N230 Ch 15 NCLEX practice
When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? - "I will need to isolate any tissues I use so as not to infect my family." - "I will notify all of my sexual partners so they can get tested for HIV." - "Unprotected sexual contact is the most common mode of transmission." -"I do not need to worry about spreading this virus to others by sweating at the gym."
"I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.
A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? -"The baby will probably be infected with HIV." - "Only an abortion will keep your baby from having HIV." -"Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." -"The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
"Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.
The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? -A new onset of polycythemia -Presence of mononucleosis-like symptoms -A sharp decrease in the patient's CD4+ count -A sudden increase in the patient's WBC count
A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.
The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? - All patients regardless of diagnosis - Pediatric and gerontologic patients - Patients who are immunocompromised - Patients with a history of infectious diseases
All patients regardless of diagnosis Standard precautions are designed for all care of all patients in hospitals and health care facilities.
The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? -Assessment of lung sounds -Assessment of sexual behavior -Assessment of drug and syringe use -Assessment of exposure to an ill person
Assessment of sexual behavior Assessment of drug and syringe use With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).
The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? - Presence of HIV antibodies - CD4+ T cell count below 200/µL - Presence of oral hairy leukoplakia - White blood cell count below 5000/µL
CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.
A hospital has seen a recent increase in the incidence of hospital care-associated infections (HAIs). Which measure should be prioritized in the response to this trend? - Use of gloves during patient contact -Frequent and thorough hand washing - Prophylactic, broad-spectrum antibiotics - Fitting and appropriate use of N95 masks
Frequent and thorough hand washing Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient.
The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? -Personal protective equipment -Combination antiretroviral therapy -Counseling to report blood exposures -A negative evaluation by the manager
Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.
The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? - Droplet precautions -Contact precautions -Airborne precautions -Standard precautions
Contact precautions Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., TB, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.
The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? -Delaying disease progression -Preventing disease transmission - Helping to cure the HIV infection -Enabling an increase in self-care activities
Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.
The mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? -There is currently no need for those older vaccines. -There is a reemergence of some of the infections, such as pertussis. -There is no longer an immunization available for some of those diseases. -The only way to protect your child is to have the federally required vaccines.
There is a reemergence of some of the infections, such as pertussis. Teaching the mother that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.
An 82-year-old woman is brought to her physician by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? -Urinalysis -Sputum culture -Red blood cell count -White blood cell count
Urinalysis The developments of urinary tract infections commonly contribute to atypical manifestations such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection.
The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? -Take fluconazole (Diflucan). -Take amphotericin B (Fungizone). -Use condoms for risk-reducing sexual relations. -Take emtricitabine and tenofovir (Truvada) regularly. -Have regular HIV testing for herself and her husband.
Use condoms for risk-reducing sexual relations. Take emtricitabine and tenofovir (Truvada) regularly. Have regular HIV testing for herself and her husband. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection.
A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? -Together they will cure HIV. -Viral replication will be inhibited. -They will decrease CD4+ T cell counts. -It will prevent interaction with other drugs.
Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.
What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection (select all that apply)? -Wash hands frequently. -Take antibiotics as prescribed. -Take the antibiotic until it is gone. -Take antibiotics to prevent illnesses like colds. -Save leftover antibiotics to take if needed later.
Wash hands frequently. Correct Take antibiotics as prescribed. Take the antibiotic until it is gone. To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, finish the antibiotic, do not request antibiotics for colds or flu, do not save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider.
