Question 1

The nurse is presenting information to a community group on safer sex practices.The nurse should teach that which sexual practice is the riskiest?

Accepted Answer

Anal intercourse is the riskiest sexual practice because the fragile anal tissue can tear,creating a portal of entry for human immune deficiency virus.

Question 2

A client has a primary selective immunoglobulin A deficiency.The nurse should prepare the client for self-management by teaching what principle of medical management?

Accepted Answer

Treatment for this disorder is vigorous management of infection,not infusion of exogenous immunoglobulins.The other responses are inaccurate.

Question 3

A client has been hospitalized with an opportunistic infection secondary to acquired immune deficiency syndrome.The client's partner is listed as the emergency contact,but the client's mother insists that she should be listed instead.What action by the nurse is best?

Accepted Answer

The client should make his or her wishes known and formalize them through advance directives.The nurse should help the client by contacting someone to help with this process.Ignoring the mother or telling the client that nurses cannot be involved does not help the situation.Legal statutes vary by state; as more states recognize gay marriage,this issue will continue to evolve.

Question 4

An HIV-negative client who has an HIV-positive partner asks the nurse about receiving Truvada (emtricitabine and tenofovir).What information is most important to teach the client about this drug?

Accepted Answer

Truvada is a new drug used for pre-exposure prophylaxis and appears to reduce transmission of human immune deficiency virus (HIV)from known HIV-positive people to HIV-negative people.The drug does not reduce the need for practicing safe sex.Since the drug can lead to drug resistance if used,clients will still need HIV testing every 3 months.This drug has not been taken off the market and is not used for postexposure prophylaxis.

Question 5

A client with human immune deficiency virus is admitted to the hospital with fever,night sweats,and severe cough.Laboratory results include a CD4+ cell count of 180/mm³ and a negative tuberculosis (TB)skin test 4 days ago.What action should the nurse take first?

Accepted Answer

Since this client's CD4+ cell count is low,he or she may have anergy,or the inability to mount an immune response to the TB test.The nurse should first place the client on Airborne Precautions to prevent the spread of TB if it is present.Next the nurse notifies the provider about the low CD4+ count and requests alterative testing for TB.Droplet Precautions are not used for TB.Standard Precautions are not adequate in this case.

Question 6

A client with human immune deficiency virus infection is hospitalized for an unrelated condition,and several medications are prescribed in addition to the regimen already being used.What action by the nurse is most important?

Accepted Answer

The drug regimen for someone with HIV/AIDS is complex and consists of many medications that must be given at specific times of the day,and that have many interactions with other drugs.The nurse should consult with a pharmacist about possible interactions.Client teaching is important but does not take priority over ensuring the medications do not interfere with each other,which could lead to drug resistance or a resurgence of symptoms.

Question 7

A client is hospitalized with Pneumocystis jiroveci pneumonia.The client reports shortness of breath with activity and extreme fatigue.What intervention is best to promote comfort?

Accepted Answer

This client has two major reasons for fatigue: decreased oxygenation and systemic illness.The nurse should not do everything for the client but rather let the client do as much as possible within limits and allow for adequate rest in between.Sleeping medications may be needed but not as the first step,and only with caution.Increasing oxygen during activities may or may not be warranted,but first the nurse must try pacing the client's activity.

Question 8

A client has just been diagnosed with human immune deficiency virus (HIV).The client is distraught and does not know what to do.What intervention by the nurse is best?

Accepted Answer

This client needs the assistance of support systems.The nurse should help the client identify them and what role they can play in supporting him or her.A clergy member may or may not be welcome.Legal requirements about disclosing HIV status vary by state.Telling the family for the client is enabling,and the client may not want the family to know.

Question 9

A client with acquired immune deficiency syndrome has been hospitalized with suspected cryptosporidiosis.What physical assessment would be most consistent with this condition?

Accepted Answer

Cryptosporidiosis can cause extreme loss of fluids and electrolytes,up to 20 L/day.The nurse should assess signs of hydration/dehydration as the priority,including checking the client's mucous membranes for dryness.The nurse will perform the other assessments as part of a comprehensive assessment.

Question 10

A student nurse is learning about human immune deficiency virus (HIV)infection.Which statements about HIV infection are correct? (Select all that apply.)

Accepted Answer

In HIV,CD4+ cells begin to create new HIV particles.Antibodies the client produces are incomplete and do not function well.Macrophages also stop functioning properly.Opportunistic infections and cancer are the two leading causes of death in clients with HIV infection.People infected with HIV are infectious in all stages of the disease.

Question 11

A nurse works on a unit that has admitted its first client with acquired immune deficiency syndrome.The nurse overhears other staff members talking about the "AIDS guy" and wondering how the client contracted the disease.What action by the nurse is best?

Accepted Answer

The professional nurse should be able to confront unethical behavior assertively.The staff should not be talking about clients unless they have a need to do so for client care.Ignoring the behavior may be more comfortable,but the nurse is abdicating responsibility.The behavior may need to be reported,but not as a first step.Telling the client that others are talking about him or her does not accomplish anything.

Question 12

An HIV-positive client is admitted to the hospital with Toxoplasma gondii infection.Which action by the nurse is most appropriate?

Accepted Answer

Toxoplasma gondii infection is an opportunistic infection that poses no threat to immunocompetent health care workers.Use of Standard Precautions is sufficient to care for this client.

Question 13

A nurse is talking with a client about a negative enzyme-linked immunosorbent assay (ELISA)test for human immune deficiency virus (HIV)antibodies.The test is negative and the client states "Whew! I was really worried about that result." What action by the nurse is most important?

Accepted Answer

The ELISA test can be falsely negative if testing occurs after the client has become infected but prior to making antibodies to HIV.This period of time is known as the window period and can last up to 36 months.The nurse needs to assess the client's sexual behavior further to determine the proper response.The other actions are not the most important,but discussing safer sex practices is always appropriate.

Question 14

A client with acquired immune deficiency syndrome is hospitalized and has weeping Kaposi's sarcoma lesions.The nurse dresses them with sterile gauze.When changing these dressings,which action is most important?

Accepted Answer

All of the actions are important,but due to the infectious nature of this illness,ensuring proper disposal of soiled dressings is vital.

Question 15

A client with HIV wasting syndrome has inadequate nutrition.What assessment finding by the nurse best indicates that goals have been met for this client problem?

Accepted Answer

The weight gain is the best indicator that goals for this client problem have been met because it demonstrates that the client not only is eating well but also is able to absorb the nutrients.

Question 16

A nurse is caring for four clients who have immune disorders.After receiving the hand-off report,which client should the nurse assess first?

Accepted Answer

A client who is this immunosuppressed and who has this high of a fever is critically ill and needs to be assessed first.The client who is post immunoglobulin infusion should have had all infusion-related vital signs and assessments completed and should be checked next.The client receiving antibiotics should be seen third,and the client waiting for discharge teaching is the lowest priority.Since discharge teaching can take time,the nurse may want to delegate this task to someone else while attending to the most seriously ill client.

Question 17

The nurse is caring for a client diagnosed with human immune deficiency virus.The client's CD4+ cell count is 399/mm³.What action by the nurse is best?

Accepted Answer

This client is in the Centers for Disease Control and Prevention stage 2 case definition group.He or she remains highly infectious and should be counseled on either safer sex practices or abstinence.Abstaining from alcohol is healthy but not required.Genetic testing is not commonly done,but an alteration on the CCR5/CXCR4 co-receptors is seen in long-term nonprogressors.High-protein/iron meals are important for people who are immunosuppressed,but helping to plan them does not take priority over stopping the spread of the disease.

Question 18

The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV)from clients.Which practice is most effective?

Accepted Answer

According to The Joint Commission,the most effective preventative measure to avoid HIV exposure is consistent use of Standard Precautions.Double-gloving is not necessary.Labeling charts and armbands in this fashion is a violation of the Health Information Portability and Accountability Act (HIPAA).Wearing a mask within 3 feet of the client is part of Airborne Precautions and is not necessary with every client contact.

Question 19

A client with human immune deficiency virus (HIV)has had a sudden decline in status with a large increase in viral load.What action should the nurse take first?

Accepted Answer

Adherence to the complex drug regimen needed for HIV treatment can be daunting.Clients must take their medications on time and correctly at a minimum of 90% of the time.Since this client's viral load has increased dramatically,the nurse should first assess this factor.After this,the other assessments may or may not be needed.

Question 20

A client with HIV/AIDS asks the nurse why gabapentin (Neurontin)is part of the drug regimen when the client does not have a history of seizures.What response by the nurse is best?

Accepted Answer

Many classes of medications are used for neuropathic pain,including tricyclic antidepressants such as gabapentin.It is not being used as an antidepressant or to prevent seizures from fungal infections.If the nurse does not know the answer,he or she should find out for the client.

Quiz 19: Care of Patients with HIV Disease and Other Immune Deficiencies

The nurse is presenting information to a community group on safer sex practices.The nurse should teach that which sexual practice is the riskiest?

A client has a primary selective immunoglobulin A deficiency.The nurse should prepare the client for self-management by teaching what principle of medical management?

A client has been hospitalized with an opportunistic infection secondary to acquired immune deficiency syndrome.The client's partner is listed as the emergency contact,but the client's mother insists that she should be listed instead.What action by the nurse is best?

An HIV-negative client who has an HIV-positive partner asks the nurse about receiving Truvada (emtricitabine and tenofovir) .What information is most important to teach the client about this drug?

A client with human immune deficiency virus is admitted to the hospital with fever,night sweats,and severe cough.Laboratory results include a CD4+ cell count of 180/mm³ and a negative tuberculosis (TB) skin test 4 days ago.What action should the nurse take first?

A client with human immune deficiency virus infection is hospitalized for an unrelated condition,and several medications are prescribed in addition to the regimen already being used.What action by the nurse is most important?

A client is hospitalized with Pneumocystis jiroveci pneumonia.The client reports shortness of breath with activity and extreme fatigue.What intervention is best to promote comfort?

A client has just been diagnosed with human immune deficiency virus (HIV) .The client is distraught and does not know what to do.What intervention by the nurse is best?

A client with acquired immune deficiency syndrome has been hospitalized with suspected cryptosporidiosis.What physical assessment would be most consistent with this condition?

A student nurse is learning about human immune deficiency virus (HIV) infection.Which statements about HIV infection are correct? (Select all that apply.)

A nurse works on a unit that has admitted its first client with acquired immune deficiency syndrome.The nurse overhears other staff members talking about the "AIDS guy" and wondering how the client contracted the disease.What action by the nurse is best?

An HIV-positive client is admitted to the hospital with Toxoplasma gondii infection.Which action by the nurse is most appropriate?

A nurse is talking with a client about a negative enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV) antibodies.The test is negative and the client states "Whew! I was really worried about that result." What action by the nurse is most important?

A client with acquired immune deficiency syndrome is hospitalized and has weeping Kaposi's sarcoma lesions.The nurse dresses them with sterile gauze.When changing these dressings,which action is most important?

A client with HIV wasting syndrome has inadequate nutrition.What assessment finding by the nurse best indicates that goals have been met for this client problem?

A nurse is caring for four clients who have immune disorders.After receiving the hand-off report,which client should the nurse assess first?

The nurse is caring for a client diagnosed with human immune deficiency virus.The client's CD4+ cell count is 399/mm³.What action by the nurse is best?

The nurse providing direct client care uses specific practices to reduce the chance of acquiring infection with human immune deficiency virus (HIV) from clients.Which practice is most effective?

A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load.What action should the nurse take first?

A client with HIV/AIDS asks the nurse why gabapentin (Neurontin) is part of the drug regimen when the client does not have a history of seizures.What response by the nurse is best?