Chapter 19 Care of Patients with HIV Disease PDF

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Chapter19:CareofPatientswithHIVDisease MULTIPLECHOICE 1.Thenurseiscaringforaclientdiagnosedwithhumanimmunedeficiencyvirus.TheclientsCD4+cellcount is399/mm3.Whatactionbythenurseisbest? a.Counseltheclientonsafersexpractices/abstinence. b.Encouragetheclienttoabstainfromalcohol. c.FacilitategenetictestingforCD4+CCR5/CXCR4co-receptors. d.Helptheclientplanhigh-protein/ironmeals. ANS:A 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. DIF:Applying/ApplicationREF:339 KEY:HIV/AIDS|safersex|immunedisorders MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 2.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.Analintercourse b.Masturbation c.Oralsex d.Vaginalintercourse ANS:A Analintercourseistheriskiestsexualpracticebecausethefragileanaltissuecantear,creatingaportalofentry forhumanimmunedeficiencyvirus. DIF:Understanding/ComprehensionREF:341 KEY:HIV/AIDS|safersex|infection|immunedisorders MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:HealthPromotionandMaintenance 3.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.ConsistentuseofStandardPrecautions b.Double-glovingbeforebodyfluidexposure c.LabelingchartsandarmbandsHIV+ d.Wearingamaskwithin3feetoftheclient ANS:A 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. DIF:Remembering/KnowledgeREF:343 KEY:HIV/AIDS|infectioncontrol|StandardPrecautions|immunedisorders MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 4.Aclientwithhumanimmunedeficiencyvirusisadmittedtothehospitalwithfever,nightsweats,andsevere

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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.InitiateDropletPrecautionsfortheclient. b.NotifytheproviderabouttheCD4+results. c.PlacetheclientunderAirbornePrecautions. d.UseStandardPrecautionstoprovidecare. ANS:C Sincethisclients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. DIF:Applying/ApplicationREF:345 KEY:HIV/AIDS|Transmission-BasedPrecautions|infectioncontrol|immunedisorders MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 5.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.Assesstheclientssexualactivityandpatterns. b.Expresshappinessoverthetestresult. c.Remindtheclientaboutsafersexpractices. d.Telltheclienttoberetestedin3months. ANS:A 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clientssexualbehaviorfurthertodeterminetheproperresponse.Theother actionsarenotthemostimportant,butdiscussingsafersexpracticesisalwaysappropriate. DIF:Applying/ApplicationREF:347 KEY:HIV/AIDS|safersexualpractices|nursingassessment|immunedisorders MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 6.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.Asktheclientabouttraveltoanyforeigncountries. b.Assesstheclientforadherencetothedrugregimen. c.Determineiftheclienthasanynewsexualpartners. d.Requestinformationaboutnewlivingquartersorpets. ANS:B 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clientsviralloadhasincreased dramatically,thenurseshouldfirstassessthisfactor.Afterthis,theotherassessmentsmayormaynotbe needed. DIF:Applying/ApplicationREF:349 KEY:HIV/AIDS|nursingassessment|immunedisorders|medications MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 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? a.Administersleepingmedication. b.Performmostactivitiesfortheclient.

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c.Increasetheclientsoxygenduringactivity. d.Paceactivities,allowingforadequaterest. ANS:D 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clients activity. DIF:Applying/ApplicationREF:351 KEY:HIV/AIDS|immunedisorders|restandsleep|fatigue MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:PhysiologicalIntegrity:BasicCareandComfort 8.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.Chooseshigh-proteinfood b.Hasdecreasedoraldiscomfort c.Eats90%ofmealsandsnacks d.Hasaweightgainof2pounds/1month ANS:D 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. DIF:Evaluating/SynthesisREF:352 KEY:HIV/AIDS|malnutrition|nutrition MSC:IntegratedProcess:NursingProcess:Evaluation NOT:ClientNeedsCategory:PhysiologicalIntegrity:BasicCareandComfort 9.AclientwithacquiredimmunedeficiencysyndromeishospitalizedandhasweepingKaposissarcoma lesions.Thenursedressesthemwithsterilegauze.Whenchangingthesedressings,whichactionismost important? a.AdheringtoStandardPrecautions b.Assessingtolerancetodressingchanges c.Performinghandhygienebeforeandaftercare d.Disposingofsoileddressingsproperly ANS:D Alloftheactionsareimportant,butduetotheinfectiousnatureofthisillness,ensuringproperdisposalof soileddressingsisvital. DIF:Applying/ApplicationREF:353 KEY:HIV/AIDS|woundcare|dressings|infectioncontrol MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 10.AclienthasaprimaryselectiveimmunoglobulinAdeficiency.Thenurseshouldpreparetheclientforselfmanagementbyteachingwhatprincipleofmedicalmanagement? a.Infusionswillbescheduledevery3to4weeks. b.Treatmentisaimedattreatingspecificinfections. c.Unfortunately,thereisnoeffectivetreatment. d.YouwillneedmanyimmunoglobulinAinfusions. ANS:B Treatmentforthisdisorderisvigorousmanagementofinfection,notinfusionofexogenousimmunoglobulins. Theotherresponsesareinaccurate.

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DIF:Understanding/ComprehensionREF:356 KEY:Immunedisorders|patienteducation MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PhysiologicalAdaptation 11.AnHIV-positiveclientisadmittedtothehospitalwithToxoplasmagondiiinfection.Whichactionbythe nurseismostappropriate? a.InitiateContactPrecautions. b.PlacetheclientonAirbornePrecautions. c.PlacetheclientonDropletPrecautions. d.UseStandardPrecautionsconsistently. ANS:D 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. DIF:Applying/ApplicationREF:345 KEY:HIV/AIDS|infectioncontrol|StandardPrecautions MSC:IntegratedProcess:NursingProcess:Implementation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:SafetyandInfectionControl 12.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.Assesstheclientforsupportsystems. b.Determineifaclergymemberwouldhelp. c.Explainlegalrequirementstotellsexpartners. d.Offertotellthefamilyfortheclient. ANS:A 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. DIF:Applying/ApplicationREF:354 KEY:HIV/AIDS|nursingassessment|psychosocialresponse|support|caring MSC:IntegratedProcess:Caring NOT:ClientNeedsCategory:PsychosocialIntegrity 13.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? a.Confrontthestaffmembersaboutunethicalbehavior. b.Ignorethebehavior;theywillstopontheirownsoon. c.Reportthebehaviortotheunitsnursingmanagement. d.Telltheclientthatotherstaffmembersaretalkingabouthimorher. ANS:A 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. DIF:Applying/ApplicationREF:355 KEY:HIV/AIDS|communication|advocacy|caring|patient-centeredcare MSC:IntegratedProcess:CommunicationandDocumentation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 14.Aclienthasbeenhospitalizedwithanopportunisticinfectionsecondarytoacquiredimmunedeficiency

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syndrome.Theclientspartnerislistedastheemergencycontact,buttheclientsmotherinsiststhatsheshould belistedinstead.Whatactionbythenurseisbest? a.Contactthesocialworkertoassisttheclientwithadvancedirectives. b.Ignorethemother;theclientdoesnotwanthertobeinvolved. c.Lettheclientknow,gently,thatnursescannotbeinvolvedinthesedisputes. d.Telltheclientthat,legally,themotheristheemergencycontact. ANS:A 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. DIF:Applying/ApplicationREF:347 KEY:HIV/AIDS|autonomy|advocacy|referrals|LGBTQ MSC:IntegratedProcess:CommunicationandDocumentation NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 15.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.Consultwiththepharmacyaboutdruginteractions. b.Ensurethattheclientunderstandsthenewmedications. c.Givethenewdrugswithoutconsideringtheoldones. d.Scheduleallmedicationsatstandardtimes. ANS:A 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. DIF:Applying/ApplicationREF:350 KEY:HIV/AIDS|immunedisorder|antiretrovirals|HAART MSC:IntegratedProcess:CommunicationandDocumentation NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 16.Aclientwithacquiredimmunedeficiencysyndromehasbeenhospitalizedwithsuspected cryptosporidiosis.Whatphysicalassessmentwouldbemostconsistentwiththiscondition? a.Auscultatingthelungs b.Assessingmucousmembranes c.Listeningtobowelsounds d.Performinganeurologicexamination ANS:B 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clientsmucousmembranesfordryness. Thenursewillperformtheotherassessmentsaspartofacomprehensiveassessment. DIF:Applying/ApplicationREF:345 KEY:HIV/AIDS|nursingassessment|fluidsandelectrolytes MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:PhysiologicalIntegrity:ReductionofRiskPotential 17.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? a.Gabapentincanbeusedasanantidepressanttoo. b.Ihavenoideawhyyoushouldbetakingthisdrug.

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c.Thisdrughelpstreatthepainfromnerveirritation. d.Youareatriskforseizuresduetofungalinfections. ANS:C 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. DIF:Understanding/ComprehensionREF:352 KEY:HIV/AIDS|neuropathicpain|tricyclicantidepressants|pain|pharmacologicpainmanagementMSC: IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies 18.Anurseiscaringforfourclientswhohaveimmunedisorders.Afterreceivingthehand-offreport,which clientshouldthenurseassessfirst? a.ClientwithacquiredimmunedeficiencysyndromewithaCD4+cellcountof210/mm3andatempof102.4 F(39.1C) b.ClientwithBrutonsagammaglobulinemiawhoiswaitingfordischargeteaching c.Clientwithhypogammaglobulinemiawhois1hourpostimmuneserumglobulininfusion d.ClientwithselectiveimmunoglobulinAdeficiencywhoisonIVantibioticsforpneumonia ANS:A 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. DIF:Applying/ApplicationREF:349 KEY:HIV/AIDS|immunedisorders|prioritizing|fever|infection|whitebloodcellcount MSC:IntegratedProcess:NursingProcess:Assessment NOT:ClientNeedsCategory:SafeandEffectiveCareEnvironment:ManagementofCare 19.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.Truvadadoesnotreducetheneedforsafesexpractices. b.Thisdrughasbeentakenoffthemarketduetoincreasesincancer. c.TruvadareducesthenumberofHIVtestsyouwillneed. d.Thisdrugisonlyusedforpostexposureprophylaxis. ANS:A 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. DIF:Understanding/ComprehensionREF:343 KEY:HIV/AIDS|immunedisorders|vaccinations|patienteducation MSC:IntegratedProcess:Teaching/Learning NOT:ClientNeedsCategory:PhysiologicalIntegrity:PharmacologicalandParenteralTherapies MULTIPLERESPONSE 1.Astudentnurseislearningabouthumanimmunedeficiencyvirus(HIV)infection.Whichstatementsabout HIVinfectionarecorrect?(Selectallthatapply.) a.CD4+cellsbegintocreatenewHIVvirusparticles. b.Antibodiesproducedareincompleteanddonotfunctionwell. c.Macrophagesstopfunctioningproperly.

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d.Opportunisticinfectionsandcancerareleadingcausesofdeath. e.Peoplewithstage1HIVdiseasearenotinfectioustoothers. ANS:A,B,C,D 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wit...