretions are being coughed up effectively, and the client states that breathing is easier. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.

A client with human immunodeficiency virus infection has signs and symptoms of cryptosporidiosis. The nurse should prepare the client for which test that will assist in confirming the diagnosis? A. Stool culture B. Bronchoscopy C. Sputum culuture D. Chest x-ray study

A. stool culture Rationale: Cryptosporidiosis is an intestinal infection caused by Cryptosporidium organisms. The client with cryptosporidiosis will present with signs and symptoms of watery diarrhea, flatus, abdominal distention, pain, and fever. It is important for the nurse to monitor for an electrolyte imbalance. Diagnostic tests include a stool culture with a bowel biopsy. The other options are incorrect.

A CD4+ lymphocyte count is performed in a client with human immunodeficiency virus (HIV) infection. When providing education about the testing, what should the nurse tell the client? A."It establishes the stage of HIV infection." B."It confirms the presence of HIV infection." C."It identifies the cell-associated proviral DNA." D ."It determines the presence of HIV antibodies in the bloodstream."

A."It establishes the stage of HIV infection." Rationale: A CD4+ lymphocyte count is performed to establish the stage of HIV infection, to help with decisions regarding the timing of initiation of antiretroviral therapy and prophylaxis for opportunistic infections and to monitor treatment effectiveness. The remaining options are unrelated to the CD4+ lymphocyte count.

The healthcare provider is teaching a patient who has been diagnosed with acquired immunodeficiency syndrome (AIDS) about the need for multi-drug therapy. Which of the following best explains the rationale for using more than one antiretroviral medication to treat AIDS? A."This is intended to keep the virus from developing resistance to the medications." B. "You will experience less side effects when you take a combination of medications." C. "You will not be able to transmit the disease while you take this medication combination." D. "This combination of medications will eliminate the AIDS virus from your body.

A."This is intended to keep the virus from developing resistance to the medications."

Other name for third HIV stage

AIDS (acquired immunodeficiency syndrome)

which statement about the transmission of HIV is true? (Select all that apply) A. can only be transmitted during end stage B. those with recent HIV infection and high viral load are very infectious C. those with end stage HIV and no drug therapy are very infectious D. HIV is only transmitted with sexual contact E. all people infected with HIV will quickly progress to AIDS

B, C

which immune function abnormalities are a result of HIV infection? (Select all that apply) A. lymphocytosis B. CD4+ depletion C. increased CD8+ activity D. long macrophage life span E. lymphocytopenia

B, E

A client has requested and undergone testing for human immunodeficiency virus (HIV) infection. The client asks what will be done next because the result of the enzyme-linked immunosorbent assay (ELISA) has been positive. Which diagnostic study should the nurse be aware of before responding to the client? A. No further diagnostic studies are needed. B. A Western blot will be done to confirm these findings. C. The client probably will have a bone marrow biopsy done. D. A CD4+ cell count will be done to measure T helper lymphocytes.

B. A Western blot will be done to confirm these findings. Rationale: If the result of the ELISA is positive, the Western blot is done to confirm the findings. If the result of the Western blot is positive, the client is considered to be seropositive for the infection and to be infected with the virus. The remaining options are incorrect.

The nurse is caring for a client with acquired immunodeficiency syndrome and detects early infection with Pneumocystis jiroveci by monitoring the client for which clinical manifestation? A. Fever B. Cough 3. Dyspnea at rest 4. Dyspnea on exertion

B. Cough Rationale: Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. The client with P. jiroveci infection usually has a cough as the first sign. The cough begins as nonproductive and then progresses to productive. Later signs and symptoms include fever, dyspnea on exertion, and finally dyspnea at rest.

A client asks the nurse about obtaining a home test kit to test for human immunodeficiency virus (HIV) status. What should the nurse tell the client? A. Home test kits are not available for testing at this time. B. Home test kits may not be as reliable as laboratory blood tests. C. Home test kits are most reliable immediately after a risk event occurs. D. Home test kits should not be used; rather, it is important to contact the health care provider (HCP) with concerns about the HIV status.

B. Home test kits may not be as reliable as laboratory blood tests. Rationale: Should a client wish to know his or her HIV status, testing is available from a HCP or a local public health clinic, or a home test kit can be used. Some test kits may not be as reliable as a laboratory blood test. It is also recommended that a home test be performed at least 3 months after a risk event occurs. If a positive result on a home test occurs then the individual requires additional testing.

The nurse is assigned to care for a client with human immunodeficiency virus (HIV) infection. The nurse reviews the client's health care record and notes documentation of toxoplasmosis encephalitis. On the basis of this information, the nurse would assess for which manifestation? A. Lesions on the skin B. Mental status changes C. Changes in bowel pattern D.. Lesions on the oral mucosa

B. Mental status changes Rationale: Toxoplasmosis encephalitis, caused by Toxoplasma gondii, is acquired through contact with contaminated cat feces or by ingesting infected undercooked meat. It manifests with signs and symptoms such as an altered mental status, neurological deficits, headaches, and fever. Additional manifestations include difficulties with speech, gait, and vision; and seizures.The other options are not associated with toxoplasmosis.

A client with acquired immunodeficiency syndrome (AIDS) is experiencing fatigue. The nurse should plan to teach the client which strategy to conserve energy after discharge from the hospital? A. Bathe before eating breakfast B. Sit for as many activities as possible C. Stand in the shower instead of taking a bath D. Group all tasks to be performed early in the morning

B. Sit for as many activities as possible Rationale: The client is taught to conserve energy by sitting for as many activities as possible, including dressing, shaving, preparing food, and ironing. The client also should sit in a shower chair instead of standing while bathing. The client needs to prioritize activities, such as eating breakfast before bathing, and should intersperse each major activity with a period of rest.

A client with human immunodeficiency virus (HIV) infection has a fever, and histoplasmosis is suspected. The nurse should prepare the client for which diagnostic test to confirm the presence of histoplasmosis? A. Skin biopsy B. Sputum culture C. Western blot D. Upper GI series

B. Sputum culture Rationale: Histoplasmosis is an opportunistic infection that affects the lungs and can occur in the client with HIV infection. Diagnostic tests include chest x-ray, sputum culture, lung biopsy, and bronchoscopy. The other options are incorrect. A Western blot test is used to confirm a diagnosis of HIV. A skin biopsy may be done if the client had Kaposi's sarcoma. Gastrointestinal series are done for a client suspected to have a gastrointestinal disorder.

A client with acquired immunodeficiency syndrome (AIDS) has a concurrent diagnosis of histoplasmosis. During the assessment, the nurse notes that the client has enlarged lymph nodes. How should the nurse interpret this assessment finding? A. The histoplasmosis is resolving B. The client has disseminated histoplasmosis 3. This is a side effect of the medications given to treat AIDS 4. The client probably has another infection that is developing

B. The client has disseminated histoplasmosis Rationale: Histoplasmosis is caused by Histoplasma capsulatum and usually starts as a respiratory infection in the client with AIDS and then becomes a disseminated infection, with enlargement of lymph nodes, spleen, and liver. The client experiences dyspnea, fever, cough, and weight loss. The remaining options are incorrect.

A client with human immunodeficiency virus (HIV) infection is diagnosed with herpes simplex virus (HSV). The nurse should prepare the client for which diagnostic test to determine the presence of herpesvirus infection? A. Chest x-ray B. Viral culture C. Stool culture D. Neuro exam

B. Viral culture Rationale: HSV in people with HIV or acquired immunodeficiency syndrome (AIDS) occurs in the perirectal, oral, and genital areas. Numbness of tingling at the site of infection occurs up to 24 hours before blisters form. Lesions are painful, with chronic open areas after blisters rupture. Diagnostic tests for herpes simplex include a viral culture and gross examination. The tests in the other options will not diagnosis herpes simplex.

A client with acquired immunodeficiency syndrome (AIDS) is receiving didanosine. When the nurse reviews the client's laboratory test results, which result should be most closely monitored? A. Protein B. Glucose C. Amylase D. Cholesterol

C. Amylase Rationale: Didanosine is toxic to the pancreas and the liver. A serum amylase level that is increased by 1.5 to 2 times normal may signify pancreatitis and may be fatal in the client with AIDS. Therefore, the nurse should monitor the results of amylase and liver function studies closely. Alterations in protein, glucose, and cholesterol levels are unrelated to this medication.

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has begun to experience multiple opportunistic infections. Which laboratory test would be most helpful in assessing the client's need for reassessment of treatment? A. Western blot B. B lymphocyte count C. CD4+ cell or T lymphocyte count 4. ELISA

C. CD4+ cell or T lymphocyte count Rationale: The T lymphocyte or CD4+ cell count indicates whether the client is responding to the medication treatment. The count should increase if the client is responding and should decrease if the client's response is poor. The Western blot and ELISA are tests to assist in diagnosing human immunodeficiency virus infection. The B lymphocyte count is not a priority marker to monitor with AIDS clients.

A client with acquired immunodeficiency syndrome (AIDS) has been started on therapy with zidovudine. The nurse should monitor the results of which laboratory blood study for adverse effects of therapy? A. Creatinine level B. Potassium concentration C. Complete blood cell (CBC) count D. Blood urea nitrogen (BUN) level

C. Complete blood cell (CBC) count Rationale: Common adverse effects of zidovudine are agranulocytopenia and anemia. The nurse should monitor the CBC count for these changes. Creatinine, potassium, and BUN are unrelated to this medication.

A patient who is human immunodeficiency positive (HIV) positive is receiving a nucleoside reverse transcriptase inhibitor (NRTI). Which of these clinical findings would indicate the patient is experiencing an adverse effect of this medication? A. Metabolic alkalosis B. Weight gain C. Decreased hemoglobin D, Increased blood glucose

C. Decreased hemoglobin

The healthcare provider is teaching a patient who has a diagnosis of acquired immunodeficiency syndrome (AIDS) about food safety. Which of the following foods should the patient avoid to prevent foodborne illnesses? A. Green salad B. Mozzarella cheese C. Deli meats D. Boiled eggs

C. Deli meats Lunch or deli meats may harbor Listeria monocytogenes, a bacterium that grows at refrigerated temperatures, and may cause severe illness. Heating these foods until they are steaming hot destroys the bacteria.

A patient is fearful that he has been infected with HIV. The nurse recognizes which as the first symptom associated with possible HIV infection? Lymphocytopenia Opportunistic infection Fever, night sweats, muscle aches Reduced numbers of CD4+ T-cells

C. Fever, night sweats, muscle aches Rationale: the first manifestation are the S/S in acute phase; as time passes, CD4 cells are infected and taken out of service, and then the cell count drops below normal levels. The cells that remain don't function normally (lymphocytopenia). As they continue to drop, the patient is at risk for opportunistic infections and cancers.

The nurse is preparing to care for a client with immunodeficiency. The nurse should plan to address which problem as the priority? A. Anxiety B. Fatigue C. Risk for infection D. Need for social isolation

C. Risk for infection Rationale: The client with immunodeficiency has inadequate or no immune bodies and is at risk for infection. The priority concern would be risk for infection. The question presents no data indicating that the client is experiencing anxiety. Fatigue may be a problem and the client may need to be placed on protective isolation, but these are not the priority problems for this client. Infection can be life-threatening and is the priority.

The nurse is caring for a client with human immunodeficiency virus (HIV) infection and notes a diagnosis of cryptococcosis in the client's medical record. The nurse understands that this opportunistic infection most likely was diagnosed by which test? A. Skin biopsy B. Viral culture C. Sputum culture D. Bone marrow biopsy

C. Sputum culture Rationale: Cryptococcosis is a fungal infection caused by Cryptococcus neoformans. It usually affects the lungs and central nervous system (brain and spinal cord) but it can also affect other parts of the body. Symptoms of lung involvement include cough, shortness of breath, chest pain, and fever. When it spreads to the brain manifestations include headache, fever, neck pain, nausea and vomiting, sensitivity to light, confusion, or changes in behavior. Diagnostic tests to confirm its presence in the lungs include chest x-ray studies and a sputum culture.

A patient who has tested positive for the human immunodeficiency virus (HIV) arrives at the clinic with a report of fever, nonproductive cough, and fatigue. The patient's CD4 count is 184 cells/mcL. How should the healthcare provider interpret these findings? : A These findings provide evidence that the patient has seroconverted. B The patient is now in the latent stages of HIV infection C The patient is diagnosed with acquired immunodeficiency syndrome (AIDS). D This is an expected finding because the patient has tested positive for HIV

C. The patient is diagnosed with AIDS

A client is tested for human immunodeficiency virus (HIV) infection with an enzyme-linked immunosorbent assay (ELISA), and the test result is positive. What should the nurse tell the client? A. HIV infection has been confirmed. B. The client probably has a gastrointestinal infection. C. The test will need to be confirmed with a Western blot. D. A positive test result is normal and does not mean that the client has acquired HIV.

C. The test will need to be confirmed with a Western blot. Rationale: A negative result on an ELISA indicates that infection is absent or that not enough time has passed since exposure for seroconversion. A positive ELISA result must be confirmed with a Western blot. The other options are incorrect.

The HCP prescribes an integrase inhibitor for an HIV patient. The patient asks the nurse how this drug works. What is the nurses best response? A. it reduces how well HIV genetic material can be converted into human genetic material B. it reinforces the immune systems ability to fight off an infection C. it prevents viral DNA from integrating into hosts DNA D. prevent HIV infection from progressing to AIDS

C. it prevents viral DNA from integrating into hosts DNA

The nurse instructs a client with candidiasis (thrush) of the oral cavity on how to care for the disorder. Which client statement indicates the need for further instruction? A. I need to eat foods that are liquid or pureed." B. "I need to eliminate spicy foods from my diet." C. "I need to eliminate citrus juices and hot liquids from my diet." D. "I need to rinse my mouth 4 times daily with a commercial mouthwash."

D. "I need to rinse my mouth 4 times daily with a commercial mouthwash." Rationale: Candidiasis is caused by Candida albicans, which is a part of the intestinal tract's natural flora. Fungal infection occurs by overgrowth of normal body flora. Candida stomatitis or esophagitis occurs often in in immunocompromised clients. On examination of the mouth and throat, the nurse would note cottage cheese-like, yellowish white plaques and inflammation. Clients with candidiasis cannot tolerate commercial mouthwashes because the high alcohol concentration in these products can cause pain and discomfort to the lesions. A solution of warm water or mouthwash formulas without alcohol are better tolerated and may promote healing. A change in diet to liquid or pureed food often eases the discomfort of eating. The client should avoid spicy foods, citrus juice, and hot liquids.

A client reports to the health care clinic for testing for human immunodeficiency virus (HIV) immediately after being exposed to HIV. The test results are negative, and the client expresses relief about not contracted HIV. What should the nurse emphasize when explaining the test results to the client? A. No further testing is needed. B. The test should be repeated in 1 month. C. A negative HIV test result is considered accurate. D. A negative HIV test result is not considered accurate immediately after exposure.

D. A negative HIV test result is not considered accurate immediately after exposure. Rationale: A test for HIV should be repeated if results are negative. Seroconversion is the point at which antibodies appear in the blood. The average time for seroconversion is 2 months, with a range of 2 to 10 months. For this reason, a negative HIV test result is not considered accurate immediately after exposure. The remaining options are incorrect.

A client with acquired immunodeficiency syndrome (AIDS) is experiencing nausea and vomiting. The nurse should include which measure in the dietary plan? A. Provide large, nutritious meals. B. Serve foods while they are hot. C. Add spices to food for added flavor. D. Remove dairy products and red meat from the meal.

D. Remove dairy products and red meat from the meal. Rationale: The client with AIDS who has nausea and vomiting should avoid fatty products such as dairy products and red meat. Meals should be small and frequent to lessen the chance of vomiting. The client should avoid spices and odorous foods because they aggravate nausea. Foods are best tolerated cold or at room temperature.

The healthcare provider is teaching a patient who has tested positive for human immunodeficiency virus (HIV) about the antiretroviral medication maraviroc. Which of the following statements best describes how this drug is effective against HIV? A. The process of viral DNA synthesis is suppressed. B. The cellular membrane of the HIV virus is disrupted. C. New virus particles lose their ability to be infectious. D. The HIV virus is prevented from entering the target cells.

D. The HIV virus is prevented from entering the target cells Rationale: maraviroc is an entry/fusion inhibitor that prevents HIV from entering host cells

The nurse is assigned to care for a client with human immunodeficiency virus (HIV) infection. The nurse notes recent documentation of herpes simplex in the client's medical record. On assessment, the nurse would expect to note which type of lesion? A. Macular lesions B. Ecchymotic lesions C. Creamy white patches D. Vesicular lesions that rupture

D. Vesicular lesions that rupture Rationale: HSV in people with HIV or acquired immunodeficiency syndrome (AIDS) occurs in the perirectal, oral, and genital areas. Numbness of tingling at the site of infection occurs up to 24 hours before blisters form. Lesions are painful, with chronic open areas after blisters rupture. The nurse should assess for fever, pain, bleeding, and enlarged lymph nodes in the affected area. The nurse should also assess for headache, myalgia, and malaise. The other options are not characteristic of herpesvirus infection.

The nurse reviews the record of a client with acquired immunodeficiency syndrome (AIDS) and notes that the client has a diagnosis of Candida. When performing history-taking and assessment, which finding should the nurse anticipate? A. Hyperactive bowel sounds B. Complaints of watery diarrhea C. Red lesions on the upper arms D. Yellowish-white, curdlike patches in the oral cavity

D. Yellowish-white, curdlike patches in the oral cavity Rationale: Candidiasis is caused by Candida albicans, which is a part of the intestinal tract's natural flora. Fungal infection occurs by overgrowth of normal body flora. In a person with AIDS, candidiasis (overgrowth of the Candida fungus) occurs because the immune system can no longer control fungal growth. Candida stomatitis or esophagitis occurs often in AIDS. On examination of the mouth and throat, the nurse would note cottage cheese-like, yellowish white plaques and inflammation. The remaining options are not findings in this disorder.

Role of integrase in HIV infection

Incorporates HIV DNA into host's DNA by transporting it into the nucleus (codes for viral proteins)

After 8 days, the patient is being discharged home, where he lives with his mother and father. The nurse is completing discharge instructions for him and his family. What infection control teaching should the nurse provide to the patient and family?

· Hand hygiene · Reduce visitors · Keep home environment clean · Avoid kitty litter · Avoid raw veggies and meat · Bodily fluids should be cleaned with soap and water and area disinfected with 1:10 bleach solution for at least 5 minutes · Soiled bed linens washed in hot water with 1 cup bleach per load · Dispose of needles in sharps · Standard precautions

Nursing interventions for HIV/AIDS

· Notify physician and care team; chart · Infectious disease consult (for opportunistic infections) · Get RD involved - nutrition plays role in wasting syndrome and skin breakdown · Alternative therapies may help relieve symptoms but make sure you get an order · ADLs, support group, home health · Often on TPN, require oxygen · May go to long term care facility or require hospice · Infectious Disease, Respiratory, RD, Rehab · Alternative treatments? · Support groups? · Home health support? Hospice? Long term care?

Case Study The patient is very weak. During this admission he has experienced anorexia, painful swallowing, severe diarrhea, and occasional vomiting. Frequent mouth care is to be delegated to the unlicensed assistive personnel (UAP). What instructions should the nurse give the UAP?

· Sit the patient up and provide emesis container · Use soft-bristled brush · Avoid alcohol or commercial based mouthwash (stomatitis) · Brush with saline solution rather than CHX solution (CHX too aggressive for mouth) every 2 hours · Wear gloves · Encourage oral water intake - bring fresh water in room and encourage them to drink · Report to RN any changes (patient complaint of pain so that NURSE can go assess) · UAPs cannot assess, but they can report if the patient is complaining of pain