Chapter 42Immunodeficiency and HIV Infection/AIDS: Nursing Management My Nursing Test Banks

Chapter 42Immunodeficiency and HIV Infection/AIDS: Nursing Management

MULTIPLE CHOICE

1.A pregnant client diagnosed with human immunodeficiency virus (HIV) is asking about her babys risk of infection. Which of the following does put the newborn at risk?

1.

Bottle-feeding

2.

Changing diapers

3.

Kissing the baby

4.

Vaginal birth

ANS: 4

Breastfeeding and vaginal birth put the newborn at risk for HIV. HIV cannot be transmitted by changing diapers (feces) or kissing the baby (saliva).

PTS:1DIF:Apply

REF: Human Immunodeficiency Virus Infection: Etiology

2.A health care provider has accidentally been stuck with a used needle. The health care provider is going to be tested for human immunodeficiency virus (HIV). Which of the following would be the testing schedule for the health care provider?

1.

Tested at 2 months, 4 months, and then at 6 months

2.

Tested immediately and then again at 2 months

3.

Tested immediately and then again at 6 months

4.

Tested in 6 months and then again in 1 year

ANS: 3

The health care provider should be tested immediately to show if any preexisting infection exists. Seroconversion usually occurs in 1 to 3 months but can take up to 6 months. Testing at 2 months is too late to discover a preexisting infection and can be too early to detect a new infection. Testing at 6 months or 1 year would not detect a preexisting infection.

PTS:1DIF:Apply

REF: Human Immunodeficiency Virus Infection: Etiology

3.Which of the following CD4+ count would be used to confirm the diagnosis of acquired immunodeficiency syndrome (AIDS)?

1.

155 cells/mcL

2.

255 cells/mcL

3.

455 cells/mcL

4.

755 cells/mcL

ANS: 1

A CD4+ count of less than 200 cells/mcL is used as a criterion to establish the diagnosis of AIDS. In cell counts less than 500 to 600 cells/mcL, antiviral therapy should be initiated. Cell counts greater than 600 cells/mcL are in the normal range.

PTS:1DIF:Analyze

REF:Human Immunodeficiency Virus Infection: Pathophysiology

4.The nurse, planning care for a client diagnosed with human immunodeficiency virus, realizes that the most common infection that occurs in clients with this health problem is:

1.

cytomegalovirus infection.

2.

Mycobacterium tuberculosis.

3.

Pneumocystis carinii pneumonia.

4.

Streptococcus pneumoniae.

ANS: 3

As the immune system becomes overpowered, opportunistic infections can occur. The most common infection is Pneumocystis carinii pneumonia. The other infections can also occur, but they occur less frequently.

PTS:1DIF:Analyze

REF: Human Immunodeficiency Virus Infection: Assessment with Clinical Manifestations

5.A client diagnosed with acquired immunodeficiency syndrome (AIDS) 6 years ago has a purple lesion located on the inner thigh. This lesion is most likely to be:

1.

AIDS-related syndrome.

2.

Burkitts lymphoma.

3.

cachexia.

4.

Kaposis sarcoma.

ANS: 4

Kaposis sarcoma presents as abnormal lesions that appear purple or blue-red in color. They can be found anywhere but are common on the feet, arms, thighs, perineal area, and face. Cachexia is tissue wasting. Burkitts lymphoma is characterized by enlarged lymph nodes. AIDS-related syndrome is a collection of symptoms and infections resulting from the specific damage to the immune system caused by the HIV virus.

PTS:1DIF:Analyze

REF: Human Immunodeficiency Virus Infection: Assessment with Clinical Manifestations

6.The nurse realizes that which of the following tests can be used to initially identify the presence of human immunodeficiency virus (HIV) antibodies in a client?

1.

Enzyme-linked immunosorbent assay (ELISA)

2.

Platelet count

3.

Red blood cell count

4.

Western blot

ANS: 1

The ELISA test detects HIV antibodies. The Western blot is used as a confirmatory test to a positive ELISA test. Red blood cell counts and platelet counts are part of standard blood studies.

PTS:1DIF:Analyze

REF:Human Immunodeficiency Virus Infection: Diagnostic Tests

7.A client diagnosed with acquired immunodeficiency syndrome (AIDS) is sitting alone crying. Which of the following is an appropriate response for the nurse to give?

1.

Everything will be okay.

2.

Let me call your doctor about your depression.

3.

Whats wrong now?

4.

Would you like to talk?

ANS: 4

Asking the client if he would like to talk allows the client an opportunity to express his feelings. The other responses give the client false reassurance or put off the client.

PTS:1DIF:Apply

REF: Human Immunodeficiency Virus Infection: Planning and Implementation

8.The nurse is instructing a client on ways to reduce the risk of exposure to the human immunodeficiency virus. Which of the following activities would present the least risk of exposure to this virus?

1.

Exposure to used needles

2.

Multiple sex partners

3.

Perinatal exposure

4.

Teeth cleaning

ANS: 4

Teeth cleaning is a procedure in a dental office that routinely sterilizes its equipment and is not considered to present an increased risk of exposure to HIV. Exposure to used needles, multiple sex partners, and perinatal exposure during pregnancy and childbirth all would increase the clients risk of exposure to the virus.

PTS:1DIF:Apply

REF:Human Immunodeficiency Virus Infection: Epidemiology

9.The nurse is teaching a small group of clients about human immunodeficiency virus (HIV) at a health clinic. Which of the following statements by a group member will need further clarification?

1.

Condoms should be used during sexual contact.

2.

Exposure can occur to a baby during pregnancy.

3.

HIV-infected mothers can breastfeed their babies.

4.

Needles should never be reused or shared.

ANS: 3

Exposure to HIV can occur while breastfeeding an infant. This is the statement that would necessitate further clarification. The other statements are correct.

PTS:1DIF:Analyze

REF:Human Immunodeficiency Virus Infection: Epidemiology

10.The nurse is caring for a client diagnosed with human immunodeficiency virus (HIV). Which of the following precautions is best in the care of the client?

1.

Gloves and an N-95 mask

2.

Gown, gloves, and mask if splashing with body fluids is likely

3.

Gown, gloves, mask, and placement into a negative-pressure room

4.

Only handwashing is needed

ANS: 2

Standard precautions should be followed when handling any body fluids and blood. An N-95 mask and a negative-pressure room are not necessary. Handwashing is always recommended, but it should be accompanied by other precautions if contact with body fluids or blood is likely.

PTS:1DIF:Apply

REF: Human Immunodeficiency Virus Infection: Planning and Implementation

11.A client receiving treatment for human immunodeficiency virus infection is demonstrating signs of resistance to the medication. Which of the following does this suggest to the nurse?

1.

The medication dosages need to be increased.

2.

The client needs to be taken off all medication.

3.

The client needs additional medication to treat side effects.

4.

The client is not adhering to the prescribed medication schedule.

ANS: 4

Resistance to medication prescribed to treat human immunodeficiency virus infection can develop if the client does not adhere to the dose schedule for each drug. Resistance to the medication does not mean the dosages need to be increased. The client should not be taken off all medication. Signs of resistance to the medication are not the same as side effects.

PTS:1DIF:Analyze

REF:Human Immunodeficiency Virus Infection: Pharmacology

12.A client diagnosed with rheumatoid arthritis receives a prescription for indomethacin. Which of the following statements by the client would indicate the need for further instruction about this medication?

1.

I have to let my doctor know if I need to start blood pressure medications.

2.

I have to make sure I get my kidneys tested as scheduled.

3.

I need to get my eyes checked regularly.

4.

This medication shouldnt upset my stomach.

ANS: 4

Indomethacin can cause nausea, dyspepsia, gastrointestinal pain, diarrhea, vomiting, constipation, and flatulence. This is the statement that would indicate the need for further instruction about this medication. The client should regularly have her eyes, kidneys, and liver checked for impairment.

PTS:1DIF:Analyze

REF: Table 42-2 Examples of Drugs Used for RA Therapy

13.The nurse is providing discharge instructions to a client diagnosed with systemic lupus erythematosus (SLE). Which of the following would not be including in these instructions?

1.

Activity will need to be decreased during an exacerbation.

2.

Body temperature should be monitored.

3.

Corticosteroid treatment must be slowly tapered off.

4.

Sunbathing decreases symptoms.

ANS: 4

Exposure to sunlight exacerbates the disease process. Body temperature should be monitored for increases and possible infection. Corticosteroid treatment cannot be abruptly stopped. Activity with rest periods should be encouraged.

PTS:1DIF:Apply

REF:Systemic Lupus Erythematosus: Planning and Implementation

14.A client is scheduled for a bone marrow transplant from cells that were donated by his identical twin. The nurse realizes that the type of transplant this client is planning would be:

1.

syngeneic.

2.

autologous.

3.

allograft.

4.

apheresis

ANS: 1

A syngeneic transplant uses bone marrow donated by an identical twin. An autologous transplant is the removal of bone marrow cells from the individual; the cells are treated and stored and then returned after the individual receives intensive chemotherapy or radiation. Allograft refers to cells and tissue obtained from the same species who has a similar type or cell compatibility. Apheresis is a procedure used to treat autoimmune disorders.

PTS: 1 DIF: Analyze REF: Graft-versus-Host Disease

MULTIPLE RESPONSE

1.The nurse is instructing a client on the modes of transmitting the human immunodeficiency virus infection. Which of the following can transmit this infection? (Select all that apply.)

1.

Blood

2.

Breast milk

3.

Emesis

4.

Saliva

5.

Semen

6.

Sweat

ANS: 1, 2, 5

HIV can be transmitted only under specific conditions that permit contact with infected body fluids. Common high-risk sources are infected blood via contaminated needlestick or sharp object, contact with infected breast milk, mucous secretions (vaginal, semen), and exposure to blood in the laboratory. HIV is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

PTS:1DIF:Apply

REF:Human Immunodeficiency Virus Infection: Epidemiology

2.A client diagnosed with human immunodeficiency virus infection is prescribed antiretroviral Group 1 medications. Which medications are included in Group 1? (Select all that apply.)

1.

Enfuvirtide (Fuzeon)

2.

Ziduvudine (AZT)

3.

Didanosine (Videx)

4.

Abacavir (Ziagen)

5.

Ritonavir (Norvir)

6.

Saquinavir (Fortovase)

ANS: 2, 3, 4

Ziduvudine (AZT), didanosine (Videx), and abacavir (Ziagen) are all Group 1 medications. Ritonavir (Norvir) and Saquinavir (Fortovase) are protease inhibitors or medications within Group 2. Enfuvirtide (Fuzeon) is a fusion inhibitor or a Group 3 medication.

PTS: 1 DIF: Analyze REF: Box 42-3 Antiretroviral Drug Classifications

3.The nurse suspects a client is experiencing rheumatoid arthritis when which of the following are assessed? (Select all that apply.)

1.

Morning stiffness lasting more than 1 hour

2.

Arthritis of three or more joint areas

3.

Arthritis of the hand joints

4.

Symmetrical arthritis

5.

Nodules over bony prominences

6.

Bruising

ANS: 1, 2, 3, 4, 5

Findings consistent with rheumatoid arthritis include morning stiffness lasting more than 1 hour, arthritis of three or more joint areas, arthritis of the hand joints, symmetrical arthritis, nodules over bony prominences, presence of serum rheumatoid factions, and radiographic changes. Bruising is not a finding consistent with rheumatoid arthritis.

PTS:1DIF:Analyze

REF: Box 42-4 The American College of Rheumatology Criteria for Diagnosis of RA

4.The nurse is planning care for a client diagnosed with rheumatoid arthritis. Which of the following should be included in this plan of care? (Select all that apply.)

1.

Muscle strengthening exercises

2.

Range-of-motion exercises

3.

Application of heat

4.

Application of cold

5.

Joint massage

6.

Yoga

ANS: 1, 2, 3, 4, 6

Interventions proven to help clients diagnosed with rheumatoid arthritis include muscle strengthening exercises, range-of-motion exercises, application of heat, application of cold, and yoga. Actual massage of the joints can aggravate the inflammation.

PTS:1DIF:Apply

REF: Rheumatoid Arthritis: Planning and Implementation

5.A client is diagnosed with progressive systemic sclerosis. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Telangiectasia

2.

Sclerodactyly

3.

Difficulty swallowing

4.

Painful cold hands and fingers

5.

Small white calcium deposits under the skin

6.

Hematuria

ANS: 1, 2, 3, 4, 5

In progressive systemic sclerosis, the skin, muscle, joints, lungs, esophagus, heart, digestive system, and kidneys are often affected in the diffuse subcutaneous form, often termed as CREST. Clinical manifestations include calcinosis, or small white calcium deposits under the skin; Raynauds syndrome, or painful cold hands and fingers; alteration in esophageal movement, or difficulty swallowing; sclerodactyly of the fingers and toes; and telangiectasia or permanent dilation of the capillaries, arterioles, and venules. Hematuria is not seen in this disorder.

PTS:1DIF:Apply

REF: Progressive Systemic Sclerosis: Assessment with Clinical Manifestations

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