Test 7

which home care instructions should the nurse plan to reinforce to the mother of a child with AIDS? select all that apply a. frequent hand washing is important b. the child should avoid exposures to other illnesses c. the childs immunization schedule will need revision d. kissing the child on the mouth will not transmit the disease e. clean body fluid spills with bleach solution f. fever, malaise, fatigue, weight loss, vomiting, and diarrhea are expected to occur and do not require special intervention

1, 2, 5 AIDS is a disorder that is caused by HIV and is characterized by a generalized dysfunction of the immune system. both cellular and humoral immunity are compromised. the horizontal transmission of HIV occurs through intimate sexual contact or parenteral exposure to blood of bodily fluid that contain blood. vertical (parenteral) transmission occurs an HIV infected pregnant woman passes the infection to her infant. home care instructions include the following: frequent hand washing, monitoring for fever, malaise, fatigue, weight loss, vomiting, diarrhea, altered activity level and oral lesions and notify the hcp if these occur.

Which type of abuse is described as the failure to meet the basic needs of children by those persons responsible for their health and well-being? 1)Physical abuse 2)Physical neglect 3)Emotional abuse and neglect 4)Nonassaultive abuse

2) physical neglect

The best way to treat violent families is to offer families: 1)A crisis intervention program. 2)A multidisciplinary approach to treatment. 3)A safe haven from the abuser. 4)Legal counseling and court assistance.

2)A multidisciplinary approach to treatment.

Which form of abuse is least reported to authorities? 1)Elder abuse 2)Sexual abuse 3)Child sexual abuse 4)Child maltreatment

3)Child sexual abuse

Infants less than 1 year of age who present with apnea, seizures, lethargy, respiratory difficulty, coma, or death should be suspected of: 1) Maltreatment. 2)Physical abuse. 3)Shaken baby syndrome. 4)Child neglect.

3)Shaken baby syndrome.

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the: A American Nurses Association's (ANA's) Code of Ethics B Nurse Practice Act (NPA) written by state legislation C Standards of care from experts in the practice field D Good Samaritan laws for civil guidelines

A (This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting.)

The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, "If I avoid strangers or situations where I am alone outside at night, I'll be safe from sexual attacks." Choose the nurse's best response. a. "Your plan is not adequate. You could still be raped or sexually assaulted." b. "I am glad you have this excellent safety plan. Would others like to comment?" c. "It's better to walk with someone or call security when you enter or leave a building." d. "Sexual assaults are more often perpetrated by acquaintances. Let's discuss ways to prevent that."

ANS: D Females know their offenders in almost 70% of all violent crimes committed against them, including rape. The nurse should share this information along with encouraging discussion of safety measures. The distracters fail to provide adequate information or encourage discussion.

A bioethical issue should be described as: A The physician's making all decisions of client management without getting input from the client B A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy. C The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident. D After the client gives permission, the physician's disclosing all information to the family for their support in the management of the client.

B (The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in the white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early in the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed.)

The distribution of nurses to areas of "most need" in the time of a nursing shortage is an example of: A Utilitarianism theory B Deontological theory C Justice D Beneficence

C (Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.)

In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. The nurse's point of view is valuable because: A Nurses have a legal license that encourages their presence during ethical discussions. B The principle of autonomy guides all participants to respect their own self-worth C Nurses develop a relationship to the client that is unique among all professional health care providers D The nurse's code of ethics recommends that a nurse be present at any ethical discussion about client care

C (When ethical dilemmas arise, the nurses point of view unique and critical. The nurse usually interacts with clients over longer time intervals than do other disciples.)

a patient known to he positive for HIV is admitted with oral thrush, recurrent vaginal yeast infections, and skin infections. what do these signs indicate? a. opportunistic infection b. antimicrobial resistance c. resistant strain of HIV d. sentinel infection

Candidiasis is a common opportunistic infection (OI) in the HIV-positive patient. Antimicrobial resistance can be determined only via microbiologic culture accompanied by the antibiogram (test that shows drug sensitivities). Resistant strains of HIV are mutations of the virus that do not respond well to chemotherapy. Sentinel infections are seen in AIDS-defining infections and where the candidiasis is currently located is not indicative of this type of infection.

the obligation to do or cause no harm to another

Nonmaleficence

the nurse is assisting in planning care for a client with a diagnosis of immune deficiency. the nurse should incorporate which as a priority in the plan of care? a. protecting the client from infection b. providing emotional support to decrease fear c. encouraging discussion about lifestyle changes d. identifying factors that decreased the immune function

a the client with an immune deficiency has inadequate or absent immune bodies and is at risk for infection. the priority nursing intervention would be to protect the client from infection. options b, c, and d may be components of care but not the priority

a nurse in the ED is caring for a client who sustained minor injuries in a motor vehicle crash. the client's spouse was killed in the accident. which of the following actions should the nurse take first? a. determine if the client has thoughts of self-harm b. ask the client how the accident occurred c. assist the client in setting short term treatment goals d. instruct the client on use of coping strategies

a the greatest risk for this patient is the risk of harming themself or others. the nurse should do the other things also, but a is the top priority

a nurse is reinforcing teaching with a client who has a new diagnosis of rheumatoid arthritis. which of the following instructions should the nurse give? a. you can experience morning stiffness when you get out of bed b. you can experience abdominal pain c. you can experience weight gain d. you can experience low blood sugar

a the nurse should reinforce in the teaching that someone with RA can experience stiff joints when they wake up. the cleint with RA does not experience abdominal pain but pleuritic pain. they experience weight loss not gain. they do not experience low blood sugar

a nurse is teaching an adolescent client who has a new prescription for fluoxtine to treat OCD. which of the following instructions should the nurse include? a. wear sunscreen when outdoors b. check your weight daily c. take this medication at bedtime d. the effects of this medication are immediate

a wearing protective clothing and sunscreen when outdoors will decrease reactions caused by photosensitivity, an adverse effect of SSRI medications. the client should check their weight weekly. the client should take this medication in the morning to prevent insomnia. the nurse should instruct the client that it may take 1-3 weeks for the medication to take effect

a nurse is caring for a client who is suspected of having HIV. which of the following diagnostic tests and lab values are used to confirm HIV infection? select all that apply a. western blot b. indirect immunofluorescence assay c. CD4+ t-lymphocyte count d. HIV RNA quantification test e. cerebrospinal fluid analysis

a, b positive western blot and indirect immunofluorescence confirm the presence of HIV. CD4+ determines what stage of HIV. HIV RNA classifications are to determine the viral level and to monitor treatment. CSF analysis is used to determine meningitis

regarding sexuality of the older adult: select all that apply a.rates of HIV are decreasing but other STIs are increasing in the older population b. older women are more vulnerable than older men to acquiring a new HIV infection c. HCPs are less likely to ask the older patients about their sex practices d. people living with HIV/AIDS typically do not live into their older adult years e. older adults are at low risk for STIs because condom use is a well developed habit

a, b, c Health care providers are less likely to ask the older patient about risky behaviors that might place them at risk for HIV. The percentage of older adults infected with HIV and other STIs is increasing, partly because people are living longer with the HIV virus, but also because the use of condoms in this population is low. In addition, women are at greater risk than men because of the normal changes of aging (vaginal dryness) and risk of tearing of the vaginal wall.

a nurse is assisting with admitting a child who has HIV. the nurse should identify which of the following findings as indications that the child is in the moderately symptomatic category (B)? select all that apply a. herpes zoster b. bronchitis c. oral candidiasis d. mycobacterial pneumonia e. TB

a, b, c herpes zoster, bronchitis, and oral candidiasis are all in the moderate category. mycobacterium pneumonia and TB are in the severe category

a nurse in an outpatient clinic is collecting data from a client who reports night sweats and fatigue. the clients oral is 100.6 degrees F. the client is afraid he has HIV. which of the following actions should the nurse take? select all that apply a. measure vital signs b. determine when manifestation began c. weigh the client d. reinforce teaching about opportunistic infections e. obtain a sexual history

a, b, c, e the nurse should measure VS, determine first signs, weight and sexual history about the clients condition. the nurse should not teach about opportunistic infections until a diagnosis is made

a nurse in an outpatient clinic is collecting data from a client who reports night sweats, fatigue, cough, nausea, and diarrhea. the client asks the nurse is it is possible he has HIV. which of the following actions should the nurse take? select all that apply a. measure vital signs b. determine when manifestations began c. obtain a weight d. reinforce teaching about HIV transmission e. obtain a sexual history from the client

a, b, c, e the nurse should measure vitals to collect data about the clients condition. the nurse should should gather more data to determine whether manifestations are acute or chronic. the nurse should weigh the client. the nurse should obtain a sexual history to determine how the client might have acquired the illness. the nurse should not reinforce teaching about transmission until there is a diagnosis.

which statement(s) is/are true regarding HIV transmission? select all that apply a. breast milk can harbor the virus b. proper use of PPE reduces the risk of transmission c. needle exchange programs facilitate the spread of the virus d. being assessed two hours after a blood-bourne pathogen exposure reduces the risk conversion e. monogamous relationships provide the best defense from the virus

a, b, d The virus can be found in the breast milk of HIV-positive women. Appropriate use of personal protective equipment (PPE) minimizes the risk of exposure to health care workers. Needle exchange programs decrease the spread of HIV. The health care worker must be seen by a health care provider and started on postexposure prophylaxis (PEP) therapy within 2 hours of a significant exposure to HIV-positive blood or body fluids. Abstinence provides the best defense from the virus.

nursing ethics is balanced on principles of moral autonomy, beneficence, fidelity, justice, non-maleficence, and veracity. these principles of moral conduct can be distinctly involved in which of the following? select all that apply a. caregiving relationships between nurse and client's family members b. patients right to self-determination c. working relationship between nurse and attending physician d. nursing responsibilities to dose management

a, b, d nursing ethics apply most directly to relationships, responsibilities, and actions of nursing providers with clients

a nurse in an outpatient clinic is collecting data from a client who has rheumatoid arthritis. the client reports increased joint tenderness and swelling. which of the following should the nurse expect? select all that apply a. recent influenza b. decreased ROM c. hypersalivation d. increased BP e. pain at rest

a, b, e some recent illnesses can exacerbate RA, they experience decreased ROM, and have pain. clients who has RA can experience xerostomia not hypersalivation. increased BP doesnt relate to RA.

in determining the optimal therapy for a client infected with HIV, what would the nurse consider in developing a nursing care plan? place in order of priority a. clinical data b. compliance with therapy c. medication tolerance d. support system e. patient expectations

a, c, b, e, d Clinical data provides current health status of patient by report. If there are too many side effects, the patient is more likely to stop taking the medication. A noncompliant patient will be more difficult to treat. It is the patient's expectations that help drive successful therapy. A reliable support system will assist the HIV/AIDS patient in managing their disease.

a nurse is collecting data from a child who has severely symptomatic HIV. the nurse should recognize that which of the following conditions is part of the severely symptomatic category? select all that apply a. kaposi's sarcoma b. hepatitis c. wasting syndrome d. pulmonary candidiasis e. cardiomyopathy

a, c, d kaposi's sarcoma, wasting syndrome, and pulmonary candidiasis are severe symptoms for someone with HIV. hepatitis and cardiomyopathy are moderate symptoms.

a nurse is reviewing discharge teaching with a parent of a child who has HIV. which of the following information should the nurse include. select all that apply a. obtain yearly influenza vaccine b. monitor a fever for 24 hours before seeking medical care c. avoid individuals who have colds d. provide nutritional supplements e. administer aspirin for pain

a, c, d yearly vaccine, avoiding people with colds, and nutritional supplements are recommended to protect the child. the child who has HIV should receive prompt medical care for a fever. the parent should administer acetaminophen, NSAIDS, or opioids for pain.

a patient with an immune disorder is very susceptible to infection. which interventions would be used in the care of this patient? select all that apply a. all health care workers should perform scrupulous hand hygiene b. the patient should be instructed how to wear PPE c. the patient is placed in contact isolation d. caregivers with any type of infection should not be assigned to this patient e. a high protein diet with nutritional supplements is encouraged

a, d, e Performing hand hygiene, providing protection from exposure to known infectious sources, and giving protein to make antibodies and strengthen the immune system are appropriate interventions. The patient generally will not don PPE (those entering the room will don PPE). The patient will be placed in transmission-based isolation, not Contact Isolation.

a nurse is collecting data from a client to identify risk factors for HIV. which of the following are risk factors associated with this virus? select all that apply a. perinatal exposure b. pregnancy c. monogamous sex partners d. older adult woman e. occupational exposure

a, d, e perinatal exposure, older female, and occupational exposure are risk factors for HIV. pregnancy and monogamous sex partner are not risks of HIV

respect for an individuals right to self-determination

autonomy

a type of fracture in a child that may be indicative of child abuse is: a. greenstick fracture of the tibia b. spiral fracture of the femur c. pathological fracture of the fibula d. aligned fracture of the wrist

b A spiral fracture of the femur is caused by a forceful twisting motion. When the history of an injury does not correlate with x-ray findings, child abuse should be suspected because spiral fractures can be the result of manual twisting of the extremity.

a nurse is reinforcing teaching with a group of adolescents about HIV/AIDS. which of the following statements should the nurse include? a. you can contact HIV through causal kissing b. HIV is transmitted through IV substance abuse c. HIV is now curable if caught in the early stages d. Medications inhibit transmission of the HIV virus

b HIV is spread by via blood, semen, vaginal secretions, and breast milk. IV or needle use is another way to contract HIV if an infected needle was used. casual kissing does not spread HIV. antiretroviral therapy slows the progression of HIV, but does not cure it. medications can suppress the progression and can reduce the risk of transmission, but medications can not completely prevent HIV.

a nurse is conducting chart reviews of multiple clients at a mental health facility. which of the following events should the nurse identify as an example of a maturational crisis? a. rape b. marriage c. physical illness d. job loss

b marriage is a naturally occurring event in life that occurs in the lifetime. rape is an adventitious crisis. severe physical illness and loss of a job are situational crisis.

the most opportunistic infection in clients with HIV infection is: a. aphthae b. candidiasis c. cytomegalovirus (CMV) d. herpes simplex (HSV)

b oral candidiasis or thrush is the most common opportunistic infections in HIV clients. although CMV and HSV are opportunistic infections that are typically seen in full blown AIDS. aphthae or canker sores are not opportunistic infections

a nurse is discussing the risk factors for somatic symptoms with a newly licensed nurse. which of the following risk factors should the nurse include? select all that apply a. age older than 65 years b. anxiety disorder c. female gender d. coronary artery disease e. obesity

b, c

a nurse is caring for a client who is in labor and has HIV. which of the following procedures should the nurse identify as being safe for his client? select all that apply a. vacuum extraction b. oxytocin infusion c. use of forceps d. cesarean birth e. internal fetal monitoring

b, d oxytocin infusion is a noninvasive procedure and has less risk of exposing the baby to the mothers blood. c-section birth is recommended for people with HIV to reduce the risk of transmission to the baby. vacuum extraction, use of forceps, and internal fetal monitoring pose an increased risk at spreading the virus to the baby, so those should be avoided.

a nurse is reviewing the medical record of a client who has rheumatoid arthritis. the nurse should review which of the following lab results when monitoring the disease? select all that apply a. urinalysis b. ESR c. BUN d. ANA titer e. WBC counts

b, d, e ESR, ANA titer, and WBC are labs that help diagnose RA. urinalysis detects kidney function. BUN detects kidney failure

a nurse is caring for a client who is experiencing a crisis. which of the following medications should the nurse plan to administer? select all that apply a. lithium carbonate b. paroxetine c. risperidone d. haloperidol e. lorazepam

b, e SSRI antidepressants like paroxetine, and benzodizepines like lorazepam can be used to decrease anxiety. lithium carbonate is a mood stabilizer, and c, d are antipsychotics

the duty to do good to others and maintain a balance between benefits and harms. paternalism is an undesirable outcome, in which the HCP decides what is best for the client and encourages the client to act against his or her own choices

beneficence

a 46 year old woman is diagnosed with generalized anxiety disorder. which behavior is more likely to be displayed with this diagnosis? a. runs out of the room when she sees a spider in the corner b. continuously checks to see if doors are shut and locked c. has difficulty concentrating and excessively worries about her family d. wakes at night screaming because of recurrent nightmares

c Difficulty concentrating and excessive worry are part of diagnostic criteria for general anxiety disorder (GAD). Excessive fear of spiders is an example of phobic disorder; Repetitive checking and rechecking doors is an example of behavior associated with obsessive-compulsive disorder; Recurrent nightmares are associated with post-traumatic stress disorder (PTSD).

the nurse reinforces the providers orders to draw blood for HIV genotyping. the patient asks "how does that help in my treatment?" what is the best explanation for the test? a. confirms the presence of a viral automimmune disease b. informs how much of the virus has been replicated c. determines the presence of any mutations in the virus d. reveals the viral load or count of the virus

c HIV genotyping is the correct test to identify mutations in the virus. Not all autoimmune diseases are caused by viruses. Phenotyping test is what tells about viral replication. Viral load test is HIV RNA quantitative.

a nurse is assessing a client who has HIV. which of the following findings should the nurse identify as a manifestation of HIV associated muscle wasting? a. unintentional weight loss of 15% of body weight in 6 months b. fecal impaction c. diminished strength d. report of increased fat gain on the back of the neck

c a client with muscle wasting will report having diminished strength due to GI malabsorption.HIV associated weight loss is 5% in 6 months. they may have diarrhea instead of fecal impaction. increased fat on the back of the neck can mean that there is HIV associated lipodystrophy not muscle wasting.

an older adult client is a victim of elder abuse, and the clients family has been attending weekly counseling sessions. which statement by the abusive family member indicated the client has learned positing coping skills? a. i will be more careful to make sure that my fathers needs are met b. now that my father is moving into my home, i will need to change my ways c. i feel better able to care for my father now that i know where to obtain assistance d. i am so sorry and embarrassed that the abusive event occurred. it wont happen again

c elder abuse sometimes occurs with family members who are being expected to care for their aging parents. this can cause family members to become over extended, frustrated, or financially depleted. knowing where in the community to turn for assistance in caring for aging family members can bring much needed relief. taking advantage of these alternatives is a positive alternative coping strategy.

a pregnant client with known HIV infection is admitted to the hospital in active labor. which method for assessing the fetus is most appropriate for the nurse to perform at this time? a. fetal scalp sampling b. chorionic villi sampling c. external fetal monitoring d. internal fetal monitoring

c external fetal monitoring minimizes the risk of exposing the fetus to the mother's HIV infected blood. external monitoring is the only non-invasive option listed.

a nursing assistant voices concern for personal safety when assigned care for a client with AIDS. which information from the nurse is best for allaying the nursing assistants fears? a. the life expectancy for AIDS clients is longer than previous years b. AIDS is commonly transmitted by contact with blood or body fluids c. standard precautions can prevent HIV transmission d. if infected, workers comp will cover the cost of care

c reinforcing the fact that standard precautions can block the transmission of the virus from the client to the healthcare worker is the best information among the choices

a nurse is helping admit a child who has HIV. the nurse should identify which of the following findings as indications that the child is in the mildly symptomatic category of HIV? select all that apply a. herpes zoster b. anemia c. dermatitis d. hepatomegaly e. lymphadenopathy

c, d, e mildly symptomatic includes atleast two manifestations like dermatitis, hepatomegaly, and lymphadenopathy. herpes and anemia are in the moderate symptomatic category

A health care issue often becomes an ethical dilemma because: A A clients legal rights coexist with a health professionals obligation B Decisions must be made quickly, often under stressful conditions C Decisions must be made based on value systems D The choices involved do not appear to be clearly right or wrong

d

a nurse feels that there may be a need to administer ordered medication to an older adult for anxiety. which strategy would help the nurse make this clinical decision? a. listen to verbalization of apprehension b. be sensitive to somatic complaints c. initiate therapeutic communication d. observe for escalation of agitation

d Escalation of agitation is a sign that medication is necessary. Listening to verbalization of apprehension in itself will not help make this clinical decision. Listening to somatic complaints may temporarily give the patient a sense of gratification, but the long-term goal for patients with somatic complaints may be better served by setting limits. The nurse would use listening and therapeutic communication as the first-line intervention to try and help the patient gain self-control without medication; the nurse then observes to see if these measures are working.

a nurse is reinforcing teaching with a client who has stage 3 HIV. which of the following statements by the client should indicate an understanding? a. i will wear gloves while changing the litter box b. i will rinse raw fruits in water before eating them c. i will wear a mask around family members who are sick d. i will cook vegetables before eating them

d a client who has AIDS should cook vegetables before eating them to kill the bacteria. a client who has AIDS should avoid changing the litter box because of toxoplasmosis, avoid eating raw fruit due to the bacteria, and they should avoid all contact with any sick person in the family.

the nurse is assisting in administering immunizations at a health clinic. the nurse understands that immunizations provides which? a. protection from all diseases b. innate immunity from disease c. natural immunity from disease d. acquired immunity from disease

d acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. natural (innate) immunity is present at birth. no immunization to protect the client from all diseases

a mother with HIV brings her 10 month old infant to the clinic for a checkup. a hcp has documented that the client is asymptomatic for HIV infection. after the checkup the mother tells the nurse that she is so pleased that the infant will not get HIV. which response by the nurse is appropriate? a. i am also so pleased that everything has turned out fine b. since symptoms has not developed it is unlikely that the infant will develop HIV infection c. everything looks great but be sure that that you return with your infant next month for the scheduled visit d. most children infected with HIV develop symptoms within the first 9 months of life and some become symptomatic at some point before the age of three

d most children who are infected with HIV develop symptoms within the first 9 months of life. the remainder of these infected children become symptomatic sometime before the age of 3 years. children with their immature immune systems have a shorter incubation period than adults. options 1, 2, 3 are incorrect

a nurse is caring for a child who has AIDS. which of the following isolation precautions should the nurse implement? a. contact b. airborne c. droplet d. standard

d standard isolation precautions prevent transmission of diseases that spread through blood or bodily fluids. contact, airborne, and droplet precautions are only needed for someone with a disease that can spread easily

a nurse is reinforcing teaching with a client who has stage 2 HIV and is having difficulty maintaining a normal weight. which of the following statements indicates understanding? a. i will choose a diet high in fat to help gain weight b. i will be sure to eat 3 large meals a day c. i will drink up to 1 L of liquid a day d. i will add high protein foods to my diet

d the client should add high protein, high calorie to the diet to maintain health and gain weight

the hcp provides laboratory studies for an infant of a woman positive for HIV to determine the presence of HIV antigen in the infant. the nurse anticipates that which laboratory study will be prescribed for the infant? a. chest x-ray b. western blot c. CD4+ cell count d. p24 antigen assay

d the detection of HIV in infants is confirmed by a p24 antigen assay, virus culture of of HIV, or polymerase chain reaction. a chest x-ray evaluates the presence of other manifestations of HIV infection such as pneumonia. a western blot test confirms the presence of HIV antibodies. the CD4+ cell count indicates how well the immune system is working

a friend shares with a nurse about being engaged to be married. the nurse knows that the friend's fiance has tested positive for HIV. what is the nurse's legal obligation to do? a. inform the friend of the fiances HIV infectious status b. recommend the friend be tested for HIV c. advise the friend to postpone the marriage indefinitely d. safeguard information in the fiances history of health

d the nurse has a legal and ethical responsibility to protect the confidentiality of the person who tested positive for HIV

the duty to do what one has promised

fidelity

the equitable distribution of potential benefits and tasks determining the order in which clients should be provided care

justice

the obligation to tell the truth

veracity