PrepU CH.16

The nurse knows that further teaching is needed when a client who is HIV positive makes which of the following statements? The client is aware that his blood work reflects a CD4+ cell count of 800. Select all that apply.

c) "I am disappointed that I am not yet cured of HIV." d) "Since my CD4+ count is 800, I understand that I am of little risk of infecting my sexual partner."

Which one of the following is a nonimmune defense mechanism?

Complement system reaction

The nurse is caring for a client who is HIV positive and is newly diagnosed with Mycobacterium tuberculosis (TB). Which of the following symptoms does the nurse associate with TB? Select all that apply.

• Cough • Fever • Night sweats

A 39 year-old female with has been characterized as a typical progressor by her care team, and is experiencing an increase in her manifestations and health complaints as her CD4+ count declines. Which of the following health problems would her care team most likely attribute to a cause other than her HIV?

Her decreased bone density and recent fractures.

When explaining what is occurring when their child has an acute bronchial asthma attack, the nurse will emphasize that which mediator is primarily responsible for the bronchial constriction?

Histamine.

A client is suffering from the effects of the opportunistic infection, Cryptosporidium parvum. An important nursing intervention would be to encourage which of the following?

Hydration

The surgeon is performing a kidney transplant on a client. The surgeon attaches the kidney and immediately notes that the kidney takes on a cyanotic, mottled appearance. The surgeon would interpret this as:

Hyperacute rejection

The nurse is caring for a client who has just been diagnosed with AIDS. The client asks the nurse, "How long will I live?" Which of the following is an appropriate response by the nurse?

"AIDS is considered to be a chronic illness today."

The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get AIDS from the blood. Select the best response from the nurse.

"All blood is now tested for the AIDS virus, so the risk of getting AIDS from a blood transfusion is extremely low."

When a patient who has been newly diagnosed with HIV asks, "What are the chances that I can be cured," which of the following is the nurse's most therapeutic response?

"Although there is no current treatment that provides a possible cure, there are ones that have successfully managed the infection."

The nurse is teaching a group of college students about reducing the risk of HIV transmission during sexual relations. The nurse makes which of the following appropriate teaching points?

"If a person has a sexually transmitted disease (STD), there is an increased risk for HIV infection."

The nurse is caring for a client who has been told that he is HIV infected. The client asks the nurse, "Can my partner and I ever have sex again?" Which of the following is an appropriate response by the nurse?

"If you use latex condoms with water-soluble lubricant consistently, sex is safer, but not completely risk free."

As part of her prenatal education, a 29 year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission?

"It's discouraging to know that my breast milk can pass on HIV to my baby."

A client describes himself as being "devastated" after hearing that his HIV test has come back positive. Which response by the nurse is most appropriate?

"It's entirely normal to feel that way. We are going to try our best to help you get all the support you need."

An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation?

"Our son likely has a deficiency of B-lymphocytes and can't produce antibodies."

A patient who was tested for HIV received a positive result from the enzyme-linked immunosorbent assay (ELISA) followed by a negative Western blot test asks the nurse what this means. Which of the following is the nurse's best response?

"The ELISA test gives some false positives, but the Western blot confirms you don't have HIV."

When counseling a male patient with suspected HIV, the nurse informs him that if the enzyme-linked immunosorbent assay (ELISA)come back positive, then:

A second test known as the Western blot assay will be ordered to confirm positive HIV status.

Which of the following patients has the highest risk of contracting an opportunistic infection?

A patient who has had HIV for 3 years and has a CD4+ count of 50 cells/μL

Which of the following is true regarding perinatal HIV infection? Check all that apply.

A woman infected with HIV may not breastfeed her infant. Women who are HIV positive should receive zidovudine during labor. In order to accurately make the diagnosis of HIV in an infant, two HIV-positive results are required.

The school nurse is teaching a health class to a group of high school students. She is preparing a lecture on HIV/AIDS. The nurse would know to include what information about the transmission of AIDS in her lecture? (Select all that apply.)

AIDS is transmitted through blood-to-blood contact. AIDS is transmitted through sexual contact. AIDS is transmitted from the mother to her unborn baby.

Which of the following would be the best treatment option to prevent perinatal transmission of HIV antibodies to a fetus from the HIV-positive mother?

Administration of zidovudine to the mother during pregnancy, labor, and delivery

An infant is suspected of having a severe combined T- and B-cell immunodeficiency disorder. Which of the following effects on the infant makes early detection a priority?

Administering live attenuated virus vaccines can be fatal.

A client presents to the Urgent Care with erythematous, papular, and vesicular lesions associated with intense pruritus and weeping. The client states he was in the woods and thinks he may have come in contact with poison ivy .The reaction may be classified as:

Allergic contact dermatitis

A patient will be receiving a bone graft from an unrelated individual. Which of the following types of graft does the nurse inform the patient that he or she will be receiving?

Allograft

A patient with common variable immunodeficiency (CVID) who is also deficient in IgA is being treated with IV immunoglobulin (IV Ig) in the hospital. For which of the following should the nurse closely monitor the client during treatment?

Anaphylaxis

Select the statement that best describes autoimmune disease.

Autoimmune diseases represent a disruption in self-tolerance that results in damage to body tissues by the immune system.

Which of the following types of a hypersensitivity reaction involves failure of the development of self-tolerance?

Autoimmune reaction

A client has developed a type 1 hypersensitivity reaction. The nurse recognizes that a secondary or late-phase response:

May occur 2 to 8 hours after the primary or initial-phase response and lasts for several days

A diagnosis of acquired immunodeficiency syndrome (AIDS) is identified when the CD4+ T cell count reaches which level?

Below 200 cells/μL

A patient has been diagnosed with Hodgkin's disease after a series of diagnostic tests. This condition would be related to which of the following immunodeficiencies?

Cellular (T cell)

Which one of the following statements about acquired immunodeficiency syndrome (AIDS) is true?

Both B-cell and T-cell function are affected.

HIV virus preferentially infects which of the following cells?

CD4+T lymphocytes and nerve cells

A client with end-stage renal disease received a kidney transplant with a kidney donated by a family member. The client has been carefully monitored for signs of rejection. The physician informs the client that there has been a gradual rise in the serum creatinine over the last 5 months. What type of rejection does this depict?

Chronic rejection

All antiretroviral medications interfere with some stage of the HIV life cycle. What stage do protease inhibitors prevent?

Cleavage of the polyprotein chain into the individual proteins that will be used to make new virus

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis?

Common variable immunodeficiency

In providing education to a sexually active 22-year-old female, which of the following would be most beneficial to discuss to decrease her risk for contracting HIV?

Consistent use of latex condoms with sexual activity

A client suspects they may have developed an allergic response to latex. What most common allergic response would the nurse expect to find?

Contact dermatitis

Which of the following serves as recognition markers to aid in self-tolerance?

HLA antigens encoded by MHC genes

Which of the following is a cost-effective diagnostic method that is used as a screening test for HIV antibodies?

Enzyme-linked immunosorbent assay (ELISA)

Which one of the following is the main effect of HIV infection?

Poor helper T-cell function

One week after a client received a transplant the nurse notes that the skin shows a maculopapular rash on the hands and feet. The client reports itching and nausea. What is the likely cause of these manifestations?

Graft versus host disease

The treatment of HIV/AIDS is complicated because different drugs act on different stages of the replication cycle of the virus. Therefore, treatment includes combinations of two, three, or more drugs. What is this treatment called?

HAART treatment

A male elementary school student has a severe allergy to peanuts and is displaying the signs of anaphylactic shock after inadvertently eating a peanut-containing candy bar. Which of the following statements best captures the boy's current status and preferred treatment?

He is approaching vascular shock and developing edema due to actions of IgE antibodies, situations that can be reversed by administration of epinephrine.

A 48 year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which of the following facts most accurately conveys an aspect of his diagnosis?

He is likely to have lesions on his skin, mouth or GI tract.

While undergoing a kidney transplant from a non-family member, the patients' transplanted kidney has just had the arterial clamps removed. The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement?

Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis.

The immune system typically responds to invaders of all types in our body. However, it can also cause tissue injury and disease. What is this effect called?

Hypersensitivity action

A patient with common variable immunodeficiency (CVID) is admitted to the hospital for treatment. Which of the following types of treatment will the nurse be administering to the patient?

IV immunoglobulin

Infants are born with a passive immunity that occurs when immunoglobulin antibodies cross the placenta from the maternal circulation prior to birth. Which immunoglobulin is capable of crossing the placenta?

IgG

The nurse is teaching a new mother about caring for her baby and reducing the risk for infection. On which of the following does the nurse base the knowledge of passive immunity?

Infants are protected at birth from infection by maternal IgG.

The nurse is caring for a child who has a defect in humoral immunity. The nurse is aware that the child is at risk for:

Infections with S. pneumonia, Haemophilus influenza, Staphylococcus aureus, and gram-negative organisms such as Pseudomonas species

Which of the following is the most common type of immunoglobulin deficiency, affecting 1 in 400 to 1 in 1000 persons?

Inherited selective IgA deficiency

A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?

Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

The nurse is teaching a client who has HIV infection about complications associated with HAART therapy, including which of the following?

Insulin resistance

Which of the following is a characteristic finding in AIDS?

Kaposi sarcoma

A 36-year-old male who is positive for HIV antibodies notices purplish spots on his upper body. Which of the following terms is used to identify these areas as an opportunistic infection?

Kaposi's sarcoma

Which one of the following is often found in a patient with AIDS?

Kaposi's sarcoma

Which of the following is a characteristic indicator that an individual is in the latent phase of HIV?

Lack of symptoms

The nurse is reviewing risk factors for a client to develop a type II (antibody-mediated) hypersensitivity reaction. These include: Select all that apply.

Mismatched blood transfusion reaction • Hemolytic disease of the newborn due to ABO or Rh incompatibility

Which of the following is least likely to contribute to the spread of HIV infection?

Mosquitoes

Systemic lupus erythematosus is best characterized by which one of the following?

Most patients have antinuclear antibodies present in their blood.

Which disorder does the nurse know is considered to be an autoimmune disease?

Myasthenia gravis

The nurse is assessing a client who has AIDS and has the opportunistic infection toxoplasmosis. In view of this diagnosis, the nurse performs a focused assessment on which of the following body systems?

Nervous

Typical symptoms seen in the latent period of HIV infection include which of the following?

No signs or symptoms

A 37 year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNAto DNA in a CD4+ cell. Which of the following classes of medications address this component of the HIV replication cycle?

Non-nucleoside reverse transcriptase inhibitors

The nurse is caring for a client who has AIDS and suffers from wasting syndrome. Which of the following is the priority nursing consideration for this client?

Nutrition

A 21-year-old woman diagnosed with HIV/AIDS 4 years ago now presents with cytomegalovirus. The nurse explains to the woman that the infection is caused by a common organism that normally does not cause infection in someone with a healthy immune system. This type of infection is called what?

Opportunistic infection

The nurse is caring for an infant wih DiGeorge syndrome. Which of the following organs does the nurse know will be underdeveloped or absent?

Parathyroid and thymus glands

Which of the following patients would be diagnosed with wasting syndrome?

Patient with HIV, fever, diarrhea, and significant involuntary weight loss

The CDC recommends routine testing for HIV of which groups of people? Select all that apply.

People who inject illicit drugs People who exchange sex for money People who have more than one sex partner

Which of the following is the main effect of HIV infection?

Poor helper T-cell function

A 40 year-old male who has been HIV-positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact?

Presentation of major histocompatibility molecules on body cells

A nurse is caring for a child who has had a history of recurrent severe infections that have been resistant to treatment with antibiotics. Which of the following disorders should be suspected in this child?

Primary immunodeficiency disorder (PID)

Which of the following is the priority intervention for a nurse caring for a patient with wasting syndrome from HIV?

Promote nutritional intake

The treatment prescribed for an autoimmune disorder is primarily dependent upon what?

The current manifestations of the disease and the mechanisms that cause the disease process

What instruction will the nurse provide to a client with a new diagnosis of anaphylactic reaction to peanuts?

Routinely wear medical alert identification.

A client with cirrhosis has just received a liver transplant. Tissue rejection can be best prevented by what means?

Suppression of CD8+ cytotoxic T cells

The nurse understands that a positive ELISA test reported in a baby born to a woman who is HIV positive indicates which of the following?

The baby has antibodies from the mother and it is uncertain whether the baby is infected with HIV.

An infant has been born to a client who is HIV positive. What is the infant's most likely prognosis for developing AIDS?

The infant can be HIV antibody positive by ELISA for up to 18 months of age without being actively infected with HIV.

A nurse practitioner is explaining the current methods of detection of HIV to a community group. In explaining the definitive method of detection, which statement is most accurate?

The most sensitive and specific test is the Western blot analysis.

Why is early diagnosis essential for an infant with severe combined immunodeficiency disorders (SCIDs)?

There is better opportunity for successful treatment.

A pregnant client who is positive for HIV is concerned about her infant acquiring the virus. The best response by the nurse would be that children born to mothers with HIV infection are considered uninfected if: Select all that apply.

They haven't met the surveillance case definition criteria for AIDS in children, they become HIV antibody negative after 18 months of age, and they have no other laboratory evidence of HIV infection

Which of the following serves as the rationale for AIDS treatment with antiretroviral therapy?

Triple therapy with reverse transcriptase, protease, and fusion inhibitors

Children born to mothers who are infected with HIV are considered uninfected if the children become HIV antibody negative after 18 months of age, have no other laboratory evidence of HIV infection, and have not met the surveillance case definition criteria for AIDS in children.

True

The type of hypersensitivity reaction that is dependent on IgE-mediated activation of mast cells and basophils and the subsequent release of chemical mediators of the inflammatory response is known as which of the following types of hypersensitivity reaction?

Type I

The type of hypersensitivity reaction that is mediated by IgG or IgM antibodies directed against target antigens on specific host cell surfaces or tissues is also known as which of the following types of hypersensitivity reaction?

Type II

A client has developed a hypersensitivity reaction resulting in the formation and deposition of insoluble antigen-antibody complexes that cause serum sickness and acute glomerulonephritis. The nurse would document this as:

Type III hypersensitivity reaction

The nurse is caring for a client who is diagnosed with Pneumocystis jiroveci pneumonia (PCP). Which of the following interventions will the nurse implement?

Universal precautions

What is the length of time from infection with the AIDS virus to seroconversion?

Up to six months

A patient in the primary or initial phase of a type I hypersensitivity reaction would most likely experience which of the following?

Vasodilation of the capillaries from the release of histamine

A client presents at the clinic complaining of unplanned weight loss of up to 10% of her body weight. She states that she has had diarrhea, more than twice a day. She goes on to say the she has fever and weakness that "just won't go away." After a complete history and physical, an enzyme-linked immunosorbent assay test is ordered. This order is based on what suspected diagnosis?

Wasting syndrome

The nurse is administering an intramuscular medication to a client who has AIDS. Which of the following precautions will the nurse take when administering the medication?

Wear gloves

A nursing student is assigned to care for a client who has AIDS. The student is unsure of what personal protective equipment should be worn while caring for this client. Which of the following statements is appropriate direction from the student's nursing instructor?

Wear gloves if there is a chance you will come in contact with the client's blood or body fluids.

A 20-year-old male presents at the clinic complaining of severe fatigue, night sweats, and fever. While taking the client's history, he reports having multiple sexual partners and unprotected sex. HIV/AIDS is suspected. What diagnostic test would be ordered to confirm the diagnosis?

Western blot assay

The nurse is caring for a client who has lesions of Kaposi sarcoma (KS). The nurse understands that KS:

is a malignancy of the endothelial cells that line small blood vessels.

HIV is considered to be a retrovirus because:

it carries its genetic information in ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA).

The nurse is reviewing the client's medical record for the results of a Western blot test with the understanding that:

the Western blot is used to confirm a diagnosis of HIV infection.