NUR 220 Exam 1 Study Questions

AST level

0-35

Normal Creatinine

0.6-1.2 mg/dL

BUN normal range

10-20 mg/dL

ALT level

10-40 U/L

serum albumin

3.5-5.5 g/dL

WBC level

4,000-11,000

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? 3 to 5 days 1 to 3 weeks 2 to 4 months 6 to 12 months

6 to 12 months

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? 3 months 3 to 5 months 6 to 12 months 13 to 18 months

6-12 months

Cryptococcal meningitis treatment

Amphotericin B with Diflucan Then Flucanazole

Immune responses

Antibody mediated/hummoral medication Cell mediatied/Tcells

Medical management of HIV: Depression

CBT Prozac Tofranil

IgE

Emotional! Hypersensitive Minute, less than 1% Protects parasitic infection On mast cells, on basophils Allergic response

Which blood test confirms the presence of antibodies to HIV? Erythrocyte sedimentation rate (ESR) p24 antigen Reverse transcriptase Enzyme immunoassay (EIA)

Enzyme immunoassay (EIA)

IgG

Gee, I remember you the second time around 75-76% circulating in all fluids crosses to fetus defends against bacteria/virus

Hepatitis B identified

HBcAG

In hepatitis AST and ALT

HIGH

TB Drugs

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse? Obtain counseling. Call the lab to draw the nurse's blood. Fill out a risk management report. Report the incident to the supervisor.

Report the incident to the supervisor.

The nurse is caring for a client who has a diagnosis of human immunodeficiency virus (HIV). Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? The use of condoms What vaccinations to have Side effects of drug therapy The action of each antiretroviral drug

Side effects of drug therapy

Stages of HIV (numbers)

Stage 1-500 cells/mEq/L or more, 29 or more CD4. Stage 2- 200-499 cells/mEq/L, CD4 14-28 Stage 3-less than 200 cell/mEq/L, CD4 less than 14

Adverse reactions to TMP SMX medication is

Steven Johnson Leukopenia Hepatitis Thrombocyctopenia Azotemia Hyperkalemia

HIV therapy ART Goal

Suppress virus and restore immune function to prevent HIV transmission. Viral load must be less than diagnosis amount

Stage 3 HIV patients should be given chemoprophylaxis which includes this medication

TMP-SMX with Prednisone for 21 days

A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? TMP-SMZ Cephalexin Azithromycin Garamycin

TMP-SMZ

Nursing considerations for Priftin

Watch out for orange red color to sweat and secretions. Use with cautions in olds and renal disease

A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? Wearing a disposable particulate respirator that fits snugly around the face Instructing the client to wear a mask at all times Wearing a gown and gloves when providing direct care Keeping the door to the client's room open to observe the client

Wearing a disposable particulate respirator that fits snugly around the face

A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform a: p24 antigen test for confirmation of diagnosis. Western blot test for confirmation of diagnosis. polymerase chain reaction test for confirmation of diagnosis. T4-cell count for confirmation of diagnosis.

Western blot test for confirmation of diagnosis.

fremitus

a palpable vibration from the spoken voice felt over the chest wall In TB, not present

Physical assessment for TB

breath sounds wheeze, crackles, diminished

IRIS (Immune Reconstitution Inflammatory Syndrome)

can occur with AT therapy when immune system is restored. S/S fever, respi, abdominal issues, opportunistic infections TX: cortisone

When reviewing an allergic reaction

check WBC and diff, esinophil will be high, neutrophil low

Drugs for allergic reaction

cromolyn- blocks histamine glucocortosteiod- heps with inflammation and pain IV Epi

Type 4 immune response

delayed reaction antigen lympocyte reaction PPD reaction for TB

Nursing considerations for ethambutol

do vision checks before starting therapy & monthly thereafter Bacteriostatic

Chemical manifestation of anaphylaxis: Neuro

headache, dizziness, paraesthesia, feeling of doom

Types of t cells

killer t cells- carry CD8 antigen, attack malignant cells, they reject organs Regulator cells including: Helper T cells- carry CD4 innitate immune response Suppressor T cells- carry CD8, stop immune response

Medical management of HIV: Kaposi sarcoma

local therapy, chemo

Hepatitis C

mild symptoms inflammation of the liver caused by the hepatitis C virus (HCV), which is transmitted by exposure to infected blood; this strain is rarely contracted sexually

HIV Manifestations include:

pancreatitis, hepatitis SOB, fever, cough, NVD Wasting

Vitamin B6 is given with TB therapy to

prevent nerve problems from isoniazid

direct combs test

should be neg (on RBCs)

Medical management of HIV: Lymphoma

stem cell trans and chemo

in hepatitis PTT

will be high

in hepatitis bilirubin

will be high

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member? "The client probably has a case of the flu and you should give acetaminophen." "The client may have cryptococcal meningitis and will need to be evaluated by the health care provider." "This is one of the side effects from antiretroviral therapy and will require changing the medication." "The client probably has pneumocystis pneumonia and will need to be evaluated by the health care provider."

"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient? "Only wear your contact lenses during the day and take them out in the evening before bed." "You should switch to wearing your glasses while taking this medication." "The physician can give you eye drops to prevent any problems." "There are no significant problems with wearing contact lenses."

"You should switch to wearing your glasses while taking this medication."

Manifestations of TB

-cough, hypoptysis -low-grade fever with night sweats -anorexia, weight loss -malaise, fatigue

Seven ART drugs

1) Nucleoside/Nucleotic Reverse Transcriptase Inhibator 2) Non-Nucleoside/Nucleotic Reverse Transcriptase Inhibator 3) Protease inhibator 4) Fusion inhibator 5) CCR5 antagonist 6) Intergrine strenal transfer inhibator 7) Post-cobistat and ritonavir to increase ART effect

Three types of hypersensitivities

1) overraction/hypersensitive 2) Incompetency- immuno defienct from aids 3) autoimmune disorder- Lupus

PTT level

60-70 seconds

Total serum protein

7-7.5 g/dL

Bilirubin level

<1.0 mg/dL

PPD test results

<4mm = neg 5-10mm = sensitive or HIV+ 10mm+ = positive

Egophony

A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound. Happens in TB

Hepatitis E

A virus spread via fecal-oral transmission (contaminated water) especially in developing countries 15-65 days IGM or IGG

IgA

Absent from blood, surface defense 15-20% circulating On all external surfaces (mucosa, tears, saliva, respi/GI tract) and in milk Most common ummunodefiency

A client with AIDS has become forgetful with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? distal sensory polyneuropathy (DSP) candidiasis AIDS dementia complex (ADC) cytomegalovirus (CMV)

AIDS dementia complex (ADC)

A client with acquired immune deficiency syndrome (AIDS) informs the nurse of difficulty eating and swallowing, and shows the nurse white patches in the mouth. What problem related to AIDS does the nurse understand the client has developed? MAC Wasting syndrome Kaposi's sarcoma Candidiasis

Candidiasis

Mycobacterium avium complex (MAC) is treated with

Clarithromycin (Biaxin) or Azithromycin (Zithromax) with Ethambutol

HIV diagnostic tests

PCR HIV blood testing, then if positive they complete the more expensive western blot test. Polymerase Chain Reaction 1) antigen/antibodies first Serological testing algorthisms (STARHS )- tells if infection is new or old 2) Antibody test (if positive, do RNA test) 3) RNA tests (NAT)- Detects HIV 4) Antibody diff

Cellular lymphocytes speciica antigens natural include

Passive from milk in baby Active in learning resistence from killing disease

Humoral antibodies for specific antigens (Artifical)

Passive: injection of antibodies Active: Immunization

Hepatitis D

Depends on hepatitis B for replication IGM or IGG 30-150 days

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? Client teaching about the cause of TB Reviewing the risk factors for TB Developing a list of people with whom the client has had contact Client teaching about the importance of TB testing

Developing a list of people with whom the client has had contact

IgD

Duh I dont know what this does On surface B cells Minute, 1% not understood

A healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection? Limit interactions with people who are not HIV infected. Limit interactions with people who are already HIV infected. Follow the same sexual precautions as someone who has been diagnosed with AIDS. Quit their job and get admitted to a hospital or a cancer treatment center.

Follow the same sexual precautions as someone who has been diagnosed with AIDS.

TB drug therapy

Give RIPE RIPE (rifampin, isoniazid, pyrazinamide, ethambutol) with b6 for 8 weeks Then give INH and rifamptin for 5-7 months Monitor liver enzymes, BUN, creatinine

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? Less than 200/mm3 Between 200 to 350/mm3 Between 350 to 499/mm3 Greater than 500/mm3

Greater than 500/mm3

A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? Distal sensory polyneuropathy (DSP) Candidiasis HIV encephalopathy Cytomegalovirus (CMV)

HIV encephalopathy

Nursing considerations for INH

Have them avoid tyramine food and alcohol

A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find? Urine specific gravity of 1.010 Hypernatremia Hypokalemia Proteinuria

Hypokalemia

Type 3

IGG or IGM like strep throat

Type 2 immune response

IGG or IGM Complement cascade systems- macrophage, eat damaged cells Antibodies formed

Hep A is identified with

IGM

antibody-mediated immunity

Immunity that results from the presence of antibodies in blood and lymph.

IgM

Macro too big to leave blood. First antibody at scene. 5-8% circulatin Present at birth

Medical management of HIV: Nutrition

Megace to help with weight gain Marinol to get rid of NV TPN as last resort

Chemical manifestation of anaphylaxis: GI

NVD, ab pain, cramping

A nurse reading a chart notes that the client had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? Negative Positive Borderline Uncertain

Negative

Hepatitis A

Oral fecal incubation: 4-6weeks Ill for 4-8 weeks low mortality manifests in flu like symptoms, fever, dark urin, liver enlargement

Common HIV diseases

Pnemocytosis Pneumonia (PCP) Mycobacterium Avium Complex (MAC) TB AIDS related lymphoma (hodgkins or non).

The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? Cytomegalovirus Legionnaire's disease Mycobacterium tuberculosis Pneumocystis pneumonia

Pneumocystis pneumonia

Three Phases of Hepatitis A

Preicteric/prodomal: weight loss, fatigue, fever, dark urine, clay stools Icteric/clinical jaundice: big liver, abdomonal pain, jaundice. Posticteric: mild flu symptoms, fever, normal liver size, healing

RAST

Radioallergosorbent blood test that measures the amount of IgE produced each time the blood is mixed with a specific allergen

Type 1 immune response

allegoric reaction w/ IGE Mast cell and basophil factors released serious reaction S/S hives, SOB, rash to anphalaxisis

Older adult considerations for TB

altered mental status, unusual behavior, fever, anorexia, weight loss

Cryptococcal Meningitis treatment side effects

anaphylaxis, kidney and hepatic impairment, altered electrolytes

Treatment for cytomegalovirus and side effects

antivirals bone marrow suppression, neutropenia, hepatitis, renal toxicity, seizures.

Kaposi sarcoma (KS) is diagnosed through skin scraping. biopsy. visual assessment. computed tomography.

biopsy

Hepatitis B

blood spread, given to baby Long incubation 1-6 months

Quantiferon TB gold

blood test alternative to PPD Perferred for BCG patients Greater specificity (fewer false positives)

Hepatitis C identified

by Serum antibody assay

Cytomegalovirus (CMV)

causes blindness

antigen antibody interaction

causes tissue damage involve immediate reaction after prior sensization includes systemic reaction 1, 2, 3

If a patient tests positive for PPD

chest xray, sputum sample, blood test Lesions in upper lung lobes

Side effects from ART include

hepatoxicity, nephrotxicity, osteopenia, high CVD, high MI, insulin resistance, lipodystrophy, loss of fat on face, lipohypertrophy

Chemical manifestation of anaphylaxis: respi

horseness, coughing, narrowed airway, wheezing, stridor, dyspena

Chemical manifestation of anaphylaxis: cardio

hypotension, dysymia, tachycardia, cardiac arrest

Hepatitis B manifestations

insidious and variable, like HAV, loss of appetite, dyspepsia, abdominal pan, generalized aching, malaise, weakness, maybe jaundice

Chemical manifestation of anaphylaxis: skin

prutis, angioedma, erythema

The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. semen urine breast milk blood vaginal secretions

semen breast milk blood vaginal secretions

indirect combs test

should be neg (circulating antibodies)

Immoncomplex assay

shows how well complement system works

cell-mediated immune response

specialized T cells destroy infected host cells

in hepatitis WBC

will be low, neutropenia

T spot TB test

will say if TB exists and will not interfer BCG vaccine