Question 1

Which action by the nurse is most effective to prevent becoming exposed to the human immune deficiency virus (HIV)?

Accepted Answer

The best prevention for health care providers is the consistent use of Standard Precautions with all clients,as recommended by the Centers for Disease Control and Prevention (CDC).Contact Precautions are not indicated unless the client has an infection such as Clostridium difficile or MRSA (methicillin-resistant Staphylococcus aureus).

Question 2

A client with AIDS has been admitted with fever,night sweats,and weight loss of 6 pounds in 2 weeks.The client's purified protein derivative (PPD)test,placed 3 days ago in the clinic,is negative.Which action by the nurse is most appropriate?

Accepted Answer

The client's symptoms are indicative of tuberculosis (TB).With AIDS,the client's CD4+ T-cell count is so low that the client cannot mount an immune response to the PPD; thus it appears negative.The client needs to be placed in Airborne Precautions until other diagnostic tests rule out TB.The other interventions are appropriate,but they do not take priority over infection control principles.

Question 3

The nurse is caring for a young woman at the primary health care clinic.Which assessment finding leads the nurse to question the client about risk factors for HIV?

Accepted Answer

Persistent or recurrent vaginal candidiasis may be the first symptom of HIV in women.Decreased immune function allows overgrowth of this fungus.Infertility,heavy periods,and cramping are not generally indicative of HIV.

Question 4

The nurse is teaching a client who has AIDS how to avoid infection at home.Which statement indicates that additional teaching is needed?

Accepted Answer

The client should avoid eating raw fruits,vegetables,and salads because of the risk of infection.Hands should be washed whenever returning home,and immune compromised clients should not share toothbrushes or toothpaste.Toothbrushes should be run through the dishwasher nightly.

Question 5

The nurse is teaching a postmenopausal client about the risk of acquiring HIV infection.The client states,"I'm an old woman! I cannot possibly get HIV." What is the nurse's best response?

Accepted Answer

Women are the fastest growing group with HIV infection and AIDS.Infection with HIV can occur at any age,and postmenopausal women experience thinning of vaginal tissue along with an age-related (not hormonal)decline in immune function.This places the older woman at higher risk of acquiring HIV infection.The frequency of sexual activity is not as relevant as the sexual activities the person practices.

Question 6

The nurse is teaching a client how to prevent transmitting HIV to his sexual partner.Which statement by the client indicates that additional teaching is needed?

Accepted Answer

Condoms should be stored in a cool,dry place.Wallets are not recommended because body heat can weaken the latex in the condom.The condom should stay on the penis until it is completely withdrawn.Condoms should be used only once and then discarded.Oil-based lubricants can weaken latex,possibly causing tearing or leakage,so only water-based lubricants are recommended.

Question 7

The nurse is caring for a newly diagnosed HIV-positive client who will be taking enfuvirtide (Fuzeon).Which precaution is important for the nurse to communicate to this client?

Accepted Answer

Fuzeon is available only as a subcutaneous injection and can cause injection site reactions and nodules.The client should be taught the subcutaneous technique,including rotation of sites.The client should not stop taking this medication for fever,it can be given without regard to food,and the drug will not make the client sleepy or drowsy,so caution with driving or operating machinery is not needed.

Question 8

A client who is positive for HIV presents with confusion,fever,headache,blurred vision,nausea,and vomiting.What does the nurse do first?

Accepted Answer

The client's symptoms are associated with cryptococcal meningitis,so the nurse should first ask the client to place the chin on his or her chest.The presence of nuchal rigidity (pain when flexing the chin to the chest)helps confirm the diagnosis.An IV line may be started after the neurologic assessment is completed.

Question 9

The nurse is caring for a client with AIDS who has just been diagnosed with cryptococcal meningitis.Which is the best nursing intervention for this client?

Accepted Answer

Cryptococcosis is a debilitating form of meningitis that can cause seizures,so seizure precautions should be initiated.Respiratory isolation is not indicated.Dysphagia is not seen with cryptococcal meningitis,so thickened liquids are not indicated.Pentam is given for Pneumocystis jiroveci pneumonia (PJP).

Question 10

The nurse is working with a client at a public health clinic.The client says to the nurse,"The doctor said that my CD4+ count is 450.Is that good?" What is the nurse's best response?

Accepted Answer

A CD4+ T-cell count of 450 cells/mm³ of blood is low,and the client is at increased risk for developing an infection.Normal CD4+ counts range from 800 to 1000 cells/mm³.To be diagnosed with AIDS,a client must have a CD4+ T-cell count of <200 cells/mm³ (or a CD4+ T-cell percentage of <4%)and/or an opportunistic infection.

Question 11

An HIV-positive client verbalizes concerns about the high cost of antiretroviral medications.What is the nurse's best response?

Accepted Answer

This response demonstrates the nurse's role as client advocate by identifying resources to help meet the client's needs.The nurse should not belittle the client's concerns by telling the client to be glad the medications are working,or that they are less expensive than previously.

Question 12

A client has selective immune globulin A (IgA)deficiency.The provider orders an infusion of immune globulin (IVIG).Which action by the nurse is best?

Accepted Answer

Clients with selective IgA deficiency are not treated with IVIG because it contains very little IgA,and because the risk of allergic reactions is high.The nurse should contact the provider to clarify what medications the client will be taking.

Question 13

The nurse has been exposed to HIV through splashing of urine from a client who is HIV positive with a low viral load.The urine came into contact with the nurse's face.Which drug regimen does the nurse prepare to initiate?

Accepted Answer

The Centers for Disease Control and Prevention have developed guidelines for postexposure prophylaxis (PEP).This nurse's exposure requires basic PEP with two drugs for 28 days.

Question 14

The nurse is teaching a seminar about preventing the spread of HIV.Which statement by a student indicates that additional teaching is required?

Accepted Answer

HIV may be transmitted via oral sex when mucous membranes or nonintact skin comes in contact with infected body fluids (semen or vaginal secretions)or blood.Women who are HIV positive may get pregnant,and showering after intercourse will not reduce the risk of HIV transmission.HAART will lower viral loads,but the client will still be able to transmit the HIV virus to others.

Question 15

The nurse is working with a client who has AIDS-related dementia and will soon be discharged to the care of family members.What teaching topic is best for the nurse to include in the discharge plan?

Accepted Answer

Having a clock and a calendar easily visible will help the client keep track of the date and time and will assist with reorientation.Banning smoking,removing locks,and feeding the client will not facilitate reorientation when the client is confused.

Question 16

The nurse is seeing clients at a drop-in primary health clinic.Which client does the nurse teach about the risks of acquiring HIV?

Accepted Answer

All sexually active people should know their HIV status,and all people need to have education on their risk of acquiring HIV infection.Anyone who engages in sexual activity has some risk.

Question 17

A client who is receiving highly active antiretroviral therapy (HAART)tells the nurse,"The doctor said that my viral load is reduced.What does this mean?" What is the nurse's best response?

Accepted Answer

The fact that the amount of virus is reduced means that the HAART regimen is working well to suppress viral replication.The risk of becoming infected by an HIV-positive person is always present.The reduced viral load is not related to an opportunistic infection or to resistance to medication.

Question 18

A client with HIV who is taking highly active antiretroviral therapy (HAART)medications is in radiology waiting for a chest x-ray when medications are due.What action by the nurse is best?

Accepted Answer

HAART medications must be given on time and in the correct dose when an HIV client is in the hospital.Missing or delaying even a few doses can lead to drug resistance.The best option would be for the nurse to administer the medications in radiology as the client continues to wait for the x-ray.Calling the radiology department might give the nurse information but does not ensure that the client receives the medication on time.Bringing the client back to the nursing unit might delay the x-ray.

Question 19

An HIV-positive client is taking lopinavir/ritonavir (Kaletra)and reports nausea,abdominal pain,and diarrhea.What orders does the nurse anticipate?

Accepted Answer

Kaletra can cause liver complications,and clients taking it should have liver function studies.The client's symptoms could indicate a liver problem.Renal function and blood glucose are not affected by Kaletra.The client may have an albumin and a prealbumin drawn if he or she has lost a great deal of weight and malnutrition is suspected,but the more common diagnostic test for a client taking Kaletra would be liver function studies.

Question 20

The nurse is caring for a young client who has acquired immune deficiency syndrome (AIDS)and a very low CD4+ cell count.The nurse is teaching the client how to avoid infection at home.Which statement by the client indicates that additional teaching is needed?

Accepted Answer

Immune compromised clients should avoid having reptiles or turtles as pets and should avoid changing cat litter to help prevent opportunistic infections.Drinking juice that has been at room temperature for longer than 1 hour can lead to opportunistic infection and should be avoided.Clients should clean their toothbrushes daily by running them in the dishwasher or rinsing them in liquid laundry bleach.

Quiz 21: Care of Clients With Hiv Disease and Other Immune Deficiencies

Which action by the nurse is most effective to prevent becoming exposed to the human immune deficiency virus (HIV) ?

A client with AIDS has been admitted with fever,night sweats,and weight loss of 6 pounds in 2 weeks.The client's purified protein derivative (PPD) test,placed 3 days ago in the clinic,is negative.Which action by the nurse is most appropriate?

The nurse is caring for a young woman at the primary health care clinic.Which assessment finding leads the nurse to question the client about risk factors for HIV?

The nurse is teaching a client who has AIDS how to avoid infection at home.Which statement indicates that additional teaching is needed?

The nurse is teaching a postmenopausal client about the risk of acquiring HIV infection.The client states,"I'm an old woman! I cannot possibly get HIV." What is the nurse's best response?

The nurse is teaching a client how to prevent transmitting HIV to his sexual partner.Which statement by the client indicates that additional teaching is needed?

The nurse is caring for a newly diagnosed HIV-positive client who will be taking enfuvirtide (Fuzeon) .Which precaution is important for the nurse to communicate to this client?

A client who is positive for HIV presents with confusion,fever,headache,blurred vision,nausea,and vomiting.What does the nurse do first?

The nurse is caring for a client with AIDS who has just been diagnosed with cryptococcal meningitis.Which is the best nursing intervention for this client?

The nurse is working with a client at a public health clinic.The client says to the nurse,"The doctor said that my CD4+ count is 450.Is that good?" What is the nurse's best response?

An HIV-positive client verbalizes concerns about the high cost of antiretroviral medications.What is the nurse's best response?

A client has selective immune globulin A (IgA) deficiency.The provider orders an infusion of immune globulin (IVIG) .Which action by the nurse is best?

The nurse has been exposed to HIV through splashing of urine from a client who is HIV positive with a low viral load.The urine came into contact with the nurse's face.Which drug regimen does the nurse prepare to initiate?

The nurse is teaching a seminar about preventing the spread of HIV.Which statement by a student indicates that additional teaching is required?

The nurse is working with a client who has AIDS-related dementia and will soon be discharged to the care of family members.What teaching topic is best for the nurse to include in the discharge plan?

The nurse is seeing clients at a drop-in primary health clinic.Which client does the nurse teach about the risks of acquiring HIV?

A client who is receiving highly active antiretroviral therapy (HAART) tells the nurse,"The doctor said that my viral load is reduced.What does this mean?" What is the nurse's best response?

A client with HIV who is taking highly active antiretroviral therapy (HAART) medications is in radiology waiting for a chest x-ray when medications are due.What action by the nurse is best?

An HIV-positive client is taking lopinavir/ritonavir (Kaletra) and reports nausea,abdominal pain,and diarrhea.What orders does the nurse anticipate?

The nurse is caring for a young client who has acquired immune deficiency syndrome (AIDS) and a very low CD4+ cell count.The nurse is teaching the client how to avoid infection at home.Which statement by the client indicates that additional teaching is needed?