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

Question 1

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

A) Always use Standard Precautions with all clients in the workplace.
B) Place clients who are HIV positive in Contact Precautions.
C) Wash hands before and after contact with clients who are HIV positive.
D) Convert parenteral medications to an oral form for clients who are HIV positive.

Answer 1

Always use Standard Precautions with all clients in the workplace.

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?

A) Place the client in Airborne Precautions.
B) Facilitate the client's chest x-ray.
C) Initiate a 3-day calorie count.
D) Start an IV of normal saline.

Answer 2

Place the client in Airborne Precautions.

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?

A) Six vaginal yeast infections in the last 12 months
B) Unable to become pregnant for the last 2 years
C) Severe cramping and irregular periods
D) Very heavy periods and breakthrough bleeding

Answer 3

Six vaginal yeast infections in the last 12 months

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?

A) "I will wash my hands whenever I get home from work."
B) "I will make sure to have my own tube of toothpaste at home."
C) "I will run my toothbrush through the dishwasher every evening."
D) "I will be sure to eat lots of fresh fruits and vegetables every day."

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?

A) "Your vaginal walls become thicker after menopause, which increases your risk."
B) "Women in your age-group are the fastest growing population of AIDS clients today."
C) "Hormonal fluctuations after menopause make it harder to fight off infection."
D) "You might be right. How often do you engage in sexual activities?"

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?

A) "I can throw the condoms in the trash after I have used them."
B) "I will store my condoms in my wallet so they are always handy."
C) "Water-based lubricants are best to prevent condom breakage."
D) "The condom needs to stay on until I withdraw my penis."

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?

A) "Stop taking the medication if you develop a fever."
B) "Rotate the sites where you will be giving the injections."
C) "Take this medication with a snack or a small meal."
D) "Do not drive or operate machinery while taking this drug."

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?

A) Assess the client's deep tendon reflexes.
B) Ask the client to place his chin on his chest.
C) Start an IV line with normal saline.
D) Assess the client's pupil reaction.

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?

A) Initiate respiratory isolation for the next 72 hours.
B) Initiate seizure precautions with padded siderails.
C) Thicken the client's liquids to honey consistency.
D) Administer IV pentamidine isethionate (Pentam).

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?

A) "Your count is high so you can cut back on your medication."
B) "Your count is normal because your medications are working well."
C) "Your count is a bit low and you are susceptible to infection."
D) "Your count is very low and you actually now have AIDS."

Question 11

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

A) "The medications are actually less expensive than they used to be."
B) "These medications are the best course of treatment for you."
C) "You should be glad the medications will help prolong your life."
D) "Let's talk to the social worker about getting financial assistance for you."

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?

A) Start a second IV line for the client's antibiotics.
B) Call the physician to clarify the order.
C) Review the client's renal panel before administration.
D) Obtain baseline vital signs and another set after 15 minutes.

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?

A) Retrovir (zidovudine) for 14 days
B) Retrovir (zidovudine) for 28 days
C) Retrovir (zidovudine) and Epivir (lamivudine) for14 days
D) Retrovir (zidovudine) and Epivir (lamivudine) 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?

A) "A woman can still get pregnant if she is HIV positive."
B) "I won't get HIV if I only have oral sex with my partner."
C) "Showering after intercourse will not prevent HIV transmission."
D) "People with HIV are still contagious even if they take HAART drugs."

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?

A) Feed the client when he will not do it by himself.
B) Make sure that a clock and a calendar are easily visible.
C) Remove locks from bathroom and bedroom doors.
D) Do not allow the client to smoke when he is alone.

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?

A) Middle-aged woman with a new sexual partner
B) Young male who has male sexual partners
C) All clients who come to the clinic
D) Young woman having her first gynecologic examination

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?

A) "The HAART medications are working well right now."
B) "You are not as contagious as you were anymore."
C) "Your HIV infection is becoming resistant to your medications."
D) "You are developing an opportunistic infection."

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?

A) Call radiology to see when the client will be brought back to the nursing unit.
B) Send the nursing assistant to radiology to bring the client back to the nursing unit.
C) Take the client's medications to radiology and administer them there if possible.
D) Stagger the next dose of the medication if the current dose is given late.

Question 19

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

A) Renal function studies
B) Liver enzymes
C) Blood glucose monitoring
D) Albumin and prealbumin

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?

A) "I will let my sister clean my pet iguana's cage from now on."
B) "My brother will change the kitty litter box from now on."
C) "It will seem funny but I'll run my toothbrush through the dishwasher."
D) "I will not drink juice that has been sitting out for longer than an hour."

Question 21

The nurse is completing a health history for a client and begins to obtain a sexual history.What is the nurse's best opening question?

A) "How long have you been sexually active?"
B) "Are you in a monogamous relationship with your spouse?"
C) "How do you feel about answering questions about your sexual history?"
D) "Have you noticed any problems with your ability to have or enjoy sex?"

Question 22

The nurse asks a young adult client if she is sexually active.The client asks why the nurse needs to know.What is the nurse's best response?

A) "I just need to make sure that the information you are providing is reliable."
B) "I have to fill in answers to all of the questions on the health history form."
C) "If you are sexually active, we should talk about ways to prevent getting HIV."
D) "I will have to notify your partner if you have a sexually transmitted disease."

Question 23

The nurse is caring for a hospitalized client who has AIDS and is severely immune compromised.Which interventions are used to help prevent infection in this client?

A) Use sterile gloves and gowns whenever the nursing staff is in contact with the client.
B) Provide an incentive spirometer to encourage coughing and deep breathing by the client.
C) Keep a blood pressure cuff, thermometer, and stethoscope in the client's room for his or her use only.
D) Use N95 respirators (all nursing staff) when in the client's room.
E) Request that the family take home the fresh flowers that are at the client's bedside.
F) Assist the client with meticulous oral care after meals and at bedtime.

Question 24

The nurse is to give a client ganciclovir (Cytovene)for cytomegalovirus (CMV)retinitis.The dosage is 5 mg/kg IV every 12 hours.The client weighs 185 pounds.How many milligrams of ganciclovir does the client receive per dose? mg/dose

Question 25

The nurse is to give a client rifampin (Rifadin)for tuberculosis.The dosage is 10 mg/kg/day.The client weighs 198 lb,and the medication is available in 150-mg capsules.How many capsules of rifampin does the client receive daily? __________ capsules/day

Question 26

A client verbalizes a fear of contracting HIV because she has a history of intravenous substance abuse.What instructions does the nurse provide to the client to help minimize this risk?

A) "Boil all needles and syringes for at least 20 minutes before using them again and be sure not to share them."
B) "Rinse used needles and syringes with water followed by laundry bleach after using them."
C) "Rinse used needles and syringes with rubbing alcohol before and after using them."
D) "Run all needles and syringes through the dishwasher with an extra rinse cycle before using them again."

Question 27

When obtaining a sexual history from a client in a clinic setting,the nurse notes that the client appears very uncomfortable and pauses for long periods before answering the nurse's questions.What is the nurse's best response?

A) "I am sorry that my questions are making you very uncomfortable."
B) "Don't worry. We'll be done with these questions in no time at all."
C) "Take your time. I realize that this is a very private topic to talk about."
D) "These questions are making you uncomfortable, so we'll finish next time."

Question 28

The nurse is caring for a client with HIV who has been prescribed didanosine (Videx EC).Which action by the nurse is most appropriate?

A) Help the client plan specific meal and dosing times.
B) Explain that the client will have frequent complete blood counts (CBCs) drawn.
C) Advise the client to take Videx EC with milk or a small meal.
D) Tell the client to take Tylenol (acetaminophen) for any abdominal pain.

Question 29

The nurse is caring for an HIV-positive client.What assessment finding assists the nurse in confirming progression of the client's diagnosis to AIDS?

A) Generalized lymphadenopathy
B) HIV-positive status for 8 years
C) Low-grade fever for the last 10 days
D) Thick white patches on the client's tongue

Question 30

The nursing supervisor is working with an HIV-positive nurse who has open weeping blisters on her arms after being exposed to poison ivy.Which instructions should the nursing supervisor provide to the nurse before she starts her shift?

A) "You should reassure your clients that you are not contagious."
B) "You should work phone triage at the desk today rather than taking clients."
C) "You should wear a long-sleeved scrub jacket today while working with clients."
D) "You should not care for clients who are immune compromised or in isolation."

Question 31

A nursing assistant asks the nurse if respiratory isolation is needed for a client with Pneumocystis jiroveci pneumonia.What is the nurse's best response?

A) "This type of pneumonia is an opportunistic infection, so the staff is not at risk."
B) "You should wear a mask and a gown to provide care."
C) "Yes, please institute respiratory isolation because this is very contagious."
D) "You are not at risk for this infection if you have had a vaccination."

Question 32

The nurse is caring for a client who is HIV positive.The client has become confused over the course of the shift,and the client's pupils are no longer reacting to light equally.The nurse anticipates an order for which medication?

A) Prednisone (Deltazone)
B) Trimethoprim/sulfamethoxazole (Bactrim)
C) Pentamidine isethionate (Pentam)
D) Ketoconazole (Nizoral)