CH 32: Management of Patients with Immune Deficiency Disorders
A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? A) Candidiasis B) Wasting syndrome C) Kaposi's sarcoma D) MAC
A
The lower the client's viral load, A) the longer the survival time. B) the shorter the survival time. C) the longer the time immunity. D) the shorter the time to AIDS diagnosis.
A
What treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? A) Radiation therapy B) Bone marrow transplantation C) Removal of the thymus gland D) Antibiotics
B
Which adverse effect(s) should the nurse closely monitor in a client who has secondary immunodeficiencies due to immunosuppressive therapy? A) Rheumatoid arthritis B) Depression, memory impairment, and coma C) Cardiac dysrhythmias and heart failure D) Respiratory or urinary system infections
D
A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's best action? A) Assess blood urea nitrogen and creatinine. B) Encourage the client to drink more fluids. C) Assess liver function tests. D) Administer fluids 100 mL/hour IV.
A
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: A) Western blot test for confirmation of diagnosis. B) T4-cell count for confirmation of diagnosis. C) p24 antigen test for confirmation of diagnosis. D) polymerase chain reaction test for confirmation of diagnosis.
A
A home health nurse will soon begin administering IVIG to a new client on a regular basis. What teaching should the nurse provide to the client? A) Expected benefits and outcomes of the treatment B) The need for a sterile home environment C) Technique for managing and monitoring daily fluid intake D) Complementary alternatives to IVIG
A
A nurse is collecting objective data for a client with AIDS. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does this finding indicate? A) candidiasis B) hairy leukoplakia C) Kaposi's sarcoma D) coccidioidomycosis
A
The nurse is teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed? A) "I will be sure to eat lots of fresh fruits and vegetables every day." B) "I will make sure to have my own toothbrush and tube of toothpaste at home." C) "I will avoid contact with people who are sick or who have recently been vaccinated." D) "I will wash my hands whenever I get home from work."
A
Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis? A) Eczema B) Vascular lesions C) Thrombocytopenia D) Thrush
B
A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? A) Sickle cell anemia B) Gastric ulcer C) Pernicious anemia D) Hyperthyroidism
C
A nurse is preparing an in-service presentation about primary immunodeficiencies. When describing these conditions, what would the nurse need to integrate into the presentation? A) Most cases are typically diagnosed in infancy. B) Overall, these conditions more commonly affect females. C) The conditions appear to predominate in males after adolescence. D) Primary immunodeficiencies are more common than secondary immunodeficiencies
A
A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement? A) "We can ask our family members to donate blood for stem cell harvesting." B) "We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling." C) "Hematopoietic stem cell transplantation cannot be performed until the age of 5 years." D) "The only treatment option is thymus gland transplantation."
B
A client diagnosed with human immunodeficiency virus (HIV) asks how the health care provider determines what his or her viral load is. What is the nurse's best response? A) The health care provider can have a sedimentary rate run. B) The health care provider can have a basic metabolic panel run. C) The health care provider can have an ELISA test run. D) The health care provider can have a polymerase chain reaction test run.
D
A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started? A) Chest physiotherapy B) Antibiotic therapy C) Anticoagulation D) Immunosuppressive agents
D
A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize what intervention? A) Screening programs for youth and young adults B) Appropriate use of standard precautions C) Lifestyle actions that improve immune function D) Educational programs that focus on control and prevention
D
When reviewing the laboratory test results of a client with X-linked agammaglobulinemia, which of the following would be most likely? Select all that apply. A) Hypocalcemia B) Absent B cells C) Pernicious anemia D) Leukopenia E) Low levels of IgM
B and E
While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? A) Seborrheic dermatitis B) Kaposi's sarcoma C) Molluscum contagiosum D) Tuberculosis of the skin
B
Which of the following indicates that a client with HIV has developed AIDS? A) Pain on standing and walking B) Herpes simplex ulcer persisting for 2 months C) Weight loss of 10 lb over 3 months D) Severe fatigue at night
B
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? A) Iron and zinc B) Liquids C) Sucrose D) Gluten
B
Which term defines the balance between the amount of HIV in the body and the immune response? A) Window period B) Viral set point C) Viral clearance rate D) Primary infection stage
B
The nurse is aware that the most prevalent cause of immunodeficiency worldwide is A) Malnutrition B) Neutropenia C) Chronic diarrhea D) Hypocalcemia
A
When a nurse infuses gamma globulin intravenously, the rate should not exceed A) 1.5 mL/min B) 3 mL/min C) 10 mL/min D) 6 mL/min
B
A client has discussed therapy for his HIV-positive status. What does the nurse understand is the goal of antiretroviral therapy? A) Bring the viral load to a virtually undetectable level B) Treat mycobacterium avium complex. C) Reverse the HIV+ status to a negative status. D) Eliminate the risk of AIDS.
A
The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? A) Side effects of drug therapy B) The use of condoms C) What vaccinations to have D) The action of each antiretroviral drug
A
What test will the nurse assess to determine the client's response to antiretroviral therapy? A) Viral load B) Enzyme immunoassay C) Western blotting D) Complete blood count
A
A client asks a nurse, "What can I use to decrease my risk of exposure to HIV?" What will the nurse include as effective in reducing the risk of HIV exposure? Select all that apply. A) Polyurethane female condoms B) Sexual abstinence C) Dental dams D) Lambskin condoms E) Latex male condoms
A, B, C, and E
A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? A) Nucleic acid sequence-based amplification B) OraSure test C) Western blot assay D) p24 antigen capture assay
C
A new nursing graduate is working at the hospital in the medical-surgical unit. The preceptor observes the nurse emptying a patient's wound drain without gloves on. What important information should the preceptor share with the new graduate about standard precautions? A) Standard precautions should only be used with patients who are HIV positive to reduce the risk of transmission of the HIV virus. B) It is only necessary to use gloves when you are emptying reservoirs that have body fluids in them. C) If you are careful and do not expose yourself to blood or body fluids, it is not necessary to use gloves all of the time. D) Standard precautions should be used with all patients to reduce the risk of transmission of bloodborne pathogens.
D
A client on antiretroviral drug therapy informs the nurse about sometimes forgetting to take the medication for a few days. What should the nurse inform the client can occur when the medications are not taken as prescribed? A) The client will have to take higher doses of the antiviral medications. B) The client is risking the development of drug resistance and drug failure. C) The client will have to take the drugs intravenously to ensure compliance. D) The funding for the medications will cease if the client is not taking the meds correctly.
B
A client taking fosamprenavir reports "getting fat." What is the nurse's best action? A) Assess the client's diet. B) Teach the client about medication side effects. C) Arrange for a psychological counseling. D) Have the client increase exercise.
B
A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? A) "I won't go to see my nephew right after he gets his vaccines." B) "I can eat whatever I want as long as it's low in fat." C) "I stopped smoking last year; this year I'll quit drinking alcohol." D) "I won't go to see my sister while she has a cold."
B
What intervention is a priority when treating a client with HIV/AIDS? A) Monitoring skin integrity B) Assessing fluid and electrolyte balance C) Monitoring psychological status D) Assessing neurologic status
B
A hospital client is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Ensure that the radiology department has been disinfected prior to the test. B) Have the client wear a mask to the x-ray department. C) Send the client to the x-ray department, and have the staff in the department wear masks. D) Arrange for a portable x-ray machine to be used.
D
A nurse is teaching the parents of an infant about primary immunodeficiencies. Which statement verifies that the parents understand the teaching? A) "My baby cannot survive into childhood with a diagnosis of primary immunodeficiency." B) "Girls are diagnosed with primary immunodeficiencies more often than boys." C) "The primary immunodeficiency will disappear with age." D) "The majority of primary immunodeficiencies are diagnosed in infancy."
D
A client with paroxysmal hemoglobinuria, a deficiency of complement proteins, reports headache and weakness of the right arm and leg. Based on these symptoms, for which health complication should the nurse assess? A) Cerebral venous thrombosis B) Edema in subcutaneous tissues of the extremities C) Bacterial meningitis D) Rheumatoid arthritis
A
A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV? A) Gynecologic problems B) Muscle and joint pain C) Weight loss D) Rashes on the face, trunk, palms, and soles
A
A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? A) Limit interactions with people who are not HIV infected. B) Follow the same sexual precautions as someone who has been diagnosed with AIDS. C) Limit interactions with people who are already HIV infected. D) Quit their job and get admitted to a hospital or a cancer treatment center.
B
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits what behavior? A) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle. B) The nurse performs hand hygiene with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse wears face protection, gloves, and a gown when irrigating a wound. D) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure.
D
Antiretroviral medications should be offered to clients with T-cell counts less than A) 50 cells/mm3. B) 150 cells/mm3. C) 250 cells/mm3. D) 350 cells/mm3.
D
Based on the nurse's base knowledge of primary immunodeficiencies, how would the nurse complete this statement? Primary immunodeficiencies A) disappear with age. B) occur most commonly in the aged population. C) develop as a result of treatment with antineoplastic agents. D) develop early in life after protection from maternal antibodies decreases.
D
Kaposi sarcoma (KS) is diagnosed through A) skin scraping. B) computed tomography. C) visual assessment. D) biopsy.
D
A client is beginning highly active antiretroviral therapy (HAART). The client demonstrates an understanding of the need for follow up when scheduling a return visit for viral load testing at which time? A) 6 weeks B) 24 weeks C) 18 weeks D) 12 weeks
A
A client is prescribed antihistamines, and asks the nurse about administration and adverse effects. The nurse should advise the client to avoid: A) alcohol. B) applying skin moisturizers. C) exposure to sunlight. D) seafood.
A
Thirty minutes after the nurse begins an intravenous immunoglobulin (IVIG) infusion, the client reports itching at the site and a lump in the throat. Which action should the nurse take first? A) Stop the infusion. B) Administer subcutaneous epinephrine. C) Apply a tourniquet above the infusion site. D) Notify the physician.
A
When do most perinatal HIV infections occur? A) After exposure during delivery B) In utero C) Through casual contact D) Through breastfeeding
A
Which is usually the most important consideration in the decision to initiate antiretroviral therapy? A) CD4+ counts B) ELISA C) HIV RNA D) Western blotting assay
A
A client with HIV will be started on a medication regimen of three medications. What class of drugs will the nurse instruct the client about? A) Disinhibitors B) Reverse transcriptase inhibitors C) Hydroxyurea D) Anticholinergics
B
A client received 2 units of packed red blood cells while in the hospital with rectal bleeding. Three days after discharge, the client experienced an allergic response and began to itch and break out with hives. What type of reaction does the nurse understand could be occurring? A) Sensitization B) An immediate hypersensitivity response C) Delayed hypersensitivity response D) Anaphylactic reaction
C
The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what? A) A condition marked by development of urticaria B) Peripheral edema C) Uncoordinated muscle movement D) Vascular lesions caused by dilated blood vessels
D
Which assessment finding(s) are likely to cause noncompliance with antiretroviral treatment? A) Lack of social support B) Depression C) Past substance abuse D) Active substance abuse
D
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? A) Oral candida B) Chronic diarrhea C) Anorexia D) Nausea and vomiting
B
A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? A) Disturbed body image related to loss of fat in the face and arms B) Risk for infection related to the immune system dysfunction C) Risk for impaired liver function related to drug therapy effects D) Deficient knowledge related to the effects of the disease
A
Nursing students are reviewing the pathophysiology of human immunodeficiency virus (HIV). They demonstrate understanding of the information when they state which of the following as the form of the genetic viral material? A) Deoxyribonucleic acid (DNA) B) Glycoprotein envelope C) Ribonucleic acid (RNA) D) Viral core
C
Which condition is an early manifestation of HIV encephalopathy? A) Hallucinations B) Vacant stare C) Headache D) Hyperreflexia
C
Which of the following is the first barrier method that can be controlled by the woman? A) Diaphragm B) Birth control pills C) Female condom D) IUD
C
A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in? A) Primary infection B) Latent infection C) Tertiary infection D) Secondary infection
A
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? A) Nystatin B) Fluconazole C) Trimethoprim-sulfamethoxazole D) Amphotericin B
C
A client who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? A) Collaborate with the client's physician to obtain an order for hydromorphone. B) Increase the client's activity level. C) Teach the client guided imagery. D) Give the client more control of her antiretroviral regimen.
C
A parent brings a young child to the clinic for an evaluation of an infection. The parent states, "my child has been taking antibiotics now for more than 2 months and still doesn't seem any better." During the history and physical examination, what would alert the nurse to suspect a primary immunodeficiency? A) Weight within age-appropriate parameters B) History of fungal diaper rash C) Ten ear infections in the past year D) Superficial wound on the child's left leg
C
After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client makes which statement? A) "I should avoid being around other people who have an infection." B) "I should avoid eating cooked fruits and vegetables." C) "Alcohol is good to clean any skin areas that are dry or chafed." D) "I will clean my kitchen counter with hot water."
A
Ataxia refers to A) uncoordinated muscle movement. B) difficulty swallowing. C) vascular lesions caused by dilated blood vessels. D) inability to understand spoken words.
A
A client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care? A) Administration of antifungal agents B) Preparation for a thymus graft C) Preparation for bone marrow transplantation D) Administration of granulocyte colony-stimulating factors
C
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? A) Risk for injury B) Ineffective cerebral tissue perfusion C) Bathing or hygiene self-care deficit D) Complicated grieving
A
A child has just been diagnosed with a primary immune deficiency. The parents state, "Oh, no. Our child has AIDS." Which response by the nurse would be most appropriate? A) "Your child's condition is extremely serious. Like AIDS, it will most likely be fatal." B) "Although AIDS is an immune deficiency, your child's condition is different from AIDS." C) "Your child does not have AIDS but this condition puts your child at risk for it later in life." D) "We need to do some more testing before we will know if your child's condition is AIDS."
B
When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic? A) the fact that it is a mutated virus originally thought to be bovine in nature B) HIV-1 is more prevalent than HIV-2 subtypes C) means of transmission D) cure rate
B
