Chapter 27: HIV Infection, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases My Nursing Test Banks

Chapter 27: HIV Infection, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases

Test Bank

MULTIPLE CHOICE

1. Which of the following sexually transmitted diseases can be prevented through immunization?

a.

Chlamydia

b.

Gonorrhea

c.

Hepatitis B

d.

Herpes

ANS: C

At the time of this writing, HBV infection can be prevented by immunization; vaccines for the remaining options are not yet available.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 503

2. Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV?

a.

They are afraid to get tested for fear results will be positive.

b.

They avoid the problem (maybe it will go away).

c.

They dont recognize their symptoms as possibly being due to HIV.

d.

It is too expensive to get an HIV test.

ANS: C

When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 503

3. A client was clearly very relieved when an HIV test came back negative. Thank goodness. Ive had sex several times without a condom, and when one of my friends said he was sick, I think I panicked. Which of the following would be most important to emphasize to the client immediately?

a.

Abstinence is the only way to be certain you are HIV-free.

b.

Sex should be restricted to one partner.

c.

The test could be wrong and the client might still have an HIV infection.

d.

The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D

The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks. All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

DIF: Cognitive Level: Apply (Application) REF: p. 503

4. A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse?

a.

A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test.

b.

A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure.

c.

A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood.

d.

A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml.

ANS: D

AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

DIF: Cognitive Level: Apply (Application) REF: p. 503

5. The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately?

a.

Herpes zoster

b.

Hepatitis B

c.

Hepatitis C

d.

Tuberculosis

ANS: D

HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

DIF: Cognitive Level: Apply (Application) REF: p. 504

6. A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching?

a.

I wouldnt sit next to someone with HIV.

b.

Having unprotected sex with someone who is infected spreads HIV.

c.

Sharing needles when shooting up drugs spreads HIV.

d.

Transfusions of blood products that are contaminated can spread HIV.

ANS: A

HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

DIF: Cognitive Level: Apply (Application) REF: p. 504

7. In the United States, which demographic group has the highest risk for HIV infection?

a.

African-American homosexual men

b.

Hispanic IV drug abusers

c.

White homosexual men

d.

White lesbians

ANS: C

The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

DIF: Cognitive Level: Remember (Knowledge) REF: pp. 504-505

8. Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the clients name, address, or contact information?

a.

Client doesnt actually ever have to be told the results of the test.

b.

Client may be engaged in illegal activities (drug use).

c.

Client plans on not paying for the test and collection agencies will not be able to harass them.

d.

Client wants to be sure care providers dont share results with their family.

ANS: B

An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 505

9. A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching?

a.

Side effects of PrEP include extreme lethargy and joint pain.

b.

PrEP has been shown to be effective in preventing transmission of the disease from sharing needles.

c.

The effectiveness of PrEP will depend on your adherence to the medication regimen.

d.

PrEP will prevent you from contracting HIV and Hepatitis B.

ANS: C

Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b).

DIF: Cognitive Level: Apply (Application) REF: p. 506

10. A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted?

a.

Gonorrhea

b.

Syphilis

c.

Herpes simplex virus 2

d.

Human papillomavirus

ANS: A

The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility.

DIF: Cognitive Level: Apply (Application) REF: pp. 507, 509

11. A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit?

a.

Chancre at the site of entry

b.

Jaundice

c.

Difficulty coordinating muscle movements

d.

Skin rash without itching

ANS: D

Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

DIF: Cognitive Level: Apply (Application) REF: p. 509

12. Which of the following best explains why chlamydia is a major focus of public health efforts?

a.

It has more serious long-term outcomes than other STDs

b.

It can cause problems in infants born to infected mothers

c.

It is not frequently seen in the United States

d.

It is so difficult and expensive to treat

ANS: B

Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 510

13. Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection?

a.

HSV-2 is a viral infection that is both chronic and incurable.

b.

HSV-2 is extremely expensive to treat.

c.

HSV-2, like HIV, is almost impossible to diagnosis in the early stages.

d.

Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A

Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 510

14. When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse?

a.

Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs.

b.

Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs.

c.

The presence of an STD in women with cervical cancer may lead to congenital defects in offspring.

d.

The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

ANS: B

The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 511

15. Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)?

a.

Solitary growth with elevated borders and a central depression

b.

Elevated growths with a cauliflower appearance

c.

Thin-walled pustules that rupture to form honey-colored crusts

d.

Vesicles that ulcerate and crust within 1 to 4 days

ANS: B

HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 510-511

16. A client who is very upset says to the nurse, But we always used a condom! How could I have genital warts? Which of the following would be the best response by the nurse?

a.

Are you positive you always used a condom?

b.

Condoms dont always work.

c.

The condom might have had a tear in the latex.

d.

Skin to skin contact to a wart may have occurred outside the area that the condom covers.

ANS: D

The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

DIF: Cognitive Level: Apply (Application) REF: p. 511

17. Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV?

a.

Everyone would assume the person infected with hepatitis B is a drug user.

b.

Having HBV would mean no further employment in health care.

c.

The fatality rate is higher and occurs sooner with HBV.

d.

There is no treatment for HBV, which can be a very serious illness.

ANS: D

Both HBV and HIV are blood-borne pathogens. Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes. However, HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity. The virus can survive for at least 1 week dried at room temperature on environmental surfaces, and therefore infection control measures are crucial in preventing transmission. There is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 512

18. A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. Wait, said the new mother. Why is my son getting two shots? Which of the following statements would be the best response by the nurse?

a.

One injection protects your son, while the other encourages his body to build up immunity.

b.

One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him.

c.

Since youve already been infected with the virus, your son needs twice as much protection.

d.

The second shot is just to make sure the first one works.

ANS: A

Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection.

DIF: Cognitive Level: Apply (Application) REF: p. 513

19. A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse?

a.

Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered.

b.

This therapy is recommended to make sure that you receive the treatment you need and the infection doesnt become resistant to the drugs.

c.

This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember.

d.

Tuberculosis medications are very expensive so this method ensures that government money doesnt get wasted on those who will not take the drugs.

ANS: B

It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 515, 519

20. A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers. Which of the following activities would be best to use when implementing tertiary prevention?

a.

Administer purified protein derivative (PPD) to contacts of those with tuberculosis.

b.

Initiate directly observed therapy (DOT) for tuberculosis treatment.

c.

Provide education about the prevention of tuberculosis to members of the migrant community.

d.

Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B

Tertiary prevention is carried out among persons already infected with the disease. In this instance DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.

DIF: Cognitive Level: Apply (Application) REF: pp. 516, 519

21. A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. Dont you know HIV children are immunosuppressed? she exclaimed. Which of the following would be the nurses best response?

a.

All children have to have these immunizations before they can attend school.

b.

Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized.

c.

Im so sorry; I forgot for a moment your child was HIV positive.

d.

The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them.

ANS: B

Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Many states do have a no shots, no school law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

DIF: Cognitive Level: Apply (Application) REF: p. 506

22. A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive?

a.

15 mm of erythema in a client with HIV infection

b.

5 mm of induration in an immigrant from a country where TB is endemic

c.

A 5-mm ruptured pustule with purulent drainage in a homeless client

d.

10 mm of swelling and increased firmness in a client recently released from a correctional facility

ANS: D

Erythema alone does not indicate a positive finding. For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10 mm induration would be a positive finding in an immigrant from a region with high TB infection. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

DIF: Cognitive Level: Apply (Application) REF: p. 515

23. A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer?

a.

I will be using tiny tines to administer the TB antigen to the skin on your arm.

b.

Notify the clinic immediately if you experience any redness or itching at the test site.

c.

The areas should be kept dry until you return; cover it with plastic wrap when bathing.

d.

You will need to return in 2 to 3 days to have any reaction interpreted.

ANS: D

The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters.

DIF: Cognitive Level: Apply (Application) REF: p. 515

MULTIPLE RESPONSE

1. In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.)

a.

The child develops allergies with sneezing.

b.

The child persists in biting behavior or is unable to control body secretions.

c.

The nurse is not comfortable with being responsible for the child.

d.

There is an outbreak of chickenpox in the school.

ANS: B, D

Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Strong disapproval by parents of well children is an opportunity to teach these persons how HIV is transmitted.

DIF: Cognitive Level: Apply (Application) REF: p. 506

2. A woman and man who have come to the health clinic begin to argue loudly. You gave me an STD! the man yells. The woman screams back, Not me. I dont have an STD! Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.)

a.

Actually, youre very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done.

b.

Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary.

c.

Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again.

d.

You may be able to get treatment from your pharmacist so you wont have to be embarrassed like this again.

ANS: A, B, C

Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STD test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person.

DIF: Cognitive Level: Apply (Application) REF: p. 510

3. The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, Im sorry to bother you when youre not feeling well, but I need to ask you a few questions. Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.)

a.

Do you know how you got this infection?

b.

Who lives with you?

c.

Where are you employed?

d.

Where do you usually eat?

ANS: B, C

The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the clients place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 512

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