Medsurg 2 - exam 3
Opportunistic infection
Caused by a pathogen that does not normally produce an illness in healthy humans
Kaposi's Sarcoma
Caused by a virus that causes small blood vessels to grow abnormally and can occur anywhere in the body. Appears as pink or purple firm spots on the skin that are raised or flat.
Systemic Lupus Erythematosis (SLE, LUPUS)
Chronic autoimmune disease where the immune system attacks it's own tissues causing damage and inflammation to the brain, lungs, blood vessels, joints, skin, and kidneys
Important assessments for HIV patients?
Complete head to toe for any symptoms of the disease progressing. But specifically lung sounds, cough, SOB, skin, weight, and n/v
Hepatitis A definition and mode of transmission?
Fecal-oral. It is an RNA virus that lives on our hands. It is spread from person to person by consuming contaminated food and water. A lot of times it goes un-noticed due to flu-like symptoms.
Quetiapine (Seroquel) teaching regarding adverse effects?
Frequent eye exams, don't get up without help, call light within reach (so use it), sexual dysfunction education, and teach pt. to report suicidal thoughts/ideations
Lactulose therapeutic effect?
Helps increase the number of bowel movements per day and the number of days on which bowel movements occur in patients with a history of chronic constipation, decreases ammonia levels
Pre-exposure prophylaxis (PrEP)
Highly effective for preventing HIV from sex. It is less effective when not taken as prescribed
HIV progression is dependent on?
How it was acquired, personal factors, nutrition status, stress, frequency of re-exposure, and other health problems
Important nursing care for a patient taking belimumab?
No live virus vaccinations for 30 days, Monitor for skin reactions, Monitor :leukocytes as it can decrease, Watch for depression
Chronic Hepatitis
Occurs when inflammation of the liver lasts >6mo. Commonly seen with Hep B & C and can lead to cirrhosis (liver scaring), and liver cancer
Karposi Sarcoma assessments?
Pain, skin, respiratory, and overall head to toe
TB symptoms?
Persistent dry cough, tired, weight loss, fever, and night sweats
How do we assess our LUPUS patients?
Physical differences, pain, family history, exposures/infections, ask about any fevers, fatigue, and medications such as (hydralazine, penicillin, procainamide that can induce lupus)
Hepatitis
Inflammation and infection of liver cells. Most common is viral and it can be acute or chronic
The purpose of antiretroviral drugs?
Inhibit replication of the virus within the body
Zidovudine (Retrovir) mechanism of action and uses?
Inhibits HIV replication and suppresses synthesis of viral DNA. Relieves cognitive symptoms, mother to infant transmissions and short term prophylaxis for newborns.
Presnisone (Deltasone)
It is a anti-inflammatory corticosteroid used for Lupus to reduce inflammation, pain, and rashes
Hepatitis D definition and mode of transmission?
It is a defective RNA virus. MUST have Hep B as a carrier (it is a co-infection). Transmitted through shared IVs, or sex with someone who has Hep B and D.
Hep E incubation period and symptoms?
Jaundice, lack of appetite, nausea, and flu-like symptoms. 15-64days.
What to expect after starting PrEP?
Kidney, liver, and HIV infection testing is done every 3 months
How is HIV most commonly spread?
#1- Sexual contact (genital-anal, or oral) #2 Parental (needles/contaminated blood products), #3 Perinatal (placenta and breastmilk)
Complications of LUPUS?
#1- kidney failure, anemia, high risk of bleeds, pain with breathing, pneumothorax, CVD and heart attack, cancer, bone tissue death, and pregnancy complications
Hep D incubation period and symptoms?
14-56days. and symptoms are the same for Hep D as they are for Hep B.
Hepatitis A symptoms and incubation period?
15-50 days, consisting of fatigue, n/v, jaundice, loss of appetite, ab. pain, and low grade fever.
Hepatitis C symptoms and incubation period?
2wks-6mo. Bruising easy, fatigue, poor appetite, jaundice, dark colored urine, itchy skin, ascites, swelling in legs, weight loss, confusion, drowsiness, slurred speech, and spider like Bvs in the legs
Normal CD4 count
500-1500cell mm^3
Hepatitis B and modes of transmission?
A double shelled particle that contains its own DNA. It is transmitted by unprotected sex, razors, toothbrushes, sharps injuries, hemodialysis, birth, and direct contact with blood or an open sore
The nurse is assessing a client who is diagnosed with Hep A and asks how someone gets this disease. What is the most likely cause of Hep A? a. eating contaminated food or water b. sharing needles for drugs c. being exposed to blood or blood products d. having unprotected sex
ANS: A
The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with HIV from clients. Which practice is most effective? a. consistent use of standard precautions b. double gloving before bodily fluid exposure c. labeling charts and armbands "HIV+" d. wearing a mask within 3 feet of this client
ANS: A
The nurse is caring for a client who has cirrhosis of the liver. What nursing actionis appropriate to help control ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the patient daily.
ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.
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 (1 m) of the client
ANS: A According to The Joint Commission, the most effective preventative measure to avoid HIV exposure is consistent use of Standard Precautions. Standard Precautions are required by the CDC. 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 (1 m) of the client is not necessary with every client contact.
A client with HIV-III is hospitalized and has weeping Kaposi sarcoma lesions. The nurse dresses them with sterile gauze. When changing these dressings, which action is most important for the nurse's safety? 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
ANS: A All of the actions are important, but due to the infectious nature of this illness, the nurse would ensure he or she is following Standard Precautions (and Transmission-Based Precautions when necessary) to avoid a potential exposure.
The nurse is caring for a client with hepatitis C. The client's brother states, "I do not want to get this infection, so I'm not going into his hospital room." How would the nurserespond? a. "Hepatitis C is not spread through casual contact." b. "If you wear a gown and gloves, you will not get this virus." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."
ANS: A Although family members may be afraid that they will contract hepatitis C, the nurse would educate them about how the virus is spread. Hepatitis C is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal drug paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client's status with the brother.
The nurse is presenting information to a community group on safer sex practices. The nurse would teach that which sexual practice is the riskiest? a. Anal intercourse b. Masturbation c. Oral sex d. Vaginal intercourse
ANS: A Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear, creating a portal of entry for human immune deficiency virus in addition to providing mucus membrane contact with the virus.
The nurse is teaching a client a client about taking elbasvir for hepatitis C. What information in the client's history would the nurse need prior to drug administration? a. History of hepatitis B b. History of kidney disease c. History of cardiac disease d. History of rectal bleeding
ANS: A Elbasvir can cause liver toxicity and therefore the nurse would assess for a history of or current hepatitis B.
The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding would require immediate action by the nurse? a. Urine output via indwelling urinary catheter is 20mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 22 to 16 breaths/min d. A decrease in the client's weight by 3 lb (1.4 kg)
ANS: A Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client's weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000 mL are usually removed from the abdomen at one time. The patient's weight typically only decreases by less than 2 kg or 4.4 lb.
An HIV-negative client who has an HIV-positive partner asks the nurse about receiving tenofovir/emtricitabine. What information is most important to teach the client about this drug? a. Does not reduce the need for safe sex practices. b. Has been taken off the market due to increases in cancer. c. Reduces the number of HIV tests you will need. d. Is only used for postexposure prophylaxis.
ANS: A Tenofovir/emtricitabine is a newer drug used for preexposure prophylaxis and appears to reduce transmission of human immune deficiency virus (HIV) from known HIV-positive people to HIV-negative people. The drug does not reduce the need for practicing safe sex. Since the drug can lead to drug resistance if used, clients will still need HIV testing every 3 months. This drug has not been taken off the market and is not used for postexposure prophylaxis.
A nurse is talking with a client about a negative enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV). The test is negative and the client states "Whew! I was really worried about that result." What action by the nurse is most important? a. Assess the client's sexual activity and patterns. b. Express happiness over the test result. c. Remind the client about safer sex practices. d. Tell the client to be retested in 3 months.
ANS: A The ELISA test can be falsely negative if testing occurs after the client has become infected but prior to making antibodies to HIV. This period of time is known as the window period and can last up to 21 days. The confirmatory Western Blot test takes an additional 7 days, so using that testing algorithm, the client's status may not truly be known for up to 28 days. The client may have had exposure that has not yet been confirmed. The nurse needs to assess the client's sexual behavior further to determine the proper response. The other actions are not the most important, but discussing safer sex practices is always appropriate. Testing would be recommended every 3 months for someone engaging in high risk behaviors.
A client has been hospitalized with an opportunistic infection secondary to HIV-III. 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.
ANS: A The client should make his or her wishes known and formalize them through advance directives. The nurse would 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, but the nurse would be the client's advocate and help ensure his or her wishes are met.
A client with HIV-II 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.
ANS: A 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 and food. The nurse would consult with a pharmacist about possible interactions. Client teaching is important but does not take precedence over ensuring the medications do not interfere with each other, which could lead to drug resistance or a resurgence of symptoms.
The nurse is caring for a client diagnosed with HIV-II. The client's CD4+ cell count is 399/mm3 (0.399 109/L). 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.
ANS: A This client is in the Centers for Disease Control and Prevention HIV-II case definition group. He or she remains highly infectious and would be counseled on either safer sex practices or abstinence. Abstaining from alcohol is healthy but not required, although some medications may need to be taken while abstaining. 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 precedence over stopping the spread of the disease.
A client has just been informed of a positive HIV test. 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.
ANS: A This client needs the assistance of support systems. The nurse would 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. Positive HIV test results are reportable in all 50 states, Washington, D.C., and Canada but the nurse works with the client to support his or her choices in disclosure. The nurse would not tell the family for the client.
A client with HIV-III is admitted to the hospital with Toxoplasma gondii infection. Which action by the nurse is most appropriate? a. Initiate Contact Precautions. b. Conduct frequent neurologic assessments. c. Conduct frequent respiratory assessments. d. Initiate Protective Precautions.
ANS: A Toxoplasma gondii infection is an opportunistic infection that causes an encephalitis but poses only a rare threat to immunocompetent individuals The nurse would perform ongoing neurologic assessments. Contact and Protective Precautions are not needed. Good respiratory assessments are important to the client, but toxoplasmosis will demonstrate neurologic signs and symptoms.
A nurse is assessing a patient who has been diagnosed with PTSD. Which statements would the nurse identify as supporting this diagnosis? SATA a. I keep having nightmares about the incident b. I can't feel safe in my own house after what happened there c. Being around other people takes too much energy d. I jump when I hear any loud noise, like a bang e. I'm so worried about losing my job, I keep taking on extra assignments
ANS: A, B, C, D
Which actions are most effective for nurses and other healthcare workers to prevent occupational transmission of viral hepatitis? SATA a. washing hands before and after contact with all clients b. using needleless systems for parenteral therapy c. using standard precautions with all clients regardless of age or sexual orientation d. being fully vaccinated with Hep B vaccine e. wearing gloves during direct contact with all clients
ANS: A, B, C, D
A 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 HIV-I disease are not infectious to others. f. The CD4+ T-cell is only affected when the disease has progressed toHIV-III
ANS: A, B, C, D In HIV, CD4+ cells begin to create new HIV particles. Antibodies the client produce are incomplete and do not function well. Macrophages also stop functioning properly. Opportunistic infections and cancer are the two leading causes of death in client's with HIV infection. People infected with HIV are infectious in all stages of the disease. The CD4+ T-cell is the immune system cell most affected by infection with the HIV virus.
A nurse begins a job at a Veterans Administration Hospital and asks why so much emphasis is on HIV testing for the veterans. What reasons is this nurse given? (Select all that apply.) a. Veterans have a high prevalence of substance abuse. b. Many veterans may engage in high risk behaviors. c. Many older veterans may not know their risks. d. Everyone should know their HIV status. e. Belief that the VA has tested them and would notify them if positive.
ANS: A, B, C, D, E All options are correct for the veteran population. The nurse interacting with veteran would ensure they know about the HIV testing offered by the VA.
The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? (Select all that apply.) a. Jaundice b. Clay-colored stools c. Icterus d. Ascites e. Petechiae f. Dark urine
ANS: A, B, C, D, E, F All of these assessment findings are very common for a client who has late-stage cirrhosis due to biliary obstruction and poor liver function. The client has vascular lesions and excess fluid from portal hypertension.
The nurse is assessing a client with hepatitis C. The client asks the nurse how it was possible to have this disease. What questions might the nurse ask to help the client determine how the disease was contracted? (Select all that apply.) a. "How old are you?" b. "Do you work in health care? c. "Are you receiving hemodialysis?" d. "Do you use IV drugs?" e. "Did you receive blood before 1992?" f. "Have you even been in prison or jail?"
ANS: A, B, C, D, E, F The nurse would ask all of these questions because "baby boomers," people who use illicit drugs, people on hemodialysis, health workers, and prisoners are at a very high risk for hepatitis C. Additionally, individuals who received blood, blood products, or an organ transplant prior to 1992 before bloodborne disease screening of these products was mandated are at risk for hepatitis C.
The nurse is educating a client with HIV-II and the partner on self-care measures to prevent infection when blood counts are low. What information does the nurse provide? (Select all that apply.) a. Do not work in the garden or with houseplants. b. Do not empty the kitty litter boxes. c. Clean your toothbrush in the dishwasher daily. d. Bathe daily using antimicrobial soap. e. Avoid people who are sick and large crowds. f. Make sure meat, fish, and eggs are cooked well.
ANS: A, B, D, E, F Ways to avoid infection when immunocompromised include not working in the garden or with houseplants; not emptying litter boxes; running the toothbrush through the dishwasher at least weekly; bathing daily using antimicrobial soap; avoiding sick people and large crowds; and making sure meat, fish, and eggs are cooked well prior to eating them.
Which findings are AIDS-defining characteristics? (Select all thatapply.) a. CD4+ cell count less than 200/mm3 (0.2 109/L) or less than14% b. Infection with P. 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 f. Confusion, dementia, or memory loss
ANS: A, B, D, F 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 (0.2 109/L) or less than 14% (even if the total CD4+ count is above 200 cells/mm3) or an opportunistic infection such as P. jiroveci and HIV wasting syndrome. Confusion, dementia, and memory loss are central nervous system indications. Having a positive ELISA test and taking antiretroviral medications are not AIDS-defining characteristics.
The nurse is assessing a client for signs and symptoms of systemic lupus erythematosus (SLE). Which of the following would be consistent with this disorder? (Select all thatapply.) a. Discoid rash on skin exposed to sunlight b. Urinalysis positive for casts and protein c. Painful, deformed small joints d. Pain on inspiration e. Thrombocytosis f. Serum positive for antinuclear antibodies (ANA)
ANS: A, B, D, F Signs and symptoms of SLE include (but are not limited to) a discoid rash on skin exposed to the sun, urinalysis with casts and protein, pleurisy as manifested by pain on inspiration, and positive ANA titers in the blood. Nonerosive arthritis in peripheral joints can occur but does not lead to deformity. Thrombocytopenia is another sign.
A 23 year old male veteran of the war in Iraq is admitted with a diagnosis of PTSD following his arrest for destroying his girlfriends apartment. This is not his first angry outburst resulting in destruction of property. Which intervention by the nurse will be most helpful to this patient? SATA a. allow opportunities for him to express his anger b. provide patient and family teaching regarding PTSD c. tell the patient that hurting himself will solve nothing d. report him to the authorities e. exhibit a nonjudgemental attitude f. reassure him that everything will be alright
ANS: A, B, E
The nurse is teaching a client about medications for HIV-II treatment. What drugs are paired with the correct information? (Select all that apply.) a. Abacavir: avoid fatty and fried foods. b. Efavirenz: take 1 hour before or 2 hours after antacids. c. Atazanavir: check pulse daily and report pulse greater than 100 beats/min. d. Dolutegravir: do not take this medication if you become pregnant. e. Enfuvirtide: teach client how to operate syringe infusion pump for administration. f. All drugs: you must adhere to the drug schedule at least 90% of the time for effectiveness.
ANS: A, B, F Abacavir is a nucleoside reverse transcriptase inhibitor and clients are taught to avoid fried and fatty foods because they can lead to digestive upsets and even pancreatitis. Efavirenz is a nonnucleoside reverse transcriptase inhibitor and clients are taught to take them (doraverene) all except spaced 1 hour before or 2 hours after antacids to avoid inhibiting drug absorption. Atazanavir is a protease inhibitor and can cause bradycardia which should be reported. Dolutegravir is an integrase inhibitor and can cause birth defects. Enfuvirtide is a fusion inhibitor and is given subcutaneously. All drugs must be taken as scheduled 90% of the time in order to remain effective.
A client is being administered the first dose of belimumab for a systemic lupus erythematosus flare. What actions by the nurse are most appropriate? (Select all that apply.) a. Observe the client for at least 2 hours afterward. b. Instruct the client about the monthly infusion schedule. c. Inform the client not to drive or sign legal papers for 24 hours. d. Ensure emergency equipment is working and nearby. e. Make a follow-up appointment for a lipid panel in 2 months. f. Instruct the client to hold other medications for 72 hours.
ANS: A, D This drug is a monoclonal antibody to tumor necrosis factor. The first dose would be administered in a place where severe allergic reactions and/or anaphylaxis can be managed. This includes having emergency equipment nearby. The client would be observed for at least 2 hours after this first dose. This drug does not cause drowsiness, so there would be no restrictions on driving or signing legal documents. Elevated lipids are not associated with this drug. This drug is used in combination with other therapies, especially during a flare.
A nurse is assessing a patient with suspected PTSD. Which of the following would the nurse be LEAST likely to assess? a. hypervigilance b. diminished startle response c. lack of interest in life d. feelings of estrangement
ANS: B
A nurse suspects that a client may be experiencing PTSD. Which assessment finding would help support the nurses suspicion? a. client was just told he has lung cancer b. client was a victim of rape and beating c. client had foot amputated due to diabetes d. client recently lost a spouse to a chronic illness
ANS: B
How will the nurse interpret a clients lab finding of the presence of immunoglobulin G antibodies directed against Hep A? a. active, infectious HAV is present b. permanent immunity to HAV is present c. This is the client's first infection to HAV d. the risk for infection if exposed to HAV is high
ANS: B
What is the nurses best response to a client newly diagnosed with SLE who asks why nicotine use, especially cigarettes or vaping, should be avoided? a. smoking or vaping increases your risk for lung cancer b. nicotine reduces blood flow to your organs and increases risk for permanent damage c. using nicotine in any form reduces the effectiveness of drug therapy for lupus d. nicotine promotes muscle cell loss, increases joint inflammation, and reduces functional mobility
ANS: B
Pneumocystis Jiroveci pneumonia?
Caused by a FUNGUS and is very popular
A client with HIV-II has had a sudden decline in status with a large increase in viral load. What action would 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.
ANS: B 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 to be effective. Since this client's viral load has increased dramatically, the nurse would first assess this factor. After this, the other assessments may or may not be needed.
A client has been newly diagnosed with systemic lupus erythematosus and isreviewing self-care measures with the nurse. Which statement by the client indicates a need to review the material? a. "I will avoid direct sunlight as much as possible." b. "Baby powder is good for the constant sweating." c. "Grouping errands will help prevent fatigue." d. "Rest time will have to become a priority."
ANS: B Constant sweating is not a sign of SLE and powders are drying so they should not be used, at least not in excess. The client is correct in stating he/she should avoid direct sunlight, that grouping errands can prevent or reduce fatigue, and that rest will have to become a priority.
A client with HIV-III has been hospitalized with suspected cryptosporidiosis. What physical assessment would be most important with this condition? a. Auscultating the lungs b. Assessing mucous membranes c. Listening to bowel sounds d. Performing a neurologic examination
ANS: B Cryptosporidiosis can cause diarrhea and wasting with extreme loss of fluids and electrolytes. The nurse would assess signs of hydration/dehydration as the priority, including checking the client's mucous membranes for dryness. The nurse will perform the other assessments as part of a comprehensive assessment.
A nurse is caring for a client with HIV-III who was admitted with HAND. What sign or symptom would be most important for the nurse to report to the primary health care provider? a. Nausea b. Change in pupil size c. Weeping open lesions d. Cough
ANS: B HIV-associated neurocognitive disorder (HAND) is a sign of neurologic involvement. The nurse would report any sign of increasing intracranial pressure immediately, including change in pupil size, level of consciousness, vital signs, or limb strength. The other signs and symptoms are not life threatening and would be documented and reported appropriately.
After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching? a. "Some medications have been known to cause hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I was infected with hepatitis A through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."
ANS: B The route of transmission for hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.
The nurse is assessing a client who has hepatitis C. What extrahepatic complications would the nurse anticipate? (Select all that apply.) a. Pancreatitis b. Polyarthritis c. Heart disease d. Myalgia e. Peptic ulcer disease f. Ulcerative colitis
ANS: B, C, D 477 The client who has hepatitis C has complications that do not relate to the liver, including polyarthritis, myalgia, heart disease and vasculitis, renal disease, and cognitive impairment.
A client with HIV is in the hospital with severe diarrhea. What actions does the nurse delegate to assistive personnel? SATA a. assessing the clients fluid and electrolyte status b. assisting the client 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
ANS: B, C, D, E
A client with HIV-III is in the hospital with severe diarrhea. What actions does the nurse delegate to assistive personnel (AP)? (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
ANS: B, C, D, E The AP 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 nurse is providing education about HIV risks at a health fair. What groups would the nurse include as needing to be tested for HIV on an annual basis? (Select all that apply.) a. Anyone who received a blood product in 1989 b. Couples planning on getting married c. Those who are sexually active with multiple partners d. Injection drugs users e. Sex workers and their customers f. Adults over the age of 65 years
ANS: B, C, D, E The CDC recommends that HIV testing would be performed on those who received a transfusion between 1978 and 1985 only. People planning on getting married should be tested and all sexually active people should know their HIV status. Those engaged in sex work and their customers should also be tested, as well as injection drug users. Those over the age of 65 years need a one-time screen.
A client with HIV-III has oral thrush and difficulty eating. What actions does the nurse delegate to the assistive personnel (AP)? (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. f. Offer the client soft foods like gelatin or pudding.
ANS: B, C, E, F The AP can help the client with oral care, offer fluids, and remind the client of things the nurse (or other professional) has already taught. Soft foods and liquids are tolerated better than harder foods. Applying medications is performed by the nurse. Alcohol-based mouthwashes are harsh and drying and would not be used.
A nurse caring for clients with systemic lupus erythematosus (SLE) plans care understanding the most common causes of death for these clients is which of the following? (Select all that apply.) a. Infection b. Cardiovascular impairment c. Vasculitis d. Chronic kidney disease e. Liver failure f. Blood dyscrasias
ANS: B, D Any and all organs and tissues may be affected in SLE but the most common causes of death in clients with SLE include cardiovascular impairment and chronic kidney disease.
A nurse assesses a client who has cirrhosis of the liver. Which laboratory findings would the nurse expect in clients with this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)
ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client's confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.
A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first? a. request a psych consult b. place the client in one-to-one observation. c. complete a thorough physical assessment, including labs d. remove all hazardous materials from the environment
ANS: C
A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of: a. dysthymia b. euphoria c. anhedonia d. anergia
ANS: C
What precaution is MOST important for the nurse to teach the client with systemic lupus erythematosus (SLE) prescribed to take 45mg of a corticosteroid daily for 2 weeks to manage SLE flare? a. be sure to take this drug with food b. take 30mg in morning and 15mg at night c. do not suddenly stop taking this drug when flare is over d. check all stools for presence of blood or black, tarry appearance
ANS: C
Which side effect is highest priority for the nurse to assess for when diphenhydramine is administered to a patient also taking antipsychotic medication? a. increased psychosis b. cognitive impairment c. respiratory depression d. impaired memory
ANS: C
A client with HIV-III asks the nurse why gabapentin is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best? a. "Gabapentin can be used as an antidepressant too." b. "I have no idea why you would be taking this drug." c. "This drug helps treat the pain from nerve irritation." d. "You are at risk for seizures due to fungal infections."
ANS: C Many classes of medications are used for neuropathic pain, including tricyclic antidepressants and anticonvulsants such as gabapentin. It is not being used to prevent seizures from fungal infections. If the nurse does not know the answer, he or she would find out for the client.
A client with known HIV-II 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 would the nurse take first? a. Initiate Droplet Precautions for the client. b. Notify the primary health care provider about the CD4+results. c. Place the client under Airborne Precautions. d. Use Standard Precautions to provide care.
ANS: C Since this client's CD4+ cell count is so low, he or she may have energy, or the inability to mount an immune response to the TB test. The client also appears to have progressed to HIV-III. The nurse would first place the client on Airborne Precautions to prevent the spread of TB if it is present. Next the nurse notifies the primary health care provider about the low CD4+ count and requests alternative testing for TB. Droplet Precautions are not used for TB. Standard Precautions are not adequate in this case.
A client with HIV and 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 foods b. has decreased oral discomfort c. eats 90% of meals and snacks d. has a weight gain of 2 lbs in 1 month
ANS: D
A patient taking an MAOI is seen in the clinic with a BP of 170/96 mm Hg. What will the nurse ask this patient? a. whether any antihypertensive meds are used b. whether the patient drinks grapefruit juice c. whether SSRIs are taken in addition to MAOI d. to list all foods eaten that day
ANS: D
A patient taking fluoxetine (prozac) complains of decreased sexual interest. A prescriber orders a drug holiday. What teaching by the nurse would best describe a drug holiday? a. take the drug every other day b. discontinue the drug for one week c. cut the tablet in half anytime to reduce dosage d. dont take the medication on friday and saturday
ANS: D
Clara is under evaluation for imminent suicide risk, which information given by her would be most significant? A) At least a 2-year history of feeling depressed more days than not B) Divorced from spouse 6 months ago C) Feeling loss of energy and appetite D) Reference to suicide as best solution to identified problems
ANS: D
What is the most common route by which nurses and other healthcare workers are exposed to the HIV virus when caring for HIV-positive clients? a. getting blood on exposed skin of hands and arms b. touching infected body fluids with bare hands c. having urine splashed on mucous membranes d. sharps injuries with contaminated needles
ANS: D
The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis? a. Metabolic syndrome b. Liver cancer c. Nonalcoholic fatty liver disease d. Hepatitis C
ANS: D Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis
The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy. What health teaching would the nurse include? a. "Follow up on all appointments to monitor your lab values." b. "Do not take amiodorone at any time while on this drug." c. "Monitor for jaundice, rash, and itchy skin while on this drug." d. "Report any changes in urinary elimination while on this drug."
ANS: D Lamivudine can cause renal impairment and the nurse would remind the client of changes that may indicate kidney damage.
A nurse is teaching the client with systemic lupus erythematosus about prednisone. What information is the priority? a. Might make the client feel jittery or nervous. b. Can cause sodium and fluid retention. c. Long-term effects include fat redistribution. d. Never stop prednisone abruptly.
ANS: D The nurse teaches the client to avoid stopping the drug abruptly as the priority because this can lead to a life-threatening adrenal crisis. Short-term side effects do include jitteriness or nervousness, sodium and water retention. One long-term side effect is fat redistribution resulting in "moon face" and "buffalo hump."
A client with HIV-III and 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 lb (1 kg)/1 mo.
ANS: D 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. Choosing high-protein food is important, but only if the client eats and absorbs the nutrients.
Duloxetine (Cymbalta)
An SNRI that increases serotonin and norepinephrine in the brain.
Elbasvir (grazoprevir)
An anti-viral protease inhibitor inhibiting Hepatitis C viral replication.
Quetiapine (Seroquel)
An antipsychotic that affects neurotransmitters in the brain by inhibiting them (specifically dopamine) to allow for more coordinated movements
Hepatitis C definition and mode of transmission?
An unstable enveloped single stranded RNA virus. It is transmitted from blood to blood
Hepatits B &(D) symptoms and incubation period?
Anorexia, n/v, fever, dark urine, joint pain, jaundice, RUQ pain, light colored stools, and fatigue. Incubation period: 25-180days
Hydroxychloroquine and important teaching?
Antimalarial drug used to treat fatigue, skin and arthritic pain of Lupus. Patients need regular skin examinations and eye assessments
Where is the HIV found?
BLOOD, SEMEN, BREAST MILK, VAG SECRETIONS, urine, feces, amniotic fluid, saliva, tears, sweat, CSF, lymph nodes, cervical cells, corneal tissue, and brain tissue
Efavirenz (Sustiva) mechanism of action and uses?
Binds to HIV reverse transcriptase suppressing the enzyme and its replication. It is to lower the change of getting HIV complications and improves quality of life
Hepatitis A is resistant to acids and detergents, but it CAN be killed by?
Bleach and very high temps
Tricyclic antidepressants
Block the reuptake of serotonin and norepinephrine while blocking the receptors for ACTH, Norepinephrine, and histamine.
Zidovudine (Retrovir) Adverse effects?
Blood disorders, lactic acidosis, N/V/D, depression, insomnia, seizures, nervousness, diabetes, hyperlipidemia, anorexia, and myopathy
How do we confirm a case of Hep B?
Blood test
How to confirm TB?
Blood test, and chest x-ray
S/s of lupus?
Butterfly rash, coin-shaped lesions, photosensitivity, lesions in mouth and nose, arthritis, kidney problems (blood and proteins in urine), blood issues, fever, headaches, chest pain, high BP, abdominal pain, atherosclerosis, hair loss
Labs/diagnostics for LUPUS?
CBC, erythrocyte sedimentation rate, BUN, Crt, LFT, urinalysis, ANA testing, x-ray, ECG, biopsy
TB
Caused by a myoBACTERIUM tuberculosis. It is spread by coughing, sneezing, and talking
Prednisone teachings?
Lowers immune system, long term glaucoma and osteoporosis
Labs to assess for HIV
Lymphocyte count, antibody-antigen tests, viral load testing, CBC, lipids, Hep screening, urinalysis, Plt, LFTs, and drug screen
Side effects of Belimumab?
Migraines, depression, insomnia, n/v, Leukopenia, extremity pain, allergic reactions
Duloxetine (Cymbalta) contraindications?
NO alcohol, don't double dose, don't stop abruptly, and don't give to liver or kidney disease patients
Tricyclic antidepressant teachings?
DONT TAKE WITH MAOIs. Must wait 2 weeks before giving an MAOI or a HTN crisis will occur. Also, teach pt. to have frequent eye exams
Fluoxetine patient teaching?
DONT stop abruptly, DONT double dose. Follow up with nutrition, exercise programs, and teach pt. that it takes about 3 weeks to fully feel the affects, and that low sex drive is a potential
What to assess for TB?
Daily weight, resp, vitals, isolate the pt. and Collab with resp therapy
Anti-malarial drugs such as Hydroxychloroquine for Lupus help to?
Decrease flare ups and decreases the risk for skin lesions
Tricyclic antidepressants treat?
Depression, OCD, neuropathy
Managing nutrition with HIV patients?
Determine the cause, I&O, HIGH CAL HIGH PROTEIN diet, small frequent meals, TPN, tube feedings, and teach appropriate mouth care
Pneumocystis Jiroveci pneumonia symptoms?
Diff breathing, high fever, dry cough. Assess resp, I&O, and encourage fluids
Efavirenz (Sustiva) Nursing considerations?
Don't take with antibiotics, anti-HTNs, seizure meds, blood thinners, cholesterol meds, or other HIV meds
Efavirenz (Sustiva) Adverse effects?
Drowsiness, delusions, dizziness, depression (acute), vivid dreams and nightmares, hallucinations, teratogenicity, hyperlipidemia, and liver damage
Elbasvir (grazoprevir) adverse effects?
Dyspnea, abdominal pain, insomnia, depression, and rash
Hep C is the leading cause of?
End stage liver disease
Nursing interventions for Zidovudine (Retrovir)?
Ensure adherence to the schedule, and call physician regarding any sore throat or cold-like symptoms
Immunomodulators such as Cyclophosphamide, Methotrexate, and Azathioprine for Lupus help to?
Prevent frequent exacerbations of lupus
Monoclonal antibodies such as Belimumab for Lupus help to?
Reduce symptoms, reduce tissue damage, but require a lot of monitoring
Hepatits E definition and mode of transmission?
Single stranded RNA virus that is transmitted through fecal contaminated food and water.
Lupus is a result from genetics and the environment, but some triggers include?
Sunlight, infection, injury, hormones, and meds. Note that it is more common in women than men
Empivir teaching points?
Teach pt. to report any sudden/ severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness
What happens once a person is infected with Hepatitis?
The liver becomes enlarged and congested causing pain in the RUQ. This can compromise blood flow as well as cell regulation and can lead to jaundice
What happens when a patient has a low CD4-T cell count?
They are at higher risk for a fungal, bacterial, and viral infection, as well as opportunistic cancers
Antiretroviral therapy?
Treatment of people infected with HIV using anti-HIV drugs. Consists of a combination of drugs (HAART) that suppresses HIV replication
PrEP examples
Truvada and Discovy
Postexposure prophylaxis (PeP)
Used AFTER a high-risk HIV event. Must be started ASAP (36hrs) post exposure
Tricyclic antidepressant adverse effects?
Vision problems, constipation, dry mouth, orthostatic hypotension, and cardio-toxicity.
