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Chapter 36: Management of Patients With Immune Deficiency Disorders Since the emergence of HIV/AIDS, there have been significant changes in epidemioloMembers of what group currently have the greatest risk of contracting HIV? gic trends. A) Gay, bisexual, and other men who have sex with men B) Recrea...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter36:ManagementofPatientsWithImmuneDeficiencyDisorders  1.

SincetheemergenceofHIV/AIDS,therehavebeensignificantchangesinepidemiologictrends. MembersofwhatgroupcurrentlyhavethegreatestriskofcontractingHIV?

A)

Gay,bisexual,andothermenwhohavesexwithmen

B)

Recreationaldrugusers

C)

Bloodtransfusionrecipients

D)

Healthcareproviders

Ans:

A Feedback: Gay,bisexual,andothermenwhohavesexwithmenremainthepopulationmostaffectedbyHIVand accountfor2%ofthepopulationbut61%ofthenewinfections.Thisexceedstheincidenceamongdrug users,healthcareworkers,andtransfusionrecipients.

2.

AclinicnurseiscaringforapatientadmittedwithAIDS.Thenursehasassessedthatthepatientis experiencingaprogressivedeclineincognitive,behavioral,andmotorfunctions.Thenurserecognizes thatthesesymptomsaremostlikelyrelatedtotheonsetofwhatcomplication?

A)

HIVencephalopathy

B)

B-celllymphoma

C)

Kaposissarcoma

D)

Wastingsyndrome

Ans:

A Feedback: HIVencephalopathyisaclinicalsyndromecharacterizedbyaprogressivedeclineincognitive, behavioral,andmotorfunctions.Theotherlistedcomplicationsdonotnormallyhavecognitiveand behavioralmanifestations.

3.

Anurseisassessinga28-year-oldmanwithHIVwhohasbeenadmittedwithpneumonia.Inassessing thepatient,whichofthefollowingobservationstakesimmediatepriority?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Oraltemperatureof100F

B)

Tachypneaandrestlessness

C)

Frequentloosestools

D)

Weightlossof1poundsinceyesterday

Ans:

B

694

Feedback: Inprioritizingcare,thepneumoniawouldbeassessedfirstbythenurse.Tachypneaandrestlessnessare symptomsofalteredrespiratorystatusandneedimmediatepriority.Weightlossof1poundisprobably fluidrelated;frequentloosestoolswouldnottakeshort-termprecedenceoveratemperatureor tachypneaandrestlessness.Anoraltemperatureof100Fisnotconsideredafeverandwouldnotbethe firstissueaddressed. 4.

ApatienthascomeintothefreeclinicaskingtobetestedforHIVinfection.Thepatientasksthenurse howthetestworks.ThenurserespondsthatifthetestingshowsthatantibodiestotheAIDSvirusare presentintheblood,thisindicateswhat?

A)

ThepatientisimmunetoHIV.

B)

Thepatientsimmunesystemisintact.

C)

ThepatienthasAIDS-relatedcomplications.

D)

ThepatienthasbeeninfectedwithHIV.

Ans:

D Feedback: PositivetestresultsindicatethatantibodiestotheAIDSvirusarepresentintheblood.Thepresenceof antibodiesdoesnotimplyanintactimmunesystemorspecificimmunitytoHIV.Thisfindingdoesnot indicatethepresenceofAIDS-relatedcomplications.

5.

Ahospitalpatientisimmunocompromisedbecauseofstage3HIVinfectionandthephysicianhas orderedachestradiograph.Howshouldthenursemostsafelyfacilitatethetest?

A)

Arrangeforaportablex-raymachinetobeused.

B)

Havethepatientwearamasktothex-raydepartment.

C)

Ensurethattheradiologydepartmenthasbeendisinfectedpriortothetest.

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D)

Sendthepatienttothex-raydepartment,andhavethestaffinthedepartmentwearmasks.

Ans:

A

695

Feedback: Apatientwhoisimmunocompromisedisatanincreasedriskofcontractingnosocomialinfectionsdue tosuppressedimmunity.Thesafestwaythetestcanbefacilitatedistohaveaportablex-raymachinein thepatientsroom.Thisconfersmoreprotectionthandisinfectingtheradiologydepartmentorusing masks. 6.

ThemotheroftwoyoungchildrenhasbeendiagnosedwithHIVandexpressesfearofdying.How shouldthenursebestrespondtothepatient?

A)

Wouldyoulikemetohavethechaplaincomespeakwithyou?

B)

YoulllearnmuchaboutthepromiseofacureforHIV.

C)

Canyoutellmewhatconcernsyoumostaboutdying?

D)

Youneedtomaintainhopebecauseyoumayliveforseveralyears.

Ans:

C Feedback: Thenursecanhelpthepatientverbalizefeelingsandidentifyresourcesforsupport.Thenurseshould respondwithanopen-endedquestiontohelpthepatienttoidentifyfearsaboutbeingdiagnosedwitha life-threateningchronicillness.Immediatedeferraltospiritualcareisnotasubstituteforengagingwith thepatient.Thenurseshouldattempttofosterhope,butnotinawaythatdownplaysthepatients expressedfears.

7.

Thenurseisaddressingcondomuseinthecontextofahealthpromotionworkshop.Whendiscussingthe correctuseofcondoms,whatshouldthenursetelltheattendees?

A)

Attachthecondompriortoerection.

B)

Acondommaybereusedwiththesamepartnerifejaculationhasnotoccurred.

C)

Useskinlotionasalubricantifalternativesareunavailable.

D)

Holdthecondombythecuffuponwithdrawal.

Ans:

D

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Feedback: Thecondomshouldbeunrolledoverthehardpenisbeforeanykindofsex.Thecondomshouldbeheld bythetiptosqueezeoutair.Skinlotions,babyoil,petroleumjelly,orcoldcreamshouldnotbeused withcondomsbecausetheycauselatexdeterioration/condombreakage.Thecondomshouldbeheld duringwithdrawalsoitdoesnotcomeoffthepenis.Condomsshouldneverbereused. 8.

AnurseisplanningthecareofapatientwithAIDSwhoisadmittedtotheunitwithPneumocystis pneumonia(PCP).Whichnursingdiagnosishasthehighestpriorityforthispatient?

A)

IneffectiveAirwayClearance

B)

ImpairedOralMucousMembranes

C)

ImbalancedNutrition:LessthanBodyRequirements

D)

ActivityIntolerance

Ans:

A Feedback: AlthoughallthesenursingdiagnosesareappropriateforapatientwithAIDS,IneffectiveAirway ClearanceistheprioritynursingdiagnosisforthepatientwithPneumocystispneumonia(PCP).Airway andbreathingtaketoppriorityovertheotherlistedconcerns.

9.

Apublichealthnurseispreparinganeducationalcampaigntoaddressarecentlocalincreaseinthe incidenceofHIVinfection.Thenurseshouldprioritizewhichofthefollowinginterventions?

A)

Lifestyleactionsthatimproveimmunefunction

B)

Educationalprogramsthatfocusoncontrolandprevention

C)

Appropriateuseofstandardprecautions

D)

Screeningprogramsforyouthandyoungadults

Ans:

B Feedback: Untilaneffectivevaccineisdeveloped,preventingHIVbyeliminatingandreducingriskbehaviorsis essential.Educationalinterventionsaretheprimarymeansbywhichbehaviorscanbeinfluenced. Screeningisappropriate,buteducationisparamount.EnhancingimmunefunctiondoesnotpreventHIV infection.IneffectiveuseofstandardprecautionsapplytoveryfewcasesofHIVinfection.

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10. AnurseisworkingwithapatientwhowasdiagnosedwithHIVseveralmonthsearlier.Thenurseshould recognizethatapatientwithHIVisconsideredtohaveAIDSatthepointwhentheCD4+T-lymphocyte cellcountdropsbelowwhatthreshold? A)

75cells/mm3ofblood

B)

200cells/mm3ofblood

C)

325cells/mm3ofblood

D)

450cells/mm3ofblood

Ans:

B Feedback: WhenCD4+T-celllevelsdropbelow200cells/mm3ofblood,thepersonissaidtohaveAIDS.

DuringtheadmissionassessmentofanHIV-positivepatientwhoseCD4+counthasrecentlyfallen,the 11. nursecarefullyassessesforsignsandsymptomsrelatedtoopportunisticinfections.Whatisthemost commonlife-threateninginfection? A)

Salmonellainfection

B)

Mycobacteriumtuberculosis

C)

Clostridiumdifficile

D)

Pneumocystispneumonia

Ans:

D Feedback: ThereareanumberofopportunisticinfectionsthatcaninfectindividualswithAIDS.Themostcommon life-threateninginfectioninthoselivingwithAIDSisPneumocystispneumonia(PCP),causedbyP. jiroveci(formerlycarinii).OtheropportunisticinfectionsmayinvolveSalmonella,Mycobacterium tuberculosis,andClostridiumdifficile.

12. Apatientscurrentantiretroviralregimenincludesnucleosidereversetranscriptaseinhibitors(NRTIs). Whatdietarycounselingwillthenurseprovidebasedonthepatientsmedicationregimen? A)

Avoidhigh-fatmealswhiletakingthismedication.

B)

Limitfluidintaketo2litersaday.

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C)

Limitsodiumintaketo2gramsperday.

D)

Takethismedicationwithoutregardtomeals.

Ans:

D

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Feedback: ManyNRTIsexist,butallofthemmaybesafelytakenwithoutregardtomeals.Protein,fluid,and sodiumrestrictionsplaynoroleinrelationtothesedrugs. 13. Anurseisperforminganadmissionassessmentonapatientwithstage3HIV.Afterassessingthe patientsgastrointestinalsystemandanalyzingthedata,whatismostlikelytobetheprioritynursing diagnosis? A)

AcuteAbdominalPain

B)

Diarrhea

C)

BowelIncontinence

D)

Constipation

Ans:

B Feedback: Diarrheaisaproblemin50%to60%ofallAIDSpatients.Assuch,thisnursingdiagnosisismorelikely thanabdominalpain,incontinence,orconstipation,thoughnoneofthesediagnosesisguaranteednotto apply.

14. ApatientwitharecentdiagnosisofHIVinfectionexpressesaninterestinexploringalternativeand complementarytherapies.Howshouldthenursebestrespond? A)

Complementarytherapiesgenerallyhavenotbeenapproved,sopatientsareusuallydiscouraged fromusingthem.

B)

ResearchershavenotlookedatthebenefitsofalternativetherapyforpatientswithHIV,sowe suggestthatyoustayawayfromthesetherapiesuntilthereissolidresearchdataavailable.

C)

ManypatientswithHIVusesometypeofalternativetherapyand,aswithmosthealthtreatments, therearebenefitsandrisks.

D)

Youllneedtomeetwithyourdoctortochoosebetweenanalternativeapproachtotreatmentanda medicalapproach.

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Ans:

699

C Feedback: Thenurseshouldapproachthetopicofalternativeorcomplementarytherapiesfromanopen-ended, supportiveapproach,emphasizingtheneedtocommunicatewithcareproviders.Complementary therapiesandmedicaltreatmentarenotmutuallyexclusive,thoughsomecontraindicationsexist. Researchsupportstheefficacyofsomeformsofcomplementaryandalternativetreatment.

15. ApatientwastestedforHIVusingenzymeimmunoassay(EIA)andresultswerepositive.Thenurse shouldexpecttheprimarycareprovidertoorderwhattesttoconfirmtheEIAtestresults? A)

AnotherEIAtest

B)

Viralloadtest

C)

Westernblottest

D)

CD4/CD8ratio

Ans:

C Feedback: TheWesternblottestdetectsantibodiestoHIVandisusedtoconfirmtheEIAtestresults.Theviral loadtestmeasuresHIVRNAintheplasmaandisnotusedtoconfirmEIAtestresults,butinsteadto tracktheprogressionofthediseaseprocess.TheCD4/CD8ratiotestevaluatestheratioofCD4andCD8 cellsbutisnotusedtoconfirmresultsofEIAtesting.

16. Thenursesplanofcareforapatientwithstage3HIVaddressesthediagnosisofRiskforImpairedSkin IntegrityRelatedtoCandidiasis.Whatnursinginterventionbestaddressesthisrisk? A)

Providingthoroughoralcarebeforeandaftermeals

B)

Administeringprophylacticantibiotics

C)

Promotingnutritionandadequatefluidintake

D)

Applyingskinemollientsasneeded

Ans:

A Feedback: Thoroughmouthcarehasthepotentialtopreventorlimittheseverityofthisinfection.Antibioticsare

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irrelevantbecauseofthefungaletiology.Thepatientrequiresadequatefoodandfluids,butthesedonot necessarilypreventcandidiasis.Skinemollientsarenotappropriatebecausecandidiasisisusuallyoral. 17. ApatientwithHIVinfectionhasbegunexperiencingseverediarrhea.Whatisthemostappropriate nursinginterventiontohelpalleviatethediarrhea? A)

Administerantidiarrhealmedicationsonascheduledbasis,asordered.

B)

Encouragethepatienttoeatthreebalancedmealsandasnackatbedtime.

C)

Increasethepatientsoralfluidintake.

D)

Encouragethepatienttoincreasehisorheractivitylevel.

Ans:

A Feedback: Administeringantidiarrhealagentsonaregularschedulemaybemorebeneficialthanadministering themonanas-neededbasis,providedthepatientsdiarrheaisnotcausedbyaninfectiousmicroorganism. Increasedoralfluidmayexacerbatediarrhea;IVfluidreplacementisoftenindicated.Small,more frequentmealsmaybebeneficial,anditisunrealistictoincreaseactivitywhilethepatienthasfrequent diarrhea.

18. AnurseiscaringforapatienthospitalizedwithAIDS.Afriendcomestovisitthepatientandprivately asksthenurseabouttheriskofcontractingHIVwhenvisitingthepatient.Whatisthenursesbest response? A)

DoyouthinkthatyoumightalreadyhaveHIV?

B)

Dontworry.Yourimmunesystemislikelyveryhealthy.

C)

AIDSisnttransmittedbycasualcontact.

D)

YoucantcontractAIDSinahospitalsetting.

Ans:

C Feedback: AIDSiscommonlytransmittedbycontactwithbloodandbodyfluids.Patients,family,andfriendsmust bereassuredthatHIVisnotspreadthroughcasualcontact.Ahealthyimmunesystemisnotnecessarily aprotectionagainstHIV.AhospitalsettingdoesnotnecessarilyprecludeHIVinfection.

19. ApatientwithHIVhasanursingdiagnosisofRiskforImpairedSkinIntegrity.Whatnursing interventionbestaddressesthisrisk?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Utilizeapressure-reducingmattress.

B)

Limitthepatientsphysicalactivity.

C)

Applyantibioticointmenttodependentskinsurfaces.

D)

Avoidcontactwithsyntheticfabrics.

Ans:

A

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Feedback: Devicessuchasalternating-pressuremattressesandlow-air-lossbedsareusedtopreventskin breakdown.Activityshouldbepromoted,notlimited,andcontactwithsyntheticfabricsdoesnot necessarythreatenskinintegrity.Antibioticointmentsarenotnormallyusedunlessthereisabreakin theskinsurface. 20. Anursewouldidentifythatacolleagueneedsadditionalinstructiononstandardprecautionswhenthe colleagueexhibitswhichofthefollowingbehaviors? A)

Thenursewearsfaceprotection,gloves,andagownwhenirrigatingawound.

B)

Thenursewashesthehandswithawaterlessantisepticagentafterremovingapairofsoiled gloves.

C)

Thenurseputsonasecondpairofglovesoversoiledgloveswhileperformingabloodyprocedure.

D)

Thenurseplacesausedneedleandsyringeinthepuncture-resistantcontainerwithoutcappingthe needle.

Ans:

C Feedback: Glovesmustbechangedaftercontactwithmaterialsthatmaycontainhighconcentrationof microorganisms,evenwhenworkingwiththesamepatient.Eachoftheotherlistedactionsadheresto standardprecautions.

21. An18-year-oldpregnantfemalehastestedpositiveforHIVandasksthenurseifherbabyisgoingtobe bornwithHIV.Whatisthenursesbestresponse? A)

Thereisnowaytoknowthatforcertain,butwedoknowthatyourbabyhasaoneinfourchance ofbeingbornwithHIV.

B)

Yourphysicianislikelythebestonetoaskthatquestion.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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C)

IfthebabyisHIVpositivethereisnothingthatcanbedoneuntilitisborn,sotryyourbestnotto worryaboutitnow.

D)

ItspossiblethatyourbabycouldcontractHIV,eitherbefore,during,orafterdelivery.

Ans:

D Feedback: Mother-to-childtransmissionofHIV-1ispossibleandmayoccurinutero,atthetimeofdelivery,or throughbreast-feeding.Thereisnoevidencethattheinfantsriskis25%.Deferraltothephysicianisnot asubstituteforrespondingappropriatelytothepatientsconcern.Downplayingthepatientsconcernsis inappropriate.

22. AnurseisaddressingtheincidenceandprevalenceofHIVinfectionamongolderadults.Whatprinciple shouldguidethenurseschoiceofeducationalinterventions? A)

ManyolderadultsdonotseethemselvesasbeingatriskforHIVinfection.

B)

ManyolderadultsarenotawareofthedifferencebetweenHIVandAIDS.

C)

Olderadultstendtohavemoresexpartnersthanyoungeradults.

D)

Olderadultshavethehighestincidenceofintravenousdruguse.

Ans:

A Feedback: ItisknownthatmanyolderadultsdonotseethemselvesasbeingatriskforHIVinfection.Knowledge oftherelationshipbetweenHIVinfectionandAIDSisnotknowntoaffecttheincidenceofnewcases. ThestatementsaboutsexpartnersandIVdruguseareuntrue.

23. A16-year-oldhascometotheclinicandaskstotalktoanurse.Thenurseaskstheteenwhatsheneeds andtheteenrespondsthatshehasbecomesexuallyactiveandisconcernedaboutgettingHIV.Theteen asksthenursew...