MS Exam 4: Chapter 19
what is the AIDS dementia complex?
-HIV associated neurocognitive disorder -HIV associated dementia complex -Can see barely noticeable changes to severe dementia; can be caused by meds or disease
which bodily fluids have the lowest concentration of HIV?
-saliva -tears -sweat
what is Truvota?
-supposed to prevent HIV infection -need renal panels every 3 months -you still must practice safe sex
A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client? a. Fluconazole (Diflucan) b. Trimethoprim/sulfamethoxazole (Bactrim) c. Rifampin (Rifadin) d. Acyclovir (Zovirax)
A
The nurse is providing care to a client with impaired oxygenation related to anemia. Which nursing intervention has the highest priority? a. Administer antibiotics as prescribed. b. Transfuse ordered packed red blood cells. c. Teach pursed-lip breathing. d. Encourage increased fluid intake.
B
a client diagnosed with AIDS who is receiving combination antiretroviral therapy (cART) now has a CD4+ T-cell count of 525 cells/mm3. how will the nurse interpret this result? a. the client can reduce the dosages of the prescribed drugs b. the virus is resistant to the current combination of drugs c. the client no longer has AIDS d. the drug therapy is effective
D
what is a retrovirus?
any of a group of RNA viruses which insert a DNA copy of their genome into the host cell in order to replicate, e.g. HIV
when might a patient get a false negative HIV test?
if the test is taken within 3 weeks of the patient's exposure (find out when they think the exposure occurred)
what is the viral loading test?
measures actual amount of HIV viral RNA particles in 1 mL of blood; positives range from 40 particles per mL to 80,000 particles per mL
what are the cultural/spiritual considerations for HIV/AIDS patients?
most new HIV infections reported in the U.S. and Canada occur in racial and ethnic minorities, particularly among African Americans and Hispanics. More culturally sensitive efforts targeted at these groups for preventions and treatment are needed.
what should you do if you overhear your coworkers talking inappropriately about a patient with HIV/AIDS?
report it to the charge nurse
what are the ABCs of safer sex?
-A: Abstinence -B: Be faithful -C: Condom use
how does perinatal transmission of HIV occur?
-Across the placenta during pregnancy -Infant exposure at birth to blood and vaginal secretions -Exposure after birth through breast milk -Can pass through the placenta, can be further exposed with blood and vaginal excretions during birth, and through breast milk when breastfeeding -Risk for perinatal transmission to infants in pregnant patient with HIV infection is about 25% in women that are not using drug therapy as compared to 8% of patients who are on HIV drug therapy
how can you minimize diarrhea?
-Antidiarrheal meds: lomodal and ammodium -Diarrhea can be caused by disease or side effects of meds -May need a dietician (dietary changes are less rupage- leafy greens, vegetables; less fatty, spicy, and sweet foods; and no alcohol or caffeine) -Keep the perineal area dry and clean (use barrier cream) -Assess the skin every shift; if they have skin breakdown, may need to contact wound specialist
how can you enhance nutrition in HIV/AIDS patients?
-Antiemetics -Calorie count (dietary receives percentage of food eaten and figures this out) -Want foods high in calories and proteins, avoid fats (side effects of antiretroviral rugs can create a fat intolerance for patients), small frequent meals, drinking 2-4 L of fluids per day, look at albumin and prealbumin for indicators of malnourishment) -Sodium bicarb rinses mixed in sterile water or sterile NS for mouth pain/discomfort
what are the effects of HIV infection?
-CD4+ T-cells become "HIV factory" to make new viral particles daily -Gradually, CD4+ T-cell count falls, viral load rises -Immune systems weakens -Everyone with AIDS has HIV; not everyone with HIV has AIDS
how does HIV progress?
-Can take months to years -Personal life factors can affect timing progression (frequency of re-exposure to HIV, presence of other STDs, nutrition status, and stress)
How is HIV NOT transmitted?
-Casually -By sharing household utensils, towels, linens, toilets -Via mosquitoes or insects
how does transmission of HIV to healthcare workers occur?
-Needle stick ("sharps") injuries -Exposure of nonintact skin/mucous membranes to blood and body fluids -Standard Precautions is best prevention -Postexposure prophylaxis (PEP)
who should use HIV post-exposure prophylaxis?
-Occupational exposure -Non-occupational exposure -Sexual assault
how should you address psychosocial distress?
-Ongoing -Provide climate of acceptance -Promote trusting relationship -Encourage expression of feelings -Identify positive aspects of self -Allow for privacy; avoid isolation -Allow patients to mourn the changes -Make sure patients is not going to harm themselves (suicidal assessment)
what do you need to educate your HIV positive patient about their medications?
-Potential for infection: treat with more than 1 antiretroviral agent (only using one contributes to resistance) -Drugs can not be missed, delayed, or administered in lower than prescribed doses -Teach patients the importance of sticking to medication regimen -90% rule: meds must be taken correctly 90% of the time (9/10 must be taken correctly)
how should you prevent infections when WBC counts are low?
-avoid crowds and large gatherings of people who may be ill -do not share personal toilet articles, such as toothbrushes, toothpaste, washcloths, or deodorant sticks with others -if possible, bathe daily, using an antimicrobial. if total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap -clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing out the bleach with hot running water) -wash your hands thoroughly with an antimicrobial soap before you eat or drink, after touching a pet, after shaking hands with anyone, as soon as you come from any outing and after using the toilet -avoid eating salads, raw fruits and vegetables; undercooked meat, fish, and eggs; and pepper and paprika -wash dishes between use with hot, sudsy water or use a dishwasher -do not drink water, milk, juice, or other cold liquids that have been standing for longer than an hour -do not reuse cups and glasses without washing -do not change pet litter boxes; if unavoidable, use gloves and wash hands immediately -avoid turtles and reptiles as pets -do not feed pets raw or undercooked meats -take your temperature at least once a day and whenever you do not feel well -report any signs of infection to your health care provider immediately -take all prescribed drugs -do not dig in the garden or work with houseplants -wear a condom when having sex -avoid travel to areas of the world with poor sanitation or less-than-adequate health care facilities
what should a healthcare worker do after being exposed to HIV?
-bleed the area (push blood out of needle stick site) -wash hands really good for one full minute -contact infection control person at the hospital (incident report needs to be filled out) -at 1 month, 3 months, and 6 months you will need to have HIV testing -2 weeks after starting antiretroviral drugs, you need CBC, creatinine, and electrolytes
which bodily fluids have the highest concentration of HIV?
-blood -semen -vaginal secretions -breast milk
what is cryptosporidiosis?
-causes a range of diarrhea (mild to severe wasting with electrolyte imbalances) -can lose up to 15-20 L per day -hydration and assessments for dehydration are priorities
what is stage 3 of HIV?
-diagnosis of AIDS -CD4+ T-cell count has to be less than 200
how should patients with HIV/AIDS use infection control for home care?
-follow standard precautions and good hand-washing techniques -do not share razors or toothbrushes -wipe up feces, vomit, sputum, urine, or blood or other body fluids and the area with soap and water. dispose of solid wastes and solutions used for cleaning by flushing them down the toilet. disinfect the area by wiping with a 1:10 solution of household bleach. wear gloves during cleaning -soak rags, mops, and sponges used for cleaning in a 1:10 bleach solution for 5 minutes to disinfect them -wash dishes and eating utensils in hot water and dishwashing soap or detergent -clean bathroom surfaces with regular household cleaners and then disinfect them with a 1:10 solution of household bleach -rinse clothes, towels, and bedclothes if they become soiled with feces, vomitus, sputum, urine, or blood. dispose of the soiled water by flushing it down the toilet. launder these clothes with hot water and detergent with 1 cup of bleach added per load of laundry -keep soiled clothes in a plastic bag -dispose of needles and other sharps in a labeled puncture-proof container such as a coffee can with a lid or empty liquid bleach bottle, using standard precautions to avoid needlestick injuries. decontaminate full containers by adding 1:10 bleach solution. then seal the container with tape and place it in a paper bag. dispose of the container in the regular trash -remove solid waste from contaminated trash (paper towels or tissues, dressings, disposable incontinence pads, disposable gloves); then flush the solid waste down the toilet. place the contaminated trash items in in tied plastic bags and dispose of them in the regular trash
what are the nursing implications of PIs (protease inhibitors)?
-instruct patients to not chew or crush these drugs because this action may cause the drug to be absorbed too rapidly and increase the risk for side effects -teach patients to report jaundice, N/V, or severe abdominal pain because these drugs can induce liver toxicity -instruct patients to keep all appointments for lab work because these drugs increase blood lipid levels and increase the risk for atherosclerosis and pancreatitis -remind patients to avoid St. John's wort while taking these drugs because the supplement reduces the effectiveness of all PIs -teach patients taking atazanavir and ritonavir to check their pulse daily and report low HR to the prescriber because these 2 drugs can impair electrical conduction and lead to heart block -do not give darunavir or fosamprenavir to patients who have a known sulfa allergy because these 2 drugs contain sulfa
how should you care for a hospitalized patient with reduced immunity?
-place the patient in a private room whenever possible -use good hand-washing technique or alcohol-based hand rubs before touching the patient or any of their belongings -ensure that the patient's room and bathroom are cleaned at least once each day -do not use supplies from common areas for neutropenic patients. for example, keep a dedicated box of disposable gloves in their room and do not share this box with any other patient. provide single-use food products, individually wrapped gauze, and other individually wrapped items -limit the number of personnel entering the patient's room -monitor vital signs, including temperature every 8 hours -inspect the patient's skin and mucus membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours -inspect open areas such as IV sites every 4 hours for signs of infection -change gauze-containing wound dressings daily -obtain specimens of all suspicious areas for culture (as specified by the agency) and promptly notify the primary health care provider -help the patient perform coughing and deep breathing exercises -encourage activity at a level appropriate for the patient's current health status -keep frequently used equipment in the room for use with this patient only -limit visitors to healthy adults -use strict aseptic technique for all invasive procedures -avoid the use of indwelling urinary catheters -keep fresh flowers and potted plants out of the patient's room -teach the patient to eat a low- bacteria diet (avoid raw fruits and vegetables, undercooked meats, fish, and eggs; pepper and paprika as seasonings sprinkled on food right before eating)
A client diagnosed with acquired immunodeficiency syndrome (AIDS) shares with the nurse feelings of social isolation. Which strategy should the nurse suggest as the most useful way to decrease the client's stated loneliness? 1. Reinstituting contact with the client's family, who live in a distant city 2. Contacting a support group for clients with AIDS that is available in the local region 3. Using the Internet or the computer to facilitate communication while maintaining isolation 4. Using the television and newspapers to maintain a feeling of being "in touch" with the world
2
A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse? a. "With this treatment, I probably cannot spread this virus to others." b. "This treatment does not kill the virus." c. "This medication prevents the virus from replicating in my body." d. "Research has shown the effectiveness of this therapy if I do not forget to take any doses."
A
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? a. "Have you had sex with men or women or both?" b. "I hope you use condoms to protect your partners." c. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS." d. "You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."
A
To infect, HIV must hijack the CD4+ cell. This cell is also know as all of the following except: a. antinuclear antibody cell b. CD4+ cell c. helper/inducer T-cell d. T4-cell
A
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? a. Clean toothbrushes once a week. b. Bathe daily using an antimicrobial soap. c. Eat salad at least once a day. d. Wash dishes in cool water.
B
Poor CD4+ T-cell function leads to immunity abnormalities, which of the following is not one of these abnormalities: a. lymphocytopenia b. thrombocytosis c. non-functional antibodies d. abnormal macrophages
B
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? a. Obtain a 12-lead electrocardiogram (ECG). b. Call for a portable chest x-ray. c. Obtain blood cultures from two sites. d. Give cefazolin (Kefzol) 500 mg IV.
C
When CD4+ T-cells are changed and used as HIV factory, the immune system: a. there is no effect b. strengthens c. weakens d. who cares
C
what do you need to educate the HIV positive patient about?
Urge patients who are HIV positive to use condoms even if their partner is positive too (latex or polyurethane condoms)
what are the endocrine complications of HIV/AIDS?
adrenal insufficiency and diabetes
what is the HIV disclosure law?
need to report HIV positive status to partner before having sex (can be put in jail and/or responsible for paying for treatment of new infected person if you do not disclose this information)
what is toxoplasmosis?
patients get infected through contaminated cat feces or ingesting undercooked meat
what is the ELISA and western blot test?
positive ELISA would be confirmed with a western blot; used to be a longer lag window (28 days instead of 21 days)
what are the veterans health considerations for HIV/AIDS?
the veteran's health administration (VHA) is a major health care provider in the U.S. and has found that a significant number of veterans have undiagnosed HIV disease. As a result, in 2009 the VHA eliminated the need for written consent for including HIV screening as part of routine testing. Despite the directive, only about 9% of veterans treated annually at VHA facilities have ever been tested. When asked, most veterans believed that they were HIV negative because they thought the test had already been done as part of routine testing and that the VHA would have notified them of positive results. This false sense of security has major implications because of the high prevalence of risky behaviors such as substance abuse and unsafe sexual practices among the VHA patient population. When interacting with veterans and discussing the issue of being aware of their HIV status as part of disease prevention, be sure to inform them that HIV screening is available to them through the VHA
how do you manage pain for this patient?
-Comfort measures: pressure-relieving mattress pads, massage, warm baths -Drug therapy -Complementary and alternative therapies: acupuncture, biofeedback -Use a life sheet if they are in pain (even if they do not have bone disease)
how do you enhance oxygenation for your patient?
-Drug therapy: Bactrim, bronchodilators, and steroids -Respiratory support and maintenance -Comfort: HOB up unless they are hypotensive -Rest and activity changes (energy conservation) -Watching for N/V, fever, and rash -Chest physiotherapy (vibrates to help loosen secretions)
how can you enhance cognition?
-Introduce yourself, explain your role, explain what you are doing, give simple directions, use short uncomplicated sentences, use simple language, and involve the patient in daily care (every time you are in the room) -May need an antidepressant and anxiolytic -Safety: seizure precautions (need anticonvulsants IV PRN ordered- Ativan)
what lab assessments need to be done on a HIV positive patient?
-Lymphocyte counts may be decreased -Look at CBC (changes in platelets, etc) -Antibody tests (look for development of HIV antibodies) -ELISA and western blot -Home testing: send a sample of blood with a code, patient calls the phone number and enters the code to get results -Viral load testing
who is at high risk for HIV?
-Men who have sex with men -Heterosexually active men and women -Injecting drug users -Serodiscordant relationships
how can you prevent HIV through parental transmission?
-Proper cleaning of "works" (needles and syringes, other drug paraphernalia) -Needle exchange programs -You can put bleach in the syringe, shake it for 3—60 sec and then rinse if you cannot find a needle exchange program
how is HIV transmitted?
-Sexual contact -Parenterally -Perinatally
how do you prevent HIV transmission as a healthcare worker?
-Standard (contact) precautions with HIV positive patients (even if they are bleeding) -Exception: if patient has TB or other infection along with HIV, treat it as you normally would for TB (droplet precautions)
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? a. "When I injected heroin, I was exposed to HIV." b. "I don't understand how the antiretroviral drugs work." c. "I remember to take my antiretroviral drugs almost every day." d. "My sex drive is weaker than it used to be since I started taking my antiretroviral medications."
C
what are the nursing implications for NNRTIs (non-nucleoside reverse transcriptase inhibitors)?
-check lab values for increases in liver enzymes and decreased RBCs because the most common side effects are anemia and liver toxicity -teach patients to take these drugs at least 1 hour before or 2 hours after taking an antacid to avoid inhibiting GI absorption -instruct patients to notify the prescriber if a sore throat, fever, different types of rashes, blisters, or multiple bruises develop because these are indications of a serious adverse drug effect -do not give delavirdine or efavirenz to pregnant women because these two drugs have the potential to cause birth defects and developmental problems
what are the skin changes associated with HIV/AIDS?
-dry itchy skin -folliculitis -psoriasis -S&S of bleeding (thrombocytopenia)- bleeding in the gums, stool, or petechial rash
what are the barriers to adherence of medication regimen?
-expensive drugs (social services can help) -food restrictions and other restrictions -get pharmacy involved with medication regimen to make sure nothing will negatively interfere
what should you do during a focused assessment of an HIV positive patient?
-get a history from patient -sensitive questions- provide privacy and let them know this may be uncomfortable and they do not need to answer -might want a witness -be nonjudgmental
when should you be tested for HIV?
-if you have an STI (annually) -use injection drugs (annually) -consider yourself at risk (annually) -are a women of childbearing age with identifiable risks, including: using injection drugs, engaged in sex work? had sexual partners who were infected or at risk, and had sexual contact with men from countries with high HIV prevalence (annually) -received a transfusion between 1978 and 1985 (annually) -plan to get married (annually) -are undergoing medical evaluation or treatment for symptoms that may be HIV related (annually) -are in correctional institutions such as jails and prisons (annually) -are a sex worker or have had sex with a sex worker (annually) -between the ages of 18 and 65 years (once) -as part of routine prenatal screening when you are pregnant (once)
what is an opportunistic infection?
-infections caused by organisms that are present as part of the body's microbiome and usually are kept in check by normal immunity -UAP needs to understand that opportunistic infections are not harmful to them
what is thrush (candidiasis)?
-mouth pain, difficulty swallowing -AIDS wasting syndrome may contribute to this -treatment is Diflucan, ice chips and antiemetics as needed for this
what is the drug therapy for HIV/AIDS-related pain?
-multimodal approach -antiepileptics (gabapentin) can be used for nerve pain -narcotics -medicate the 30-60 min prior to any activities -give them soft foods (ice cream, yogurt, cottage cheese)
what are the psychosocial concerns for HIV/AIDS?
-patients are scared and might not want to share information with everyone -disease is incurable but can live on meds for a long time -refer them to local resources and support groups
what is pneumocystis pneumonia
-presents as dyspnea on exertion, tachypnea, persistent dry cough, low grade fever, and crackles -people get this thorough soil fungus (gardening)
What is Kaposi's sarcoma?
-purple, brown raised rash, not painful -look at lesions (assess how many, how big, location, and whether or not they are intact)
what are the nursing implications for NRTIs (nucleoside reverse transcriptase inhibitors)?
-remind patients to avoid fatty and fried foods with these drugs because they cause digestive upsets and may lead to pancreatitis when combined with NRTIs -teach patients to use precautions to prevent injury because these drugs induce peripheral neuropathy -teach patients taking abacavir to report flu-like symptoms to the provider immediately because these symptoms may indicate a hypersensitivity reaction that requires discontinuing the drug -instruct patients to avoid or severely limit alcoholic beverages to reduce the risk for liver damage while on these drugs -do not give abacavir to a patient who tests positive for the HLA-B 5701 tissue type because fatal allergic responses are likely
who do you need to report HIV patients to?
-the health department (they will report it to the CDC -make sure the infection disease nurse knows about this patient
what are the 3 types of opportunistic infections for HIV/AIDS?
-toxoplasmosis -pneumocystis pneumonia -cryptosporidiosis
what increases your risk of getting HIV/AIDS?
-unsafe sex (not using a mechanical barrier) -STIs -not following medications regimen (need to find out why patient is not following regimen) -stress -poor nutrition
A client diagnosed with acquired immunodeficiency syndrome (AIDS) has a problem with nutrition resulting in a weight loss. The nurse has instructed the client regarding methods of increasing weight for health maintenance. The nurse determines that there is a need for further instruction if the client states the need to implement which measure? 1. Eat low-calorie snacks between meals. 2. Eat small, frequent meals throughout the day. 3. Consume nutrient-dense foods and beverages. 4. Keep easy-to-prepare foods available in the home.
1
The nurse is caring for a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which sign/symptom indicates the presence of an opportunistic respiratory infection? 1. Nausea and vomiting 2. Fever and exertional dyspnea 3. An arterial blood gas pH of 7.40 4. A respiratory rate of 20 breaths per minute
2
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? a. "I need to know my HIV status, so I must get tested before caring for any clients." b. "Putting on a gown and gloves will cover up the itchy sores on my elbows." c. "Washing my hands and putting on a gown and gloves is what I must do before starting care." d. "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."
C
how long does HIV seroconversion take?
3 weeks (21 days)
Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? a. The dietary worker hands the disposable meal trays to the LPN assigned to the client. b. The social worker encourages the client to verbalize about stressors at home. c. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. d. The health care provider orders vital signs, including temperature, every 8 hours.
A
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing interventions would be helpful in managing this symptom? Select all that apply. a. Keep liquids at the bedside. b. Place a towel over the pillowcase. c. Make sure the pillow has a plastic cover. d. Keep a change of bed linens nearby in case they are needed. e. Administer an antipyretic after the client has a spike in temperature.
A, B, C, D
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. a. Change the decorations in the home according to the season. b. Put the bed close to the window. c. Write out detailed instructions, and have the client read them over before performing a task. d. Ask the client what time he or she prefers to shower or bathe. e. Mark off the days of the calendar, leaving open the current date.
A, B, D, E
Which factors are possible transmission routes for human immune deficiency virus (HIV)? Select all that apply. a. Breast-feeding b. Anal intercourse c. Mosquito bites d. Toileting facilities e. Oral sex
A, B, E
A 30-year-old man with HIV is admitted to the acute care unit. Which assessment findings does the nurse recognize that may indicate that the patient currently has AIDS? (Select all that apply.) A. Kaposi's sarcoma B. HIV-positive status C. Wasting syndrome D. Esophageal candidiasis E. Persistent generalized lymphadenopathy
A, C, D
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. a. "I am 78 years old, and I was treated and cured of syphilis many years ago." b. "In 1986, I received a transfusion of platelets." c. "Seven years ago, I was released from a penitentiary." d. "I used to smoke marijuana 30 years ago, but I have not done any drugs since that time." e. "At 68, I am going to get married for the fourth time."
A, C, E
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? a. Therapeutic highly active antiretroviral therapy (HAART) level b. Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA), Western blot c. Positive Papanicolaou (Pap) test d. Improved CD4+ T-cell count and reduced viral load
D
As the nurse is talking to the patient, the patient comments that he doesn't know why he must live with such a horrible disease, and states that he knows he will die soon. What is the appropriate nursing response?
The nurse should provide therapeutic communication and active listening. The patient should be encouraged to openly express his feelings about the disease. If the patient states he has thought about taking his own life, it is the responsibility of the nurse to notify the patient's health care provider.
A client diagnosed with human immune deficiency virus is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). 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? a. "This will not make any difference in the viral load." b. "Blood concentrations will be decreased, which will lead to increased viral replication." c. "If only one dose of medication is missed, this will not make a difference." d. "This will cause an increase in opportunistic infections."
B
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? a. Collaborate with the client to select foods that are high in calories. b. Provide oral care to the client before meals to enhance appetite. c. Assess the perianal area every 8 hours for signs of skin breakdown. d. Discuss the need to avoid foods that are spicy or irritating.
B
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? a. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?" b. "Is there somewhere private in the home where we can go and talk?" c. "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." d. "It is your duty to protect your family members from getting AIDS."
B
The nurse is assigned to care for four clients. Which client does the nurse assess first? a. Client with human immune deficiency virus (HIV) and Kaposi's sarcoma who has increased swelling of a sarcoma lesion on the right arm b. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature c. Client who has been admitted to receive a monthly dose of serum immune globulin to treat Bruton's agammaglobulinemia d. Client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count
B
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? a. "Condoms should be used when lesions are present on the penis." b. "Always position the condom with a space at the tip of an erect penis." c. "Make sure it fits loosely to allow for penile erection." d. "Use adequate lubrication, such as petroleum jelly."
B
Which factor relates most directly to a diagnosis of primary immune deficiency? a. History of viral infection b. Full-term infant surfactant deficiency c. Contact with anthrax toxin d. Corticosteroid therapy
B
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? a. "I told family members they need to wash their hands when they enter and leave the room." b. "The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client." c. "Yes, I understand the reasons why I have to wear gloves when I bathe the client." d. "The client's spouse told me she got HIV from a blood transfusion."
B
which part of the HIV infection process is disrupted by the antiretroviral drug class of entry inhibitors? a. activating the viral enzyme "integrase" within the infected host's cells b. binding the virus to the CD4+ receptor and either of the 2 co-receptors c. clipping the newly generated viral proteins into smaller functional pieces d. fusing the newly generated viral proteins into smaller functional pieces
B
A patient with AIDS is having difficulty maintaining body weight. Which nursing interventions are most appropriate for this patient? (Select all that apply.) A. Encourage the patient to drink at least 1 L of fluid per day. B. Collaborate with the dietician. C. Provide foods that are high in calories. D. Encourage low fat food choices. E. Provide three large meals a day. F. Ensure regular mouth care.
B, C, D, F
with which activities does the nurse teach UAPs and nursing students to care for a client who is HIV positive to wear gloves to prevent disease transmission? select all that apply. a. applying lotion during a back rub b. brushing the client's teeth c. emptying a Foley catheter reservoir d. feeding the client e. filing the client's fingernails f. providing perineal care
B, C, F
A patient is fearful that he has been infected with HIV. The nurse recognizes which as the first symptom associated with possible HIV infection? A. Lymphocytopenia B. Opportunistic infection C. Fever, night sweats, muscle aches D. Reduced numbers of CD4+ T-cells
C
In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority? a. Loss of social contact related to misunderstanding of transmission of acquired secondary immune deficiency and the social stigma b. Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency c. Potential for infection transmission related to recurring opportunistic infections d. High risk for inadequate nutrition related to acquired secondary immune deficiency and Candida albicans
C
The patient is very weak. During this admission he has experienced anorexia, painful swallowing, severe diarrhea, and occasional vomiting. Frequent mouth care is to be delegated to the unlicensed assistive personnel (UAP). What instructions should the nurse give the UAP?
Instruct the UAP to offer the patient rinses with sodium bicarbonate and normal saline every 2 hours. Tell the UAP to use a soft toothbrush and to remind the patient of the need to drink plenty of fluids. Also remind the UAP to report any mouth pain because analgesics or viscous lidocaine may need to be administered.
After 8 days, the patient is being discharged home, where he lives with his mother and father. The nurse is completing discharge instructions for him and his family. What infection control teaching should the nurse provide to the patient and family?
When the patient is discharged, one of the most important things for him or her to remember is Standard Precautions and good handwashing. When at home, the patient and family should have a good understanding that body fluids—including feces, vomitus, urine, blood, or any other body fluid—should be cleaned away with soap and water, and the area disinfected with a 1:10 bleach solution for at least 5 minutes. If bed linens or clothes become soiled, they should be washed in hot water with one cup of bleach added per load of laundry. Dispose of needles and other "sharps" in a labeled puncture-proof container to avoid needle stick injuries.
what are the gender health considerations for HIV/AIDS?
about 25% of newly diagnosed cases are women. In less affluent countries 50% of cases occur in women. The largest risk factor is sexual exposure. Women with HIV disease have a poorer outcome, with shorter mean survival time than that of men. This outcome may be the result of late diagnosis and social or economic factors that reduce access to medical care. Encourage all women to monitor their HIV status.
what information are you allowed to share with friends and family members regarding HIV/AIDS patients?
ask the patient what information you are allowed to give and who they would like you to give it to
at what stage of HIV/AIDS can the patient transmit the virus?
at any stage of the disease
what are the kidney problems associated with HIV/AIDS?
can have HIV associated nephropathy (range of symptoms from acute kidney injury to chronic kidney disease)
what is AIDS wasting syndrome?
diarrhea, malabsorption, anorexia, oral and esophageal lesions are contributing factors for weight loss and emaciated appearance (monitor for weight gain- one of best indicators)
True or False: Genetic testing has no benefit in the treatment plan of a patient with HIV.
false
who should use HIV pre-exposure prophylaxis?
those at high risk for HIV
who is at highest risk for HIV/AIDS?
those having anal intercourse
true or false: HIV progression to AIDS depends on how the infection was acquired.
true (someone will develop AIDS more quickly if they have been exposed to HIV infected blood, rather than sexual intercourse with one HIV infected person)
how do you get a blood sample from a patient if you have been exposed to bodily fluids and are worried about what diseases/illnesses you have been exposed to?
you need to get the patient's consent to get a blood sample; if patient does not consent to this, treat the bodily fluids as contaminated and assume you have been exposed
