Question 1

An adolescent patient asks the nurse about sexual practices that help avoid contracting HIV. What should the nurse instruct this patient?

Accepted Answer

The answer of An adolescent patient asks the nurse about...

Question 2

The nurse on the transplant unit is reviewing assessment data for a group of patients. Which patients should the nurse realize are at greatest risk for graft-versus-host disease? $\begin{array}{|l|l|c|l|c|}
\hline& {\text { Patient A }} & \text { Patient B } & {\text { Patient C }} & {\text { Patient D }} \
\hline \text { Transplant }&\text { Kidney } & \text { Bone Marrow } & \text { Liver } & \text { Lung } \
\hline \text { Time frame post }&\text { 2 days post } & \text { 2 months post } & 3 \text { months post } & 6 \text { months } \
\text { transplant }&&&&\text { post }\
\hline  \text { Symptoms/diagnostics }& \begin{array}{r}
\text { Diagnostic } \
\text { studies }
\end{array} & \text { Rash on } & \text { Nausea, } & \text { Inereasing } \
\text { Present }&\text { reveal poor } & \text { hands and } & \text { abdominal } & \text { dyspnea } \
&\text { perfusion to } & \text { soles of } & \text { bloody } & \text { and fever } \
&\text { renal vessels } & \text { feet. } & \text { diarrhea } & \
\hline
\end{array}$

Accepted Answer

Graft-versus-host disease (GVHD) is a condition that occurs after an allogeneic transplant when the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign and attack it. Patient B, who received a bone marrow transplant and is experiencing a rash on the hands and soles of the feet, is showing classic symptoms of GVHD. Kidney, liver, and lung transplants do not typically involve the immune system attacking the host in the same way, making GVHD primarily a concern with bone marrow or stem cell transplants.

Question 3

A patient receiving cyclosporine after an organ transplant is experiencing an acute onset of hypertension and headaches. What should these assessment findings suggest to the nurse?

Accepted Answer

Hypertension and headaches are both potential side effects of cyclosporine, particularly if the medication dosage is too high or if there is a buildup of the drug in the body. These symptoms may indicate toxicity, and the healthcare provider should be notified promptly. Impending organ failure or the beginning of organ function are not typically associated with these symptoms.

Question 4

The nurse is instructing a patient diagnosed with AIDS regarding foods that will increase caloric intake. Which meal choice indicates that the patient understands which types of foods to consume?

Accepted Answer

This meal choice includes sources of protein (meat sauce, milkshake), carbohydrates (spaghetti, roll, pie), and healthy fats (butter). The addition of a high-calorie supplement like Ensure can also be helpful for increasing calorie intake.

Question 5

A patient diagnosed with AIDS complains of nausea, fever, severe diarrhea, and anorexia. Which medication would be the most effective to relieve the anorexia, as well as to stimulate the patient's appetite?

Accepted Answer

Megestrol (Megace) is a synthetic progestin that is used to improve appetite and promote weight gain in patients with AIDS-related cachexia or anorexia. It is effective in relieving anorexia and stimulating appetite, therefore, it is the best choice for the given condition.  Ciprofloxacin (Cipro) is an antibiotic used to treat bacterial infections and would not address the symptoms mentioned. Zidovudine (Retrovir, AZT) and abacavir (Ziagen) are antiretroviral drugs used to treat HIV infections, but they do not specifically address the symptoms of anorexia or stimulate appetite.

Question 6

A patient with HIV is complaining of increased pain in the feet and legs. What should the nurse realize this patient is demonstrating?

Accepted Answer

Nervous system manifestations can occur in patients with HIV, including peripheral neuropathy which can cause pain, numbness, and tingling in the feet and legs. It is important for the nurse to assess the patient for any potential underlying causes or contributing factors, such as medication side effects or coexisting conditions.

Question 7

The nurse is determining which assigned patients might be experiencing an immunodeficiency. Which patient or patients should the nurse identify as having this health problem? \[\begin{array} { | l | l | l | l | } 
\hline \text { Patient A } & \text { Patient B } & \text { Patient C } & \text { Patient D } \
\hline \begin{array} { l } 
\text { Patient complains } \
\text { of fatigue and } \
\text { weight loss. }
\end{array} & \begin{array} { l } 
\text { Patient complains } \
\text { of rash across bridge } \
\text { of nose. }
\end{array} & \begin{array} { l } 
\text { Patient complains } \
\text { of } 14 \mathrm { lb } \text {, weight loss } \
\text { over last } 2 \text { months. }
\end{array} & \begin{array} { l } 
\text { Patient complains of } \
\text { pain and decreased } \
\text { range of motion in } \
\text { knee joints. }
\end{array} \
\hline \begin{array} { l } 
\text { Oral temp } = 100.8 ^ { \circ } \
\text { F }
\end{array} & \begin{array} { l } 
\text { Patient has } \
\text { increased/high } \
\text { Blood urea nitrogen } \
\text { (BUN) and } \
\text { creatinine levels. }\
\
\
\end{array} & \begin{array} { l } 
\text { Patient has } \
\text { purplish/blue } \
\text { patches noted on } \
\text { face }\
\
\text { and over trunk of }\
\text { body }
\end{array} & \begin{array} { l } 
\text { Patient's } \
\text { Erythrocyte } \
\text { sedimentation rate } \
\text { (ESR) is elevated. }\
\
\
\
\end{array} \
\hline \begin{array} { l } 
\text { White patches } \
\text { noted in oral } \
\text { mucosa. }
\end{array} & \begin{array} { l } 
\text { Patient has peri- } \
\text { orbital edema. }
\end{array} & \begin{array} { l } 
\text { Patient has enlarged } \
\text { auxillary lymph } \
\text { nodes. }
\end{array} & \begin{array} { l } 
\text { Patients knees feel } \
\text { warm to touch. }
\end{array} \
\hline
\end{array}\]

Accepted Answer

All patients have signs and symptoms of immunodeficiency.

Question 8

The nurse is preparing to instruct a class of young adults about ways to perform safe sex. What should be included in the nurse's presentation?

Accepted Answer

B: It is important to get tested for HIV and other sexually transmitted infections (STIs) when entering into a new sexual relationship, even if it is monogamous. This can help to prevent the spread of STIs and ensure that both partners are healthy.

E: Sharing intravenous drug paraphernalia can lead to the spread of infections such as HIV and hepatitis C. Educating young adults about the risks of sharing needles and other equipment is important in promoting safe sex practices.

A, C, and D are not recommended safe sex practices. Avoiding spermicidal agents is not necessary, as they can be an effective form of contraception if used properly. Oral birth control pills are not effective at preventing the spread of STIs, and oil-based lubricants can weaken latex condoms and increase the risk of breakage.

Question 9

A patient diagnosed with HIV has an HIV viral load test of 9,000 copies/mL. What should this test result suggest to the nurse?

Accepted Answer

The current prescribed medication therapy is not effective.

Question 10

The nurse is reviewing assessment data for several patients who are suspected of exposure to HIV. Which patients demonstrate findings consistent with HIV exposure? \(\begin{array}{|l|l|l|l|l|}
\hline \text { Diagnostic \& } & \text { Patient A } & \text { Patient B } & \text { Patient C } & \text { Patient D } \
\hline \text { Patient } & & & &\
\text { Subjective/Findin }\
\text { gs }\
\hline \text { ELISA } & \text { Positive } & \text { Negative } & \text { Negative } & \text { Negative } \
\hline \text { Westem Blot } & \text { Positive } & \text { Negative } & \text { Negative } & \text { Negative } \
\hline \text { CD4 } & 840 & 900 & 920 & 880 \
\hline \text { Oral Temperature } & 100^{\circ} \mathrm{F} & 101^{\circ 0} \mathrm{~F} & 98.6^{\circ} \mathrm{F} & 98.8^{\circ} \mathrm{F} \
\hline \text { Other Symptoms } & \text { C/O sore throat }  & \mathrm{C/O }  \text { a } & \mathrm{C/O} \text { fatigue } & \mathrm{C/O } \
& \text { anda body aches} & \text { headache } & \text { and } & \text { insomnia } \
&&\text { and upper } & \text { decreased } & \text { and } \
&&\text { respiratory } & \text { appetite } & \text { urinary } \
&&\text { congestion } & & \text { urgency }\
\
\
\hline
\end{array}\)

Accepted Answer

Patient A is the only one with both ELISA and Western Blot tests positive, which are diagnostic for HIV exposure. The CD4 count is within normal limits, but the presence of symptoms and positive tests confirm exposure.

Question 11

A patient is scheduled for allergy testing. Place an "X" over the area of the body best suited for prick or intradermal testing.

Accepted Answer

The answer of A patient is scheduled for allergy testing....

Question 12

The nurse is teaching a patient newly diagnosed with HIV. Which patient statement indicates the need for additional teaching?

Accepted Answer

Using oil-based lubricants can actually break down latex condoms, increasing the risk of transmission. Water-based lubricants are recommended instead.

Question 13

The nurse is reviewing assessment data for a group of patients. Which patient's findings are consistent with a Type II cytotoxic hypersensitivity reaction? \(\begin{array}{|l|l|l|l|}
\hline\text { Patient A } & \text { Patient B } & \text { Patient C } & \text { Patient D } \
\hline \begin{array}{c}
\text { Patient has } \
\text { history of } \
\text { allergic } \
\text { asthma. }
\end{array} & \begin{array}{l}
\text { Patient has recently } \
\text { received some drugs, } \
\text { such as penicillin or } \
\text { sulfonamides. }
\end{array} & \begin{array}{l}
\text { Patient complains of } \
\text { red itchy skin } 24 \text { hours } \
\text { after wearing Latex } \
\text { gloves }
\end{array} & \begin{array}{l}
\text { Patient has just } \
\text { had a blood } \
\text { transfusion. }
\end{array} \
\hline \text { IgE-mediated } & \text { IgG or IgM mediated } & \text { Nomal cell mediated } & \text { IgG or IgM }\
&&&\text { mediated }\
\hline\text { Histamine is } & \text { Immune complexes are } & \text { Immune mediators } & \text { Complement } \
\text { primary } & \text { deposited in walls of } & \text { from the lysoxymes } & \text { cascade is } \
\text { chemical } & \text { small blood vessels, the } & \text { within the } & \text { activated, resulting } \
\text { mediator of } & \text { kidneys, and joints. } & \text { macrophages and } & \text { in destruction of }\
\text { allergic } & &\text { killer T cells cause } & \text { the target cell. } \
\text { response. } & &\text { local tissue destruction } \
\hline
\end{array}\)

Accepted Answer

Type II hypersensitivity reactions involve IgG or IgM antibodies directed against target cells, often leading to cell destruction via the complement system, as seen in blood transfusion reactions.

Question 14

A patient tells the nurse, "I had this arthritis pain under control, but then I learned I might lose my job." How should the nurse respond?

Accepted Answer

The best response would be to acknowledge the patient's concern and bring attention to the fact that stress can have a negative impact on arthritis pain. This response both empathizes with the patient and offers helpful information for managing their condition. Options A and D are not appropriate responses given the information provided, and option B dismisses the patient's concerns.

Question 15

A patient with an autoimmune disorder tells the nurse, "My family keeps telling me I don't look sick." Which problem should the nurse use to guide this patient's care?

Accepted Answer

The patient's concern is about their family's understanding of their illness, indicating a potential lack of education or knowledge about the disease. This problem would need to be addressed in order to ensure the patient receives appropriate support and understanding from their loved ones.

Question 16

A patient is demonstrating signs of anaphylactic shock. What should the nurse do first to assist this patient?

Accepted Answer

Maintaining an airway is the first priority in any situation where a patient is experiencing respiratory distress. In anaphylactic shock, the airway can become swollen, making it difficult for the patient to breathe. Ensuring a patent airway is crucial to the patient's survival. Administering epinephrine, providing reassurance, and placing the patient on a cardiac monitor can be done after the airway is secured.

Question 17

A patient with HIV is not adhering to the prescribed medication therapy. Which nursing action will best improve patient compliance and the long-term treatment of the disease process?

Accepted Answer

It is important for the nurse to open up a dialogue with the patient about their noncompliance behavior to better understand why they are having difficulty adhering to their medication regimen. By addressing potential barriers, the nurse can work with the patient to develop strategies to increase compliance and ultimately improve long-term treatment outcomes. Confronting the patient may cause resistance and further noncompliance, while suggesting a medication change may not be appropriate without a thorough understanding of the patient's medication history and side effects. Referring the patient to a social worker for medication cost assistance may be helpful but does not address the underlying issue of noncompliance.

Question 18

A young female patient with HIV does not want to see the gynecologist because, she says, "I'm going to die anyway." How should the nurse respond?

Accepted Answer

The nurse should educate the patient on the importance of a PAP smear, as women with HIV have a higher risk of cervical cancer. It is important to provide the patient with information that will help her maintain her overall health and well-being, despite her HIV status.

Question 19

A patient is prescribed a monoclonal antibody after an allograft on the left thigh. What does the use of this medication suggest to the nurse?

Accepted Answer

Monoclonal antibodies are often used in transplant patients to prevent rejection of the graft. The need for this medication suggests that there is a risk for rejection, particularly steroid-resistant rejection, which can occur in some patients despite treatment with steroids. It does not necessarily indicate a shorter recovery time or fewer adverse effects, and there is no indication of a graft infection.

Question 20

A patient is diagnosed with a type I hypersensitivity reaction. The nurse recognizes that which chemical mediators caused the patient's symptoms?

Accepted Answer

The answer of A patient is diagnosed with a type...

Quiz 13: Nursing Care of Patients With Altered Immunity