Chapter 32- HIV
Antiretroviral medications should be offered to clients with T-cell counts less than
350 cells/mm3.
Which microorganism is known to cause retinitis in people with HIV/AIDS?
Cytomegalovirus
A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for?
Enzyme-linked immunosorbent assay
Which blood test confirms the presence of antibodies to HIV?
Enzyme-linked immunosorbent assay (ELISA)
Which of the following is a lack of one or more of the five immunoglobulins?
Hypogammaglobulinemia
Which term means a lack of one or more of the five immunoglobulins?
Hypogammaglobulinemia
Nursing students are reviewing information about the various types of primary immunodeficiencies. The students demonstrate understanding of the material when they identify which of the following as an example of a primary immunodeficiency involving B-lymphocyte dysfunction?
IgA deficiency
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?
Most cases are typically diagnosed in infancy
The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action?
Place the client on respiratory isolation and inform the physician.
The nurse's plan of care for a client with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to candidiasis. What nursing intervention best addresses this risk?
Providing thorough oral care before and after meals
A client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care?
TMP-SMZ
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?
The client is risking the development of drug resistance and drug failure.
A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. What client need should in the nurse focus on when planning this client's care?
fluid replacement
When do most perinatal HIV infections occur?
After exposure during delivery
A patient with common variable immunodeficiency (CVID) is extremely fatigued and not feeling well. What lab test does the nurse anticipate the patient will have to detect a common development related to the disease?
B12 level
The nursing instructor is talking about HIV/AIDS with their pre-nursing pathophysiology class. The instructor explains to the class that the virus that causes HIV/AIDS is called a retrovirus. What characteristics of this retrovirus would the instructor talk with the class about?
HIV-1 and HIV-2 subtypes
A nurse is developing a teaching plan for a client with an immunodeficiency. What would the nurse need to emphasize? Select all that apply.
Prophylactic medication regimens Ways to manage stress Maintenance of a well-balanced diet
A nurse is preparing to administer saquinavir, which is prescribed for a client who is HIV positive. What type of drug does the nurse identify saquinavir as?
Protease inhibitor (PI)
A nurse is reviewing the causes of genetic diseases with parents of an infant born with severe combined immunodeficiency disease (SCID). Which would be inaccurate information pertaining to SCID?
The inheritance of SCID can be autosomal dominant.
A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?
Gynecologic problems
The nurse is preparing to administer the recommended dose of intravenous gamma-globulin for a 60-kg male client. How many grams will the nurse administer?
30 g
The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse?
The client has converted from HIV infection to AIDS
When preparing a client with acquired immunodeficiency syndrome (AIDS) for discharge to home, the nurse should be sure to include which instruction?
"Avoid sharing such articles as toothbrushes and razors."
The nurse is teaching a client with HIV how to use a male condom. The client demonstrates understanding of the information when he makes which statements? Select all that apply.
"I need to hold the condom by the tip to squeeze out the air before putting it on." "I should unroll the condom all the way over my erect penis." "I should avoid using baby oil or petroleum jelly with a condom."
A client is infected with human immunodeficiency virus (HIV) after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection?
3 to 12 weeks
Which assessment finding(s) are likely to cause noncompliance with antiretroviral treatment? Select all that apply.
Active substance abuse
A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.)
Active substance abuse Depression Lack of social support
There are many ethical issues in the care of clients with HIV or HIV/AIDS. What is an ethical issue healthcare providers deal with when caring for clients with HIV/AIDS?
Disclosure of the client's condition
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?
Follow the same sexual precautions as someone who has been diagnosed with AIDS
The nurse is preparing a teaching plan for a client with an immunodeficiency. What aspect would the nurse emphasize as most important?
Frequent and thorough handwashing
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?
Primary infection
The nurse is caring for a client with an autoimmune disease. What is a characteristic of autoimmune disorders?
Progressive tissue damage without any verifiable etiology
When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority?
Risk for infection related to altered immune cell function
The nurse is gathering data from laboratory studies for a client who has HIV. The clients T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?
The client has converted from HIV infection to AIDS
Which is a major manifestation of Wiskott-Aldrich syndrome?
Thrombocytopenia
Which of the following are antidepressants used in the treatment of AIDS? Select all that apply.
Tofranil, Norpramin, Prozac
The nurse reviews laboratory results requested to track HIV. What laboratory test measures HIV RNA levels and is the best predictor of HIV disease progression?
Viral load
A treatment option for severe combined immune deficiency (SCID) includes
a stem cell transplant.
A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus?
blindness
A patient is on highly active antiretroviral therapy (HAART) for the treatment of HIV. What does the nurse know would be an adequate CD4 count to determine the effectiveness of treatment for a patient per year?
50 mm3 to 150 mm3
The home health nurse is assessing a client who is immunosuppressed. What is the most essential teaching for this client and the family?
The need to report any slight changes in the client's health status
A pediatric client is recovering from an anaphylactic reaction to an allergen. In the first assessment, the client presents with a periorbital accumulation of blood, a common occurrence in children. What type of allergic reaction presents "allergic shiners"?
type I
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?
Ten ear infections in the past year
A nurse is teaching high school students about transmission of the human immunodeficiency virus (HIV). Which comment by a student warrants clarification by the nurse?
"I won't donate blood because I don't want to get AIDS."
The period from infection with HIV to the development of antibodies to HIV is known as which of the following?
Primary infection
A secondary immunodeficiency is characterized by the following. Choose all that apply.
It usually occurs as a result of underlying disease processes. It frequently is caused by certain autoimmune disorders. It may be caused by certain viruses.
A nurse is preparing to administer an antiretroviral medication to a client who is positive for HIV. The nurse identifies the drug as a nucleoside reverse transcriptase inhibitor (NRTI). What drug will the nurse administer?
Lamivudine
A client is diagnosed with common variable immunodeficiency (CVID). When assessing the client for possible infection, what would the nurse identify as a least likely cause?
Pneumocystis jiroveci pneumonia
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse?
Report the incident to the supervisor.
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?
Expected benefits and outcomes of the treatment
The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate?
3 mL/min
The balance between the amount of HIV in the body and the immune response is the
viral set point.
The term used to define the amount of virus in the body after the initial immune response subsides is
viral set point.
Which of the following would a nurse be least likely to identify as a cause of secondary immunodeficiency?
Genetics
The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count?
Greater than 500/mm3
A client is receiving ganciclovir as part of the treatment for cytomegalovirus retinitis. What would the nurse monitor the results of the client's laboratory tests for?
Neutropenia
A client's antibody test for HIV showed no antibodies. For which reason would the client need to have a nucleic acid test completed before being told that testing for HIV is negative?
The client may be in stage 0 of the disease
An HIV-infected client presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the client's increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug?
Azithromycin
The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the client?
Can you tell me what concerns you most about dying?"
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?
Cerebral venous thrombosis