220 Unit 3

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? "Condoms should be used when lesions are present on the penis." "Always position the condom with a space at the tip of an erect penis." "Make sure it fits loosely to allow for penile erection." "Use adequate lubrication, such as petroleum jelly."

"Always position the condom with a space at the tip of an erect penis." (Positioning the condom with a space at the tip of the erect penis allows for the collection of semen at the tip of the condom.Condoms must be used by HIV-infected people at all times for sexual activity, with or without the presence of lesions. Condoms should be applied on an erect penis and should fit snugly, leaving space without air at the tip. Lubricants should be water-based only. Oil-based lubricants, for example, petroleum-based lubricants (such as petroleum jelly), can increase the likelihood of breakage and slipping of latex condoms due to loss of elasticity caused by these lubricants. Oil may also create tiny holes in the latex. Oil-based lubricants may be considered desirable for people who are in relationships not requiring condom use and who wish to avoid certain additives and preservatives often found in other lubricants.)

A client diagnosed with human immune deficiency virus is prescribed several antiretroviral drugs. 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? "This will not make any difference in the viral load." "Blood concentrations will be decreased, which will lead to increased viral replication." "If only one dose of medication is missed, this will not make a difference." "This will cause an increase in opportunistic infections."

"Blood concentrations will be decreased, which will lead to increased viral replication." (When doses are missed, blood concentrations become lower than what is needed for inhibition of viral replication (often called the inhibitory concentration). Teach clients the importance of taking their drugs exactly as prescribed to maintain the effectiveness of HAART.When the inhibitory concentration is too low, the organism can replicate and produce new organisms that are resistant to the drugs being used. It does not cause an increase in opportunistic infections but places the client at increased risk for developing one. Therefore, it does make a difference and is critical to ensure that highly active antiretroviral therapy (HAART) doses are not missed, delayed, or administered in lower-than-prescribed dosages in the inpatient setting.)

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? "Have you had sex with men or women or both?" "I hope you use condoms to protect your partners." "You must tell me all of your partners' names, so I can let them know about possibly having AIDS." "You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."

"Have you had sex with men or women or both?" (The straightforward approach of asking the client about having sex with men or women is nonjudgmental and most appropriate."I hope you use..." is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. Asking for information in the name of the public health department is not straightforward, and the tone of this entire statement is judgmental. Judgmental statements to clients by healthcare providers (HCPs) can impede the collaborative relationship and communication between client and HCP.)

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. "I am 78 years old, and I was treated and cured of syphilis many years ago." "In 1986, I received a transfusion of platelets." "Seven years ago, I was released from a penitentiary." "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." "At 68, I am going to get married for the fourth time."

"I am 78 years old, and I was treated and cured of syphilis many years ago." "Seven years ago, I was released from a penitentiary." "At 68, I am going to get married for the fourth time." (People who have had a sexually transmitted disease should be tested. People who are in or have been in correctional institutions such as jails or prisons and people who are planning to get married should be tested for HIV.HIV testing is recommended for clients who received a blood transfusion between 1978 and 1985. People who have used injectable drugs (not marijuana) should be tested.)

Which client statement regarding his or her diagnosis of HIV infection indicates a need that further teaching is necessary? "I must take these medications exactly as prescribed for the rest of my life." "I don't need to use condoms as long as I take my medication as prescribed." "I will notify my health care provider immediately if I bruise or bleed more easily than normal." "I should remain upright for 30 minutes after taking my zidovudine to prevent esophageal ulceration."

"I don't need to use condoms as long as I take my medication as prescribed." (Antiretroviral drugs do not stop the transmission of HIV, and clients need to continue standard precautions and safe sex practice, including condom use. Potential serious adverse effects of zidovudine are bone marrow suppression and esophageal ulceration.)

The nurse is teaching a client about cyclosporine (Sandimmune) therapy after liver transplantation. Which client statement indicates the need for further teaching? "I will be on this medicine for the rest of my life." "I must undergo regular kidney function tests." "I must regularly monitor my blood sugar." "My gums may become swollen because of this drug."

"I must regularly monitor my blood sugar." (Further teaching is needed when the client says, "I must regularly monitor my blood sugar." Blood sugar is not affected by taking cyclosporine, so the client has no need to monitor blood sugar.The client must take cyclosporine for the rest of his or her life. (See chart 17-2) Kidney dysfunction is a side effect of cyclosporine, so regular monitoring is required. Swollen gums are a side effect of taking cyclosporine.)

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? "When I injected heroin, I was exposed to HIV." "I don't understand how the antiretroviral drugs work." "I remember to take my antiretroviral drugs almost every day." "My sex drive is weaker than it used to be since I started taking my antiretroviral medications."

"I remember to take my antiretroviral drugs almost every day." (It is important that clients take these drugs consistently, because inconsistent use of antiretroviral medications can lead to unsuccessful therapy and the development of drug-resistant HIV strains. The nurse would immediately assess the reasons why the client does not take the medications daily and then would implement a plan to improve adherence.The nurse would assess whether the client is still injecting drugs and would make certain the client understands the risks for infection with another strain of HIV or other blood borne pathogens and the risk for spreading HIV, but this does not need to be addressed immediately. The nurse must provide further education about how the medications work and assess how the lack of knowledge or decreased libido influences compliance, but this does not need to be addressed immediately.)

Which client statement indicates in-home stem cell transplantation is not a viable option? "We live 5 miles from the hospital." "I will have lots of medicine to take." "I was a nurse, so I can take care of myself." "I don't feel strong enough, but my wife said she would help."

"I was a nurse, so I can take care of myself." (The client statement that indicates that in-home stem cell transplantation is not a viable option is "I was a nurse, so I can take care of myself." Stem cell transplantation in the home setting requires support, assistance, and coordination from others. The client cannot manage this type of care on his own.It is acceptable for the client's spouse to support the client undergoing this procedure. It is not unexpected for the client to be taking several prescriptions. Five miles is an acceptable distance from the hospital, in case of emergency.)

The nurse instructor is teaching a group of nursing students about acute rejection of kidney transplantation. What statement made by the nurse instructor is accurate? "Acute rejection manifests as pain at the transplant site." "Acute rejection can occur within 48 hours after transplantation." "A gradual increase in blood urea nitrogen (BUN) levels occurs as a result of acute rejection." "Increased doses of immunosuppressive drugs are used to treat and manage acute rejection."

"Increased doses of immunosuppressive drugs are used to treat and manage acute rejection." (Acute rejection of kidney transplantation is an immune reaction and is managed by increased doses of immunosuppressive drugs. Hyperacute rejection manifests as pain at the transplant site. Hyperacute rejection occurs within 48 hours after the surgery. Chronic rejection causes a gradual increase in BUN levels.)

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? "Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?" "Is there somewhere private in the home where we can go and talk?" "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." "It is your duty to protect your family members from getting AIDS."

"Is there somewhere private in the home where we can go and talk?" (A nonthreatening approach used initially to find out whether the client has informed family members or desires privacy is very important. The nurse needs to have a private conversation with the client to discover the client's wishes.The client has a right to privacy and can make the decision whether to post handwashing signs; caution signs invade the client's right to privacy. Protection from infection is important, but stating that the family members should know about the disease is not respectful of the client's right to privacy. The nurse suggesting that it is the client's responsibility to protect his or her family from getting AIDS is an intimidating statement. It is the client's right to make the decision whether to inform family members about his or her illness. However, this "nonaction" could be grounds for a lawsuit if the client were to infect someone inadvertently.)

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? "Your diseased kidneys will be removed at the same time the transplant is performed." "The new kidney will be placed directly below one of your old kidneys." "It is essential for you to wash your hands and avoid people who are ill." "You will receive dialysis the day before surgery and for about a week after."

"It is essential for you to wash your hands and avoid people who are ill." (Teaching the client to wash hands and stay away from sick people are important points for the nurse to include in teaching for a client scheduled for a kidney transplant. Antirejection medications increase the risks for infection, sepsis, and death. Strict aseptic technique and handwashing are essential.Unless severely infected, the client's kidneys are left in place and the graft is placed in the iliac fossa. Dialysis is performed the day before surgery. After the surgery, the new kidney should begin to make urine.)

When educating the client aboutimmunosuppressant therapy, what information would the nurse include in the teaching? Select all that apply. "If you miss a dose of medication, take extra medicine to make up the missed dose." "Never stop taking these medications without being instructed by your health care provider." "Over-the-counter medications are alright to take as needed." "You must take all medications exactly as prescribed." "Medications must be taken at the correct time every time to avoid interactions."

"Never stop taking these medications without being instructed by your health care provider." "You must take all medications exactly as prescribed." "Medications must be taken at the correct time every time to avoid interactions." (Immunosuppressants must be taken exactly as directed and at the exact times and with the exact foods. Adherence to dosing schedules can be very difficult for clients because they are taking multiple medications that must be taken at different times throughout the day. Clients should never stop taking their immunosuppressants without being told to do so by their transplant health care provider. They should always talk to the transplant health care provider before taking any over-the-counter medications or if a scheduled dose is missed.)

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? "I can stop my medications when my kidney function returns to normal." "If my urine output is decreased, I should increase my fluids." "The antirejection medications will be taken for life." "I will drink 8 ounces (236 ml) of water with my medications."

"The antirejection medications will be taken for life." (When the client states that antirejection medications must be taken for life, it indicates that the kidney transplant client understands the discharge teaching. Immune-suppressant therapy must be taken for life to prevent organ rejection. Adherence to immunosuppressive drugs is crucial to survival for clients with transplanted kidneys.Lack of adherence can lead to complications such as rejection, graft loss, return to dialysis, and death. Oliguria (decreased urine output) is a symptom of transplant rejection. If this occurs, the transplant team must be contacted immediately. It is not necessary to take antirejection medication with 8 ounces (236 mL) of water.)

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? "I told family members they need to wash their hands when they enter and leave the room." "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." "Yes, I understand the reasons why I have to wear gloves when I bathe the client." "The client's spouse told me she got HIV from a blood transfusion."

"The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." (Discussing this client's illness outside of the client's room is a breach of confidentiality and requires further education by the nurse.Instruction on handwashing to family members or friends is not a breach of confidentiality. Understanding the reasons for wearing gloves recognizes Standard Precautions in direct care and is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a breach of confidentiality.)

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? "I need to know my HIV status, so I must get tested before caring for any clients." "Putting on a gown and gloves will cover up the itchy sores on my elbows." "Washing my hands and putting on a gown and gloves is what I must do before starting care." "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."

"Washing my hands and putting on a gown and gloves is what I must do before starting care." (Standard Precautions include hand hygiene and whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes.Knowing HIV status is important for preventing transmission of HIV, but is not part of the Standard Precaution Protocol. Health care workers with weeping dermatitis should not provide direct client care regardless of the use of a gown and gloves. Unlicensed health care workers cannot make the determination of what is required for PPE or Standard Precautions.)

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

"With this treatment, I probably cannot spread this virus to others." (HAART reduces viral load and improves CD4+ T-cell counts, but the client must still protect others from contact with his or her body fluids.HAART inhibits viral replication; it does not kill the virus. Remembering to take all doses of HAART is very important for preventing drug resistance.)

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? "I'll talk to the health care provider and have your name removed from the waiting list." "You sound frustrated with the situation." "You're right, the wait is endless for some people." "I'm sure you'll get a phone call soon that a kidney is available."

"You sound frustrated with the situation." (The most therapeutic statement by the nurse is "You sound frustrated with the situation." This acknowledges the client's frustration and reflects the feelings the client is having by offering assistance and support.Talking to the health care provider and removing the client from the waiting list does not allow the nurse to hear more and perhaps offer therapeutic listening or a solution to the problem. Telling the client that the wait is endless for some people cuts the client off from sharing his or her concerns and accentuates the negative aspects of the situation. The waiting time for kidney matches is increasing due to a shortage of organs, so the nurse would not offer false hope by suggesting that the client will get a phone call soon.)

Antiretroviral general side effects (6)

-dizziness -fatigue -nausea -vomiting -diarrhea -rash

The number of CD4+ T-cells is reduced in human immunodeficiency virus (HIV) disease. How many CD4+ T-cells are usually present in a cubic millimeter (mm³) of a healthy adult's blood? 200-499 500-799 800-1000 1000+

800-1000 (A healthy adult usually has 800-1000 CD4+T-cells/mm³. A patient with 200-499 CD4+T-cells/mm³ meets the criteria for stage 2 of the Centers for Disease Control and Prevention (CDC) Case Definition of HIV disease. A patient with greater than 500 CD4+T-cells/mm³ meets the criteria for stage 1 CDC Case Definition of HIV disease. More than 1000 CD4+T-cells/mm³ may be present in a healthy adult but are not typical.)

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? Abrupt decrease in urine output Blood-tinged urine Incisional pain Increase in urine output

Abrupt decrease in urine output (If an abrupt decrease in urine output occurs in the first 24 hours after a kidney transplant, immediate intervention is needed. This may indicate complications such as rejection, acute kidney injury, thrombosis, or obstruction.Blood-tinged urine, incisional pain, and an increase in urine output are expected findings after kidney transplantation.)

What safer sex methods can reduce the risk of human immunodeficiency virus (HIV) transmission? Select all that apply. Oral sex Abstinence Monogamy Condom use Heterosexual sex

Abstinence Monogamy Condom use (Safer sex methods of A, abstinence; B, be faithful (monogamous); and C, condom use can reduce HIV transmission. Abstinence and mutually monogamous sex with a noninfected partner are the only absolutely safe methods of preventing HIV infection from sexual contact. Oral sex and heterosexual sex are not considered safer sex methods.)

In North America, the highest rates of new human immunodeficiency virus (HIV) infections occur among which population? Women Men who have sex with men African American and Hispanic adults Adults who have used injection drugs

African American and Hispanic adults (In North America, the highest rates of new HIV infections occur among African American and Hispanic adults. Women, men who have sex with men, and adults who have used injection drugs have lower rates of infection.)

Which condition is not an anticipated adverse effect of azathioprine (Imuran)? Alopecia Thrombocytopenia Leukopenia Hepatotoxicity

Alopecia (Common adverse effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) is not an expected adverse effect.)

Medications used to treat HIV infections are more specifically classified as what type of drugs? Antiparasitic Antiviral Antifungal Antiretroviral

Antiretroviral (HIV is a member of the retrovirus family; therefore, drugs used to treat this virus are classified as antiretroviral drugs. Although antiretroviral drugs also fall under the broader category of antiviral drugs in general, their mechanisms of action are unique to the acquired immune deficiency syndrome virus. So, they are more commonly referred to by their subclassification as antiretroviral drugs.)

Which nursing activity can the nurse delegate to a home health aide? Changing the dressing for a client with a low absolute neutrophil count Assisting with bathing for a client with chronic rejection of a liver transplant Teaching a client with bacterial pneumonia how to take the prescribed antibiotic Assessing incisional tenderness for a client who had a recent kidney transplant

Assisting with bathing for a client with chronic rejection of a liver transplant (Assisting with bathing for a client with chronic rejection of a liver transplant can be delegated to the home health aide.Changing the dressing for a client with a low absolute neutrophil count requires strict sterile technique by a licensed RN and should not be delegated because of the high risk for infection. Teaching about medications and assessments is within the scope of practice of the professional RN.)

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? Clean toothbrushes once a week. Bathe daily using an antimicrobial soap. Eat salad at least once a day. Wash dishes in cool water.

Bathe daily using an antimicrobial soap. (Bathing daily and using an antimicrobial soap will help decrease the risk for opportunistic infections by reducing the number of bacteria found on the skin.Toothbrushes should be cleaned daily through the dishwasher or by rinsing in liquid laundry bleach. Salads and raw fruits and vegetables could be contaminated and should be avoided. Dishes should be washed in hot, soapy water or in a dishwasher.)

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

Breast-feeding Anal intercourse Oral sex (HIV can be transmitted via breast milk from an infected mother to the child. Anal intercourse not only allows seminal fluid to make contact with the mucous membranes of the rectum, but it also tears the mucous membranes, making infection more likely. Oral sexual contact exposes the mucous membranes to infected semen or vaginal secretions.HIV is not spread by mosquito bites or by other insects. It is not transmitted by casual contact. Sharing toilet facilities does not cause transmission of HIV.)

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. Change the decorations in the home according to the season. Put the bed close to the window. Write out detailed instructions, and have the client read them over before performing a task. Ask the client what time he or she prefers to shower or bathe. Mark off the days of the calendar, leaving open the current date.

Change the decorations in the home according to the season. Put the bed close to the window. Ask the client what time he or she prefers to shower or bathe. Mark off the days of the calendar, leaving open the current date. (Changing decorations according to the season and using a calendar to mark off the days will help to keep the client oriented. Keeping the bed close to the window may help keep the client oriented. The client should be included in planning the daily schedule.Directions to the client need to be short and uncomplicated, and not detailed.)

Before administration of an immunosuppressant drug, the nurse should perform which actions? (Select all that apply.) Check liver enzyme tests. Measure abdominal girth. Assess blood pressure and heart rate. Check blood urea nitrogen and creatinine levels. Assess level of consciousness.

Check liver enzyme tests. Assess blood pressure and heart rate. Check blood urea nitrogen and creatinine levels. Assess level of consciousness. (Serious adverse effects to immunosuppressant drugs include neurotoxicity, nephrotoxicity, hepatotoxicity, and hypertension.)

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

Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature (The temperature elevation of the client with a history of liver transplantation indicates that infection may be occurring, and is at risk for overwhelming infection because of cyclosporine-induced immune suppression. Immediate assessment by the nurse is indicated.Information regarding the HIV-positive client with Kaposi's sarcoma and the client with Bruton's agammaglobulinemia indicates that these clients' physiologic statuses are relatively stable. It is not unusual for a client who is undergoing radiation to have a decreased total lymphocyte count.)

The drug mycophenolate (CellCept) has a black box warning because of which potential adverse effect? Abnormal heart rhythms Suicidal ideations Congenital malformations Hypertension

Congenital malformations (Mycophenolate (CellCept) is an antimetabolite and suppresses T cell proliferation. It is indicated for the prevention of organ rejection as well as the treatment of organ rejection. Mycophenolate has a black box warning from the U.S. Food and Drug Administration stating that it is associated with an increased risk of congenital malformations and spontaneous abortions when used during pregnancy.)

Which signs and symptoms indicate rejection of a transplanted kidney? Select all that apply. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL Crackles in the lung fields Temperature of 98.8°F (37.1°C) Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities

Crackles in the lung fields Blood pressure of 164/98 mm Hg 3+ edema of the lower extremities (Signs and symptoms indicating rejection of a transplanted kidney include: crackles in the lung fields, blood pressure of 164/78 mm/Hg and 3+ edema of lower extremities. These are assessment findings related to fluid retention and transplant rejection.Increasing BUN and creatinine are symptoms of rejection, however, a BUN of 21 mg/dL (7.5 mmol/L) and a creatinine of 0.9 mg/dL (80 mcmol/L) reflect normal values. Fever, not normothermia, is symptomatic of transplant rejection.)

How often should the patient taking tenofovir/emtricitabine for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) be tested for HIV? Every three months Every 12 months Once before beginning PrEP After each contact that puts the patient at risk for infection

Every three months (The patient taking tenofovir/emtricitabine for PrEP for HIV should be tested for HIV every three months. Every 12 months is longer than recommended. The patient should be tested once before beginning PrEP, but the patient must continue getting screened. After each contact that carries a risk of infection is more than necessary.)

A nurse is educating an immunocompromised patient about preventing infection. Which should the patient report to the health care provider immediately? Foul-smelling or cloudy urine Missing a dose of prescribed drugs An intermittent cough without sputum Temperature greater than 98°F

Foul-smelling or cloudy urine (The patient should report to the physician immediately if there is foul-smelling or cloudy urine, because this may indicate infection. The patient should take all prescribed drugs but does not need to call the physician if he or she misses a dose; rather, he or she can read the drug's instructions that describe when to take the next dose. A persistent cough with or without sputum indicates an infection, but an intermittent cough does not. The patient only needs to contact the physician if his or her is about 100°F.)

Which postoperative kidney transplantation client does the nurse assess first for signs and symptoms of hyperacute rejection? Older adult with Parkinson disease receiving a donation from an identical twin Grand multipara female with a history of subsequent blood transfusions Middle-aged man with a 20-pack-year history Young adult with type 1 diabetes

Grand multipara female with a history of subsequent blood transfusions (The grand multipara female with a history of subsequent blood transfusions should be assessed first because multiple pregnancies and blood transfusions greatly increase the risk of a hyperacute rejection. Hyperacute rejection occurs mostly in transplanted kidneys but is less common now with better HLA matching. Symptoms of rejection are apparent within minutes of attachment of the donated organ to the recipient's blood supply. The process usually cannot be stopped once it has started, and the rejected organ must be removed as soon as hyperacute rejection is diagnosed.The older adult with Parkinson disease receiving a donation from an identical twin has less chance of hyperacute rejection because his donor is an identical twin. Smoking places the middle-aged man with a 20-pack-year history at higher risk for postoperative respiratory difficulties, but not for hyperacute rejection. Type 1 diabetes requires close postoperative monitoring of blood sugar, but does not predispose the client to a hyperacute rejection.)

The nurse would teach a client prescribed cyclosporine (Sandimmune) to avoid which substance? Acetaminophen Sunscreen Grapefruit juice Chocolate milk

Grapefruit juice (Clients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. Sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset.)

When the human immunodeficiency virus (HIV) virus enters the patient's CD4+ T-cell, what is the new role served by the immune cell? Antigen Antibody HIV factory Natural killer cell

HIV factory (Effects of HIV infection are related to the new genetic instructions that now direct CD4+ T-cells to change their role in immune system defenses. The new role is to be an "HIV factory," making up to 10 billion new viral particles daily. The CD4+ cell does not become an antigen, antibody, or natural killer cell.)

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? Adherence to therapy Handwashing Monitoring for low-grade fever Strict clean technique

Handwashing (Handwashing is the most important infection control measure for the client receiving immune-suppressive therapy to perform.Adherence to therapy and monitoring for low-grade fever are important but are not infection control measures. The nurse must practice aseptic technique for this client, not simply clean technique.)

Before administration of any antiviral medication, what nursing responsibilities would be performed? Select all that apply. Monitor for medication adverse effects History of medication use Documentation of known allergies Baseline vital signs Head-to-toe physical assessment

History of medication use Documentation of known allergies Baseline vital signs Head-to-toe physical assessment (Before administering an antiviral drug, perform a thorough head-to-toe physical assessment and take a medical and medication history. Document any known allergies before use of these and any other medications. Also assess the client's nutritional status and baseline vital signs because of the profound effects of viral illnesses on physiologic status, especially if the client is immunocompromised. Assess and document any contraindications, cautions, and drug interactions associated with all of the antiviral drugs. Monitoring for adverse effects would occur after the medication has been administered.)

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? Therapeutic highly active antiretroviral therapy (HAART) level Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot Positive Papanicolaou (Pap) test Improved CD4+ T-cell count and reduced viral load

Improved CD4+ T-cell count and reduced viral load (Improved CD4+ T-cell count and reduced viral load reflect the response to prescribed HAART medication.Therapeutic HAART level is the recommended medication combination given to clients with HIV to cause an increase in the CD4+ T-cell count. ELISA and Western blot, if positive, indicate that the client is HIV positive (a fact already known for this client) and do not indicate response to prescribed medication. Pap smears can be precancerous in an HIV-positive client, but the test does not indicate the immune system's response to prescribed medication.)

The most significant drug interactions with use of antivirals occur when antivirals are administered via which route? Optically Rectally Topically Intravenously

Intravenously (Significant drug interactions that occur with antiviral drugs arise most often when they are administered via systemic routes such as intravenously and orally. Many of these drugs are also applied topically to the eye or body, however, and the incidence of drug interactions associated with these routes of administration is much lower.)

The nurse would anticipate administering which medication to a client demonstrating acute organ rejection? Muromonab-CD3 (Orthoclone OKT3) Basiliximab (Simulect) Azathioprine (Imuran) Sirolimus (Rapamune)

Muromonab-CD3 (Orthoclone OKT3) (Only muromonab-CD3 (Orthoclone OKT3) is used to treat acute organ rejection. The other immunosuppressants are used to prevent organ rejection.)

Which cells are responsible for the rejection of transplanted organs in the human body? Basophils Eosinophils Neutrophils Natural killer cells

Natural killer cells (The natural killer cells enter the transplanted organs through blood and penetrate the organ cells by causing lysis. This reaction initiates the inflammatory response and may lead to acute rejection of the organ. Basophils release histamine and heparin in the areas of tissue damage which promotes the action of neutrophils and macrophages. Eosinophils act against the infestation of parasitic larvae and decrease the inflammatory responses, especially during allergic responses. Neutrophils help with ingestion and phagocytosis of foreign proteins.)

What are the physiologic roles of natural killer (NK) cells? Select all that apply. Act as trigger for allergic disorders Nonselectively attack non-self cells Attack mutated and malignant cells Attack grafts and transplanted organs Trigger the development of autoimmune diseases

Nonselectively attack non-self cells Attack mutated and malignant cells Attack grafts and transplanted organs (The physiologic roles of NK cells are to nonselectively attack non-self cells, mutated cells, malignant cells, grafts, and transplanted organs. They are not involved in triggering allergic disorders or autoimmune disorders.)

Which factor distinguishes a diagnosis of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)? Viral load Course of treatment Duration of infection Number of CD4+ T-cells

Number of CD4+ T-cells (Everyone who has AIDS has an HIV infection, but not everyone who has HIV has AIDS. The distinction is the number of CD4+ T-cells and whether any opportunistic infections have occurred. Viral load, course of treatment, and duration of infection are not distinguishing factors between HIV and AIDS diagnoses.)

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? Obtain a 12-lead electrocardiogram (ECG). Call for a portable chest x-ray. Obtain blood cultures from two sites. Give cefazolin (Kefzol) 500 mg IV.

Obtain blood cultures from two sites. (Antibiotics should be given as soon as possible to immunocompromised clients, but blood cultures must be obtained first so that culture results will not be affected by the antibiotic.A 12-lead ECG can be obtained and calling for a portable chest x-ray can be done after other priority requests have been carried out.)

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

Potential for infection transmission related to recurring opportunistic infections (Protecting the client from further opportunistic infection such as Candida albicans is a priority. Secondary immune deficiencies are common and acquired as part of another disease or as a consequence of certain medications. The most common secondary immune deficiencies are caused by aging, malnutrition, certain medications, and some infections, such as HIV. The most common medications associated with secondary immune deficiencies are chemotherapy agents and immune suppressive medications, cancer, transplanted organ rejection, or autoimmune diseases.Loss of social contact is not a priority problem with an opportunistic infection. Mouth sores would be secondary concern because Candida Albicans causes the mouth sores. Nutrition will be affected because of Candida Albicans; however, it is not a priority.)

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? History of hiatal hernia Presence of diabetes and glycosylated hemoglobin of 6.8% History of basal cell carcinoma on the nose 5 years ago Presence of tuberculosis

Presence of tuberculosis (Long-standing pulmonary disease and chronic infection typically exclude clients from transplantation. These conditions worsen with the immune suppressants that are required to prevent rejection.A client with a history of hiatal hernia is not exempt from undergoing a kidney transplant. Good control of diabetes is a positive point and would not exclude the client from transplantation. Basal cell carcinoma is considered curable and occurred 5 years ago, consistent with appropriate candidates for transplantation.)

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? Collaborate with the client to select foods that are high in calories. Provide oral care to the client before meals to enhance appetite. Assess the perianal area every 8 hours for signs of skin breakdown. Discuss the need to avoid foods that are spicy or irritating.

Provide oral care to the client before meals to enhance appetite. (Providing oral care is within the scope of practice of unlicensed personnel such as nursing assistants.Diet planning, assessment, and client teaching are higher-level actions that require more broad education and scope of practice, and would be done by licensed staff.)

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

The dietary worker hands the disposable meal trays to the RN assigned to the client. (The dietary worker giving the meal tray to the RN limits the number of health care personnel entering the room, thus reducing the risk for infection.Verbalizing stressors does not reduce the risk for infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection, but this does not reduce the risk of infection.)

Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What would the nurse suspect is the cause of this patient's skin rash? The donor T cells are attacking the patient's skin cells. The patient's antibodies are rejecting the donor bone marrow. The patient is experiencing a delayed hypersensitivity reaction. The patient will need treatment to prevent hyperacute rejection.

The donor T cells are attacking the patient's skin cells. (The patient's history and symptoms indicate that the patient is experiencing graft-versus-host disease, in which the donated T cells attack the patient's tissues. The history and symptoms are not consistent with rejection or delayed hypersensitivity.)

What is the general action of immunosuppressants? They inhibit T-lymphocytes. They reduce hepatic metabolism of steroids. They increase antibody response. They increase natural killer cellular activity.

They inhibit T-lymphocytes. (Immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants.)

The nurse has been exposed to the blood of a patient who is human immunodeficiency virus (HIV) positive. What is the window of opportunity to begin postexposure prophylaxis (PEP) for the best possible outcome in preventing HIV infection? Two hours 72 hours Two weeks One month

Two hours (Once the exposure has been discovered, PEP with combination antiretroviral therapy (cART) within two hours of the exposure has the best possible outcome in preventing HIV infection. The window of opportunity for best outcome closes when prophylaxis is started after 72 hours. The professional receiving prophylaxis must return for complete electrolytes, creatinine, and blood counts two weeks after starting cART and periodic HIV testing at one, three, and six months.)

How is the effectiveness of antiviral drugs administered to treat HIV infection assessed and evaluated? Viral load Red blood cell counts Lymphocyte counts Megakaryocytes

Viral load (All antiretroviral drugs work to reduce the viral load, which is the number of viral RNA copies per milliliter of blood.)

A client is taking prednisone to prevent transplant rejection. What instruction by the nurse is most important? a. "Avoid large crowds and people who are ill." b. "Check over-the-counter meds for acetaminophen." c. "Take this medicine exactly as prescribed." d. "You have a higher risk of developing cancer."

a. "Avoid large crowds and people who are ill." (Prednisone, like all steroids, decreases immune function. The client should be advised to avoid large crowds and people who are ill. Prednisone does not contain acetaminophen. All clients should be taught to take medications exactly as prescribed. A higher risk for cancer is seen with drugs from the calcineurin inhibitor category, such as tacrolimus (Prograf).)

The nurse is presenting information to a community group on safer sex practices. The nurse should teach that which sexual practice is the riskiest? a. Anal intercourse b. Masturbation c. Oral sex d. Vaginal intercourse

a. Anal intercourse (Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating a portal of entry for human immune deficiency virus.)

A client has just been diagnosed with human immune deficiency virus (HIV). The client is distraught and does not know what to do. What intervention by the nurse is best? a. Assess the client for support systems. b. Determine if a clergy member would help. c. Explain legal requirements to tell sex partners. d. Offer to tell the family for the client.

a. Assess the client for support systems. (This client needs the assistance of support systems. The nurse should help the client identify them and what role they can play in supporting him or her. A clergy member may or may not be welcome. Legal requirements about disclosing HIV status vary by state. Telling the family for the client is enabling, and the client may not want the family to know.)

A client with acquired immune deficiency syndrome and esophagitis due to Candida fungus is scheduled for an endoscopy. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess the client's mouth and throat. b. Determine if the client has a stiff neck. c. Ensure that the consent form is on the chart. d. Maintain NPO status as prescribed. e. Percuss the client's abdomen.

a. Assess the client's mouth and throat. c. Ensure that the consent form is on the chart. d. Maintain NPO status as prescribed. (Oral Candida fungal infections can lead to esophagitis. This is diagnosed with an endoscopy and biopsy. The nurse assesses the client's mouth and throat beforehand, ensures valid consent is on the chart, and maintains the client in NPO status as prescribed. A stiff neck and abdominal percussion are not related to this diagnostic procedure.)

Which findings are AIDS-defining characteristics? (Select all that apply.) a. CD4+ cell count less than 200/mm³ or less than 14% b. Infection with Pneumocystis jiroveci c. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) d. Presence of HIV wasting syndrome e. Taking antiretroviral medications

a. CD4+ cell count less than 200/mm³ or less than 14% b. Infection with Pneumocystis jiroveci d. Presence of HIV wasting syndrome (A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as Pneumocystis jiroveci and HIV wasting syndrome. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.)

A student nurse is learning about human immune deficiency virus (HIV) infection. Which statements about HIV infection are correct? (Select all that apply.) a. CD4+ cells begin to create new HIV virus particles. b. Antibodies produced are incomplete and do not function well. c. Macrophages stop functioning properly. d. Opportunistic infections and cancer are leading causes of death. e. People with stage 1 HIV disease are not infectious to others.

a. CD4+ cells begin to create new HIV virus particles. b. Antibodies produced are incomplete and do not function well. c. Macrophages stop functioning properly. d. Opportunistic infections and cancer are leading causes of death. (In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produces are incomplete and do not function well. Macrophages also stop functioning properly. Opportunistic infections and cancer are the two leading causes of death in clients with HIV infection. People infected with HIV are infectious in all stages of the disease.)

The nurse is monitoring a patient who is receiving muromonab-CD3 (Orthoclone OKT3) after an organ transplant. Which effect is possible with muromonab-CD3 therapy? a. Chest pain b. Hypotension c. Confusion d. Dysuria

a. Chest pain (Muromonab-CD3 may cause chest pain, fever, chills, tremor, gastrointestinal disturbances (nausea, vomiting, diarrhea), and other effects as noted in Table 48-2. The other options are incorrect.)

A nurse is traveling to a third-world country with a medical volunteer group to work with people who are infected with human immune deficiency virus (HIV). The nurse should recognize that which of the following might be a barrier to the prevention of perinatal HIV transmission? (Select all that apply.) a. Clean drinking water b. Cultural beliefs about illness c. Lack of antiviral medication d. Social stigma e. Unknown transmission routes

a. Clean drinking water b. Cultural beliefs about illness c. Lack of antiviral medication d. Social stigma (Treatment and prevention of HIV is complex, and in third-world countries barriers exist that one might not otherwise think of. Mothers must have access to clean drinking water if they are to mix formula. Cultural beliefs about illness, lack of available medications, and social stigma are also possible barriers. Perinatal transmission is well known to occur across the placenta during birth, from exposure to blood and body fluids during birth, and through breast-feeding.)

A nurse works on a unit that has admitted its first client with acquired immune deficiency syndrome. The nurse overhears other staff members talking about the "AIDS guy" and wondering how the client contracted the disease. What action by the nurse is best? a. Confront the staff members about unethical behavior. b. Ignore the behavior; they will stop on their own soon. c. Report the behavior to the unit's nursing management. d. Tell the client that other staff members are talking about him or her.

a. Confront the staff members about unethical behavior. (The professional nurse should be able to confront unethical behavior assertively. The staff should not be talking about clients unless they have a need to do so for client care. Ignoring the behavior may be more comfortable, but the nurse is abdicating responsibility. The behavior may need to be reported, but not as a first step. Telling the client that others are talking about him or her does not accomplish anything.)

The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV) from clients. Which practice is most effective? a. Consistent use of Standard Precautions b. Double-gloving before body fluid exposure c. Labeling charts and armbands "HIV+" d. Wearing a mask within 3 feet of the client

a. Consistent use of Standard Precautions (According to The Joint Commission, the most effective preventative measure to avoid HIV exposure is consistent use of Standard Precautions. Double-gloving is not necessary. Labeling charts and armbands in this fashion is a violation of the Health Information Portability and Accountability Act (HIPAA). Wearing a mask within 3 feet of the client is part of Airborne Precautions and is not necessary with every client contact.)

A client with human immune deficiency virus infection is hospitalized for an unrelated condition, and several medications are prescribed in addition to the regimen already being used. What action by the nurse is most important? a. Consult with the pharmacy about drug interactions. b. Ensure that the client understands the new medications. c. Give the new drugs without considering the old ones. d. Schedule all medications at standard times.

a. Consult with the pharmacy about drug interactions. (The drug regimen for someone with HIV/AIDS is complex and consists of many medications that must be given at specific times of the day, and that have many interactions with other drugs. The nurse should consult with a pharmacist about possible interactions. Client teaching is important but does not take priority over ensuring the medications do not interfere with each other, which could lead to drug resistance or a resurgence of symptoms.)

A client has been hospitalized with an opportunistic infection secondary to acquired immune deficiency syndrome. The client's partner is listed as the emergency contact, but the client's mother insists that she should be listed instead. What action by the nurse is best? a. Contact the social worker to assist the client with advance directives. b. Ignore the mother; the client does not want her to be involved. c. Let the client know, gently, that nurses cannot be involved in these disputes. d. Tell the client that, legally, the mother is the emergency contact.

a. Contact the social worker to assist the client with advance directives. (The client should make his or her wishes known and formalize them through advance directives. The nurse should help the client by contacting someone to help with this process. Ignoring the mother or telling the client that nurses cannot be involved does not help the situation. Legal statutes vary by state; as more states recognize gay marriage, this issue will continue to evolve.)

The nurse is caring for a client diagnosed with human immune deficiency virus. The client's CD4+ cell count is 399/mm³. What action by the nurse is best? a. Counsel the client on safer sex practices/abstinence. b. Encourage the client to abstain from alcohol. c. Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors. d. Help the client plan high-protein/iron meals.

a. Counsel the client on safer sex practices/abstinence. (This client is in the Centers for Disease Control and Prevention stage 2 case definition group. He or she remains highly infectious and should be counseled on either safer sex practices or abstinence. Abstaining from alcohol is healthy but not required. Genetic testing is not commonly done, but an alteration on the CCR5/CXCR4 co-receptors is seen in long-term nonprogressors. High-protein/iron meals are important for people who are immunosuppressed, but helping to plan them does not take priority over stopping the spread of the disease.)

A patient has undergone bone marrow transplant. Which injection should the nurse anticipate this patient will receive to help stabilize the immune response and prevent rejection? a. Dexamethasone (Decadron) b. Filgrastim (Neupogen) c. Zidovudine (Retrovir) d. Nevirapine (Viramune)

a. Dexamethasone (Decadron) (Steroids (e.g., dexamethasone [Decadron]) are drugs used in the treatment of patients with transplanted organs to prevent rejection.)

A client has been on dialysis for many years and now is receiving a kidney transplant. The client experiences hyperacute rejection. What treatment does the nurse prepare to facilitate? a. Dialysis b. High-dose steroid administration c. Monoclonal antibody therapy d. Plasmapheresis

a. Dialysis (Hyperacute rejection starts within minutes of transplantation and nothing will stop the process. The organ is removed. If the client survives, he or she will have to return to dialysis treatment. Steroids, monoclonal antibodies, and plasmapheresis are ineffective against this type of rejection.)

A patient diagnosed with leukemia has had a bone marrow transplant and has completed chemotherapy. What is the greatest risk for this patient while healthy bone marrow is growing back? a. Infection and bleeding b. Hypertension and headache c. Oliguria and urinary retention d. Dyspnea and wheezing

a. Infection and bleeding (Patients are at greater risk for infection and bleeding while their healthy bone marrow is growing back.)

A patient is about to undergo a kidney transplant. She will be given an immunosuppressant drug before, during, and after surgery to minimize organ rejection. During the preoperative teaching session, which information will the nurse include about the medication therapy? a. Several days before the surgery, the medication will be administered orally. b. The oral doses need to be taken 1 hour before meals to maximize absorption. c. Mix the oral liquid with juice in a disposable Styrofoam cup just before administration. d. Intramuscular injections of the medication will be needed for several days preceding surgery.

a. Several days before the surgery, the medication will be administered orally. (Several days before transplant surgery, immunosuppressant drugs need to be taken by the oral route, if possible, to avoid intramuscular injections and the risk for infection caused by the injections. Avoid Styrofoam containers because the medication may adhere to the side of the container. These medications are taken with food to minimize gastrointestinal upset.)

A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load. What action should the nurse take first? a. Ask the client about travel to any foreign countries. b. Assess the client for adherence to the drug regimen. c. Determine if the client has any new sexual partners. d. Request information about new living quarters or pets.

b. Assess the client for adherence to the drug regimen. (Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time. Since this client's viral load has increased dramatically, the nurse should first assess this factor. After this, the other assessments may or may not be needed.)

A client with acquired immune deficiency syndrome has oral thrush and difficulty eating. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply oral anesthetic gels before meals. b. Assist the client with oral care every 2 hours. c. Offer the client frequent sips of cool drinks. d. Provide the client with alcohol-based mouthwash. e. Remind the client to use only a soft toothbrush.

b. Assist the client with oral care every 2 hours. c. Offer the client frequent sips of cool drinks. e. Remind the client to use only a soft toothbrush. (The UAP can help the client with oral care, offer fluids, and remind the client of things the nurse (or other professional) has already taught. Applying medications is performed by the nurse. Alcohol-based mouthwashes are harsh and drying and should not be used.)

A client with acquired immune deficiency syndrome is in the hospital with severe diarrhea. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Assessing the client's fluid and electrolyte status b. Assisting the client to get out of bed to prevent falls c. Obtaining a bedside commode if the client is weak d. Providing gentle perianal cleansing after stools e. Reporting any perianal abnormalities

b. Assisting the client to get out of bed to prevent falls c. Obtaining a bedside commode if the client is weak d. Providing gentle perianal cleansing after stools e. Reporting any perianal abnormalities (The UAP can assist the client with getting out of bed, obtain a bedside commode for the client's use, cleanse the client's perianal area after bowel movements, and report any abnormal observations such as redness or open areas. The nurse assesses fluid and electrolyte status.)

A patient must be treated immediately for acute organ transplant rejection. The nurse anticipates that muromonab-CD3 (Orthoclone OKT3) will be ordered. What is the priority assessment before beginning drug therapy with muromonab-CD3? a. Serum potassium level b. Fluid volume status c. Electrocardiogram d. Blood glucose level

b. Fluid volume status (Assess fluid volume status because muromonab-CD3 is contraindicated in the presence of fluid overload. The other options are incorrect.)

The nurse working in an organ transplantation program knows that which individual is typically the best donor of an organ? a. Child b. Identical twin c. Parent d. Same-sex sibling

b. Identical twin (The recipient's immune system recognizes donated tissues as non-self except in the case of an identical twin, whose genetic makeup is identical to the recipient.)

When administering cyclosporine, the nurse notes that allopurinol is also ordered for the patient. What is a potential result of this drug interaction? a. Reduced adverse effects of the cyclosporine b. Increased levels of cyclosporine and toxicity c. Reduced uric acid levels d. Reduced nephrotoxic effects of cyclosporine

b. Increased levels of cyclosporine and toxicity (The allopurinol may cause increased levels of cyclosporine, and toxicity may result. The other options are incorrect.)

A patient has started azathioprine (Imuran) therapy as part of renal transplant surgery. The nurse will monitor for which expected adverse effect of azathioprine therapy? (Select all that apply.) a. Tremors b. Leukopenia c. Diarrhea d. Thrombocytopenia e. Hepatotoxicity f. Fluid retention

b. Leukopenia d. Thrombocytopenia e. Hepatotoxicity (Leukopenia is an expected adverse effect of azathioprine therapy, as are thrombocytopenia and hepatotoxicity. The other options are incorrect.)

A client is recovering from a kidney transplant. The client's urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse? a. Checking skin turgor b. Taking blood pressure c. Assessing lung sounds d. Weighing the client

b. Taking blood pressure (By taking blood pressure, the nurse is assessing for hypotension that could compromise perfusion to the new kidney. The nurse then should notify the provider immediately. Skin turgor, lung sounds, and weight could give information about the fluid status of the client, but they are not the priority assessment.)

The nurse follows which procedures when giving intravenous (IV) cyclosporine? (Select all that apply.) a. Administering it as a single IV bolus injection to minimize adverse effects b. Using an infusion pump to administer this medication c. Monitoring the patient for potential delayed adverse effects, which may be severe d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy

b. Using an infusion pump to administer this medication d. Monitoring the patient closely for the first 30 minutes for severe adverse effects e. Checking blood levels periodically during cyclosporine therapy f. Performing frequent oral care during therapy (Cyclosporine is infused intravenously with an infusion pump, not as an IV bolus. Monitor the patient closely for the first 30 minutes for adverse effects, especially for allergic reactions, and monitor blood levels periodically to ensure therapeutic, not toxic, levels of the medication. Perform oral hygiene frequently to prevent dry mouth and subsequent infections.)

When monitoring a patient who is on immunosuppressant therapy with azathioprine (Imuran), the nurse will monitor which laboratory results? a. Serum potassium levels b. White blood cell (leukocyte) count c. Red blood cell count d. Serum albumin levels

b. White blood cell (leukocyte) count (Leukopenia is a potential adverse effect of azathioprine therapy, so white blood cells need to be monitored. The other options are incorrect.)

A nurse is assessing a client for acute rejection of a kidney transplant. What assessment finding requires the most rapid communication with the provider? a. Blood urea nitrogen (BUN) of 18 mg/dL b. Cloudy, foul-smelling urine c. Creatinine of 3.9 mg/dL d. Urine output of 340 mL/8 hr

c. Creatinine of 3.9 mg/dL (A creatinine of 3.9 mg/dL is high, indicating possible dysfunction of the kidney. This is a possible sign of rejection. The BUN is normal, as is the urine output. Cloudy, foul-smelling urine would probably indicate a urinary tract infection.)

A nurse is caring for a client who is about to receive a bone marrow transplant. To best help the client cope with the long recovery period, what action by the nurse is best? a. Arrange a visitation schedule among friends and family. b. Explain that this process is difficult but must be endured. c. Help the client find things to hope for each day of recovery. d. Provide plenty of diversionary activities for this time.

c. Help the client find things to hope for each day of recovery. (Providing hope is an essential nursing function during treatment for any disease process, but especially during the recovery period after bone marrow transplantation, which can take up to 3 weeks. The nurse can help the client look ahead to the recovery period and identify things to hope for during this time. Visitors are important to clients, but may pose an infection risk. Telling the client the recovery period must be endured does not acknowledge his or her feelings. Diversionary activities are important, but not as important as instilling hope.)

A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L Potassium 5 mEq/L Blood urea nitrogen (BUN) 44 mg/dL Serum creatinine 2.5 mg/dL What initial intervention would the nurse anticipate? a. Start hemodialysis immediately. b. Discuss the need for peritoneal dialysis. c. Increase the dose of immunosuppression. d. Return the client to surgery for exploration.

c. Increase the dose of immunosuppression. (The client may need a higher dose of immunosuppressive medication as evidenced by the elevated BUN and serum creatinine levels. This increased dose may reverse the possible acute rejection of the transplanted kidney. The client does not need hemodialysis, peritoneal dialysis, or further surgery at this point.)

A client with human immune deficiency virus is admitted to the hospital with fever, night sweats, and severe cough. Laboratory results include a CD4+ cell count of 180/mm³ and a negative tuberculosis (TB) skin test 4 days ago. What action should the nurse take first? a. Initiate Droplet Precautions for the client. b. Notify the provider about the CD4+ results. c. Place the client under Airborne Precautions. d. Use Standard Precautions to provide care.

c. Place the client under Airborne Precautions. (Since this client's CD4+ cell count is low, he or she may have anergy, or the inability to mount an immune response to the TB test. The nurse should first place the client on Airborne Precautions to prevent the spread of TB if it is present. Next the nurse notifies the provider about the low CD4+ count and requests alterative testing for TB. Droplet Precautions are not used for TB. Standard Precautions are not adequate in this case.)

A client has received a bone marrow transplant and is waiting for engraftment. What actions by the nurse are most appropriate? (Select all that apply.) a. Not allowing any visitors until engraftment b. Limiting the protein in the client's diet c. Placing the client in protective precautions d. Teaching visitors appropriate hand hygiene e. Telling visitors not to bring live flowers or plants

c. Placing the client in protective precautions d. Teaching visitors appropriate hand hygiene e. Telling visitors not to bring live flowers or plants (The client waiting for engraftment after bone marrow transplant has no white cells to protect him or her against infection. The client is on protective precautions and visitors are taught hand hygiene. No fresh flowers or plants are allowed due to the standing water in the vase or container that may harbor organisms. Limiting protein is not a healthy option and will not promote engraftment.)

What type of bone marrow transplant uses the patient's own bone marrow? a. Allergenic b. Allogeneic c. Peripheral blood stem cell d. Autologous

d. Autologous (An autologous bone marrow transplant uses the patient's own bone marrow.)

A client with acquired immune deficiency syndrome is hospitalized and has weeping Kaposi's sarcoma lesions. The nurse dresses them with sterile gauze. When changing these dressings, which action is most important? a. Adhering to Standard Precautions b. Assessing tolerance to dressing changes c. Performing hand hygiene before and after care d. Disposing of soiled dressings properly

d. Disposing of soiled dressings properly (All of the actions are important, but due to the infectious nature of this illness, ensuring proper disposal of soiled dressings is vital.)

A client with HIV wasting syndrome has inadequate nutrition. What assessment finding by the nurse best indicates that goals have been met for this client problem? a. Chooses high-protein food b. Has decreased oral discomfort c. Eats 90% of meals and snacks d. Has a weight gain of 2 pounds/1 month

d. Has a weight gain of 2 pounds/1 month (The weight gain is the best indicator that goals for this client problem have been met because it demonstrates that the client not only is eating well but also is able to absorb the nutrients.)

Cyclosporine is prescribed for a patient who had an organ transplant. The nurse will monitor the patient for which common adverse effect? a. Nausea and vomiting b. Fever and tremors c. Agitation d. Hypertension

d. Hypertension (Moderate hypertension may occur in as much as 50% of patients taking cyclosporine. The other options are potential adverse effects of other immunosuppressant drugs.)

A patient has an order for cyclosporine (Sandimmune). The nurse finds that cyclosporine-modified (Neoral) is available in the automated medication cabinet. Which action by the nurse is correct? a. Hold the dose until the prescriber makes rounds. b. Give the cyclosporine-modified drug. c. Double-check the order, and then give the cyclosporine-modified drug. d. Notify the pharmacy to obtain the Sandimmune form of the drug.

d. Notify the pharmacy to obtain the Sandimmune form of the drug. (The nurse must double-check the formulation before giving cyclosporine. Cyclosporine-modified products (such as Neoral or Gengraf) are interchangeable with each other but are not interchangeable with Sandimmune. In this case, the nurse must obtain the Sandimmune form of the drug from the pharmacy. The other options are incorrect.)

A patient is taking a combination of antiviral drugs as treatment for early stages of a viral infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body's healthy cells. d. They may also kill healthy cells while killing viruses.

d. They may also kill healthy cells while killing viruses. (Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs. The other options are incorrect.)