Chapter 19 - Care of Patients with Problems of HIV Disease

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Chapter 19 - Care of Patients with Problems of HIV Disease
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1

The nurse is assigned to care for four clients. Which client does the nurse assess first?

  1. Client with human immune deficiency virus (HIV) and Kaposi’s sarcoma who has increased swelling of a sarcoma lesion on the right arm
  2. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature
  3. Client who has been admitted to receive a monthly dose of serum immune globulin to treat Bruton’s agammaglobulinemia
  4. Client who has been receiving radiation to the abdomen and has a decreased total lymphocyte count

B. Client with a history of liver transplantation who is currently taking cyclosporine (Sandimmune) and has an elevated temperature

2

A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse?

  1. “With this treatment, I probably cannot spread this virus to others.”
  2. “This treatment does not kill the virus.”
  3. “This medication prevents the virus from replicating in my body.”
  4. “Research has shown the effectiveness of this therapy if I do not forget to take any doses.”

A. “With this treatment, I probably cannot spread this virus to others.”

3

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?

  1. “Have you had sex with men or women or both?”
  2. “I hope you use condoms to protect your partners.”
  3. “You must tell me all of your partners’ names, so I can let them know about possibly having AIDS.”
  4. “You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know.”

A. “Have you had sex with men or women or both?”

4

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?

  1. Clean toothbrushes once a week.
  2. Bathe daily using an antimicrobial soap.
  3. Eat salad at least once a day.
  4. Wash dishes in cool water.

B. Bathe daily using an antimicrobial soap.

5

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.

  1. Change the decorations in the home according to the season.
  2. Put the bed close to the window.
  3. Write out detailed instructions, and have the client read them over before performing a task.
  4. Ask the client what time he or she prefers to shower or bathe.
  5. Mark off the days of the calendar, leaving open the current date.

A. Change the decorations in the home according to the season.

B. Put the bed close to the window.

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.

6

In planning care for a client with an acquired secondary immune deficiency with Candida albicans, which problem has the highest priority?

  1. Loss of social contact related to misunderstanding of transmission of acquired secondary immune deficiency and the social stigma
  2. Mouth sores related to Candida albicans secondary to acquired secondary immune deficiency
  3. Potential for infection transmission related to recurring opportunistic infections
  4. High risk for inadequate nutrition related to acquired secondary immune deficiency and Candida albicans

C. Potential for infection transmission related to recurring opportunistic infections

7

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?

  1. “When I injected heroin, I was exposed to HIV.”
  2. “I don’t understand how the antiretroviral drugs work.”
  3. “I remember to take my antiretroviral drugs almost every day.”
  4. “My sex drive is weaker than it used to be since I started taking my antiretroviral medications.”

C. “I remember to take my antiretroviral drugs almost every day.”

8

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?

  1. “I need to know my HIV status, so I must get tested before caring for any clients.”
  2. “Putting on a gown and gloves will cover up the itchy sores on my elbows.”
  3. “Washing my hands and putting on a gown and gloves is what I must do before starting care.”
  4. “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. “Washing my hands and putting on a gown and gloves is what I must do before starting care.”

9

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?

  1. Collaborate with the client to select foods that are high in calories.
  2. Provide oral care to the client before meals to enhance appetite.
  3. Assess the perianal area every 8 hours for signs of skin breakdown.
  4. Discuss the need to avoid foods that are spicy or irritating.

B. Provide oral care to the client before meals to enhance appetite.

10

Which factor relates most directly to a diagnosis of primary immune deficiency?

  1. History of viral infection
  2. Full-term infant surfactant deficiency
  3. Contact with anthrax toxin
  4. Corticosteroid therapy

B. Full-term infant surfactant deficiency

11

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?

  1. “Do you think that I could post a sign on your bedroom door for everyone about the need to wash their hands?”
  2. “Is there somewhere private in the home where we can go and talk?”
  3. “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.”
  4. “It is your duty to protect your family members from getting AIDS.”

B. “Is there somewhere private in the home where we can go and talk?”

12

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?

  1. “I told family members they need to wash their hands when they enter and leave the room.”
  2. “The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client.”
  3. “Yes, I understand the reasons why I have to wear gloves when I bathe the client.”
  4. “The client’s spouse told me she got HIV from a blood transfusion.”

B. “The other health care worker and I were out in the hallway discussing our concern about getting HIV from our client.”

13

Which factors are possible transmission routes for human immune deficiency virus (HIV)? Select all that apply.

  1. Breast-feeding
  2. Anal intercourse
  3. Mosquito bites
  4. Toileting facilities
  5. Oral sex

A. Breast-feeding

B. Anal intercourse

E. Oral sex

14

The nurse is providing care to a client with impaired oxygenation related to anemia. Which nursing intervention has the highest priority?

  1. Administer antibiotics as prescribed.
  2. Transfuse ordered packed red blood cells.
  3. Teach pursed-lip breathing.
  4. Encourage increased fluid intake.

B. Transfuse ordered packed red blood cells.

15

Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)?

  1. The dietary worker hands the disposable meal trays to the LPN assigned to the client.
  2. The social worker encourages the client to verbalize about stressors at home.
  3. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client’s room.
  4. The health care provider orders vital signs, including temperature, every 8 hours.

A. The dietary worker hands the disposable meal trays to the LPN assigned to the client.

16

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?

  1. Obtain a 12-lead electrocardiogram (ECG).
  2. Call for a portable chest x-ray.
  3. Obtain blood cultures from two sites.
  4. Give cefazolin (Kefzol) 500 mg IV.

C. Obtain blood cultures from two sites.

17

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?

  1. Therapeutic highly active antiretroviral therapy (HAART) level
  2. Positive human immune deficiency virus (HIV), enzyme-linked immunosorbent assay (ELISA),
  3. Western blot Positive Papanicolaou (Pap) test
  4. Improved CD4+ T-cell count and reduced viral load

D. Improved CD4+ T-cell count and reduced viral load

18

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.

  1. “I am 78 years old, and I was treated and cured of syphilis many years ago.”
  2. “In 1986, I received a transfusion of platelets.”
  3. “Seven years ago, I was released from a penitentiary.”
  4. “I used to smoke marijuana 30 years ago, but I have not done any drugs since that time.”
  5. “At 68, I am going to get married for the fourth time.”

A. “I am 78 years old, and I was treated and cured of syphilis many years ago.”

C. “Seven years ago, I was released from a penitentiary.”

E. “At 68, I am going to get married for the fourth time.”

19

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?

  1. “Condoms should be used when lesions are present on the penis.”
  2. “Always position the condom with a space at the tip of an erect penis.”
  3. “Make sure it fits loosely to allow for penile erection.”
  4. “Use adequate lubrication, such as petroleum jelly.”

B. “Always position the condom with a space at the tip of an erect penis.”

20

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?

  1. Fluconazole (Diflucan)
  2. Trimethoprim/sulfamethoxazole (Bactrim)
  3. Rifampin (Rifadin)
  4. Acyclovir (Zovirax)

A. Fluconazole (Diflucan)

21

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?

  1. “This will not make any difference in the viral load.”
  2. “Blood concentrations will be decreased, which will lead to increased viral replication.”
  3. “If only one dose of medication is missed, this will not make a difference.”
  4. “This will cause an increase in opportunistic infections.”

B. “Blood concentrations will be decreased, which will lead to increased viral replication.”