Chapter 78 : Management of Clients with Acquired Immunodeficiency Syndrome Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 78 : Management of Clients with Acquired Immunodeficiency Syndrome

MULTIPLE CHOICE

1. Which of the following information related to medications should the nurse include in the teaching plan for a client who is positive for the human immunodeficiency virus (HIV)?

a.

Do not skip a dose. If a dose is missed, double the next dose.

b.

Take this medication at any time after eating.

c.

Tell the prescriber if you decide to stop treatment.

d.

Wait until the next visit before reporting significant side effects.

ANS: C

Instruct all clients taking retrovirals as follows: Take the drug at specified intervals. Do not skip a dose. Do not increase or decrease the number of pills you take. If side effects occur, tell your physician or nurse. If you do not want to take the drugs, tell your primary care provider. If you take the drugs only periodically, it would be better not to take them at all.

DIF: Application/Applying REF: pp. 2100-2102

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

2. The nurse understands the most significant laboratory study for the client who is HIV positive is the

a.

CD4+ cell count.

b.

enzyme-linked immunosorbent assay (ELISA) test.

c.

total white blood cell count.

d.

Western blot test.

ANS: A

The most recent classification system for HIV disease in adults and adolescents is based on two monitoring parameters used to follow a client: (1) laboratory data (CD4+ cell count) and (2) clinical presentation (the persons clinical manifestations of diseases). The Western blot test would be used to confirm the diagnosis of HIV, which is done with the enzyme-linked immunosorbent assay test. The total white blood cell count can indicate infection, but is not specific for HIV.

DIF: Comprehension/Understanding REF: pp. 2098-2099

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

3. When planning a community teaching event, the nurse should recognize that the group in which HIV infection is growing most rapidly is

a.

adults older than 50 years.

b.

blacks and Hispanics.

c.

black teenagers.

d.

gay white men.

ANS: A

An overlooked population of rapidly growing HIV-positive people are those older than the age of 50. In 2004 they represented 16% of all new cases. Minorities are also heavily affected by HIV infection. Teenagers do not have a high rate of HIV infection overall. Gay white men have high rates of infection, but their rates of infection are decreasing as a percentage of the overall population of HIV infected individuals.

DIF: Comprehension/Understanding REF: p. 2093 OBJ: Intervention

MSC: Health Promotion and Maintenance High Risk Behaviors

4. The nurse is counseling an HIV-positive woman who has just given birth to a baby. The nurse should advise the client to

a.

anticipate the needs of her child immediately and make arrangements for placement in a setting where her childs life will be comfortable.

b.

avoid breast-feeding her infant if she has access to a safe water supply to decrease the chances of vertical transmission.

c.

report all of her sexual partners to the infectious disease department in order to break the chain of transmission of the disease.

d.

seek professional counseling to deal with the guilt associated with the almost certain passing of the disease to her child.

ANS: B

Perinatal HIV exposure can occur during pregnancy, during vaginal delivery, and postpartum through breast-feeding. In places where the water supply is safe, bottle- feeding should be encouraged. In areas of the world where the risk of dying from contaminated water is high, breast-feeding is a better option. Advising the mother to place the child elsewhere is premature and judgmental. Reporting sexual partners for tracking purposes is an important activity, but is not more of a priority than keeping her baby safe. The use of zidovudine in pregnant women has drastically reduced vertical transmission.

DIF: Application/Applying REF: p. 2094 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Infectious Diseases

5. A client is afraid of a recent possible HIV exposure. The nurse should explain that the period of time it takes before HIV antibodies can be detected by laboratory tests is generally

a.

1 to 3 days.

b.

7 to 10 days.

c.

1 to 3 weeks.

d.

4 to 12 weeks.

ANS: D

There is a window for seroconversion (the time it takes for a newly infected person to develop antibodies that can be detected in a laboratory specimen). On average, antibodies can be detected in 4 to 12 weeks.

DIF: Comprehension/Understanding REF: p. 2098 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Laboratory Values

6. When teaching a client who is HIV positive, the nurse should explain that the virus can be transmitted

a.

as soon as manifestations of illness appear.

b.

once the diagnosis has been made.

c.

only to another susceptible host.

d.

to anyone having contact with blood or semen.

ANS: D

Modes of transmission have remained constant throughout the course of the HIV pandemic. The virus is spread through certain sexual practices, through exposure to blood, and through perinatal transmission. Transmission can occur via asymptomatic partners to a normal, healthy individual.

DIF: Application/Applying REF: p. 2093 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

7. A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) whose CD4+ cell count is 100. The nurse should be aware that the most effective way to prevent Pneumocystis carinii pneumonia in this client is to

a.

administer prescribed oral trimethoprim-sulfamethoxazole.

b.

encourage a high fluid intake.

c.

place the client in protective isolation.

d.

restrict the clients visitors.

ANS: A

Maintenance lifetime suppressive therapy for P. carinii is required with trimethoprim-sulfamethoxazole, pentamidine aerosol, atovaquone, dapsone, or clindamycin-primaquine.

DIF: Comprehension/Understanding REF: p. 2103 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Health Alterations

8. A nurse should plan further evaluation of an HIV-positive client when the client exhibits which early manifestation of toxoplasmosis infection?

a.

Cardiac dysrhythmias

b.

Discoloration of the mucous membranes

c.

Headache

d.

Lymphadenopathy

ANS: C

Clinical manifestations of central nervous system (CNS) infections include headache, impaired cognition, hemiparesis, aphasia, ataxia, vision loss, cranial nerve palsies, motor problems, and seizures.

DIF: Application/Applying REF: pp. 2106-2107

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Disease Management

9. The problem the nurse should plan for when a client with AIDS is infected with the Cryptosporidium parasite is

a.

delirium.

b.

painful open lesions.

c.

profuse, watery diarrhea.

d.

severe respiratory tract infection.

ANS: C

Clinical presentation includes profuse diarrhea, steatorrhea (1 L/day), flatulence, abdominal cramping and pain, anorexia, nausea, vomiting, profound weight loss, fever, fatigue, myalgia, and electrolyte imbalance.

DIF: Application/Applying REF: pp. 2106-2107

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Disease Management

10. The nurse is assessing a client with AIDS for the presence of Kaposis sarcoma (KS). The manifestation the nurse should look for is a

a.

crusty lesion on the back and groin.

b.

purple-red lesion on the body.

c.

pustular lesion with yellow exudate.

d.

thick, white exudate in the mouth.

ANS: B

Clinical presentation generally starts with an initial patch that is flat and pink, looks like a bruise, and is symmetrical on both sides of the body. Later it turns into dark violet or black plaques.

DIF: Application/Applying REF: p. 2108 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. A client with an HIV infection is receiving zidovudine (Retrovir). The nurse counsels the client about the major problem with this medication, which is/are

a.

cost.

b.

long-term administration schedule.

c.

noncompliance with its complex regimen.

d.

side effects.

ANS: C

Noncompliance relative to the complexity of the regimen is the major concern about the use of this drug.

DIF: Application REF: pp. 2101, 2102 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes and Adverse Effects

12. The nurse explains that currently the drug that is best for treating HIV wasting syndrome is

a.

human growth hormone.

b.

megestrol acetate.

c.

dronabinol.

d.

thalidomide.

ANS: A

The drug used most successfully to treat wasting is human growth hormone. Both megestrol acetate and dronabinol can increase appetite and are used in wasting syndrome, but are secondary to human growth hormone. Thalidomide is not used for appetite enhancement.

DIF: Knowledge/Remembering REF: p. 2109 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

13. A client with AIDS is experiencing fever with night sweats. A suggestion the nurse could make is to

a.

drink all liquids in the morning.

b.

keep liquids at the bedside to drink.

c.

limit fluid intake after supper.

d.

take aspirin if awakened in the night.

ANS: B

Teach the client how to manage chronic recurrent night fever and night sweats by taking the antipyretic of choice before going to sleep; having a change of bedclothes nearby; keeping a plastic cover on the pillow; placing a towel over the pillow in case of profuse diaphoresis; and keeping liquids at the bedside to drink. Limiting fluids in any manner might contribute to hypovolemia.

DIF: Application/Applying REF: p. 2109 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

14. A client with AIDS has the nursing diagnosis Fatigue. To conserve energy, the nurse encourages the client to

a.

bathe before eating breakfast.

b.

rest after every third major activity.

c.

sit down while showering.

d.

use easy-to-clean forks and knives.

ANS: C

Promote rest and activity by developing a plan of daily activities that alternates short activities with rest periods. Evaluate the clients needs and point out ways to conserve energy, such as sitting down while dressing, shaving, or preparing food; sitting on a shower chair while bathing; or using disposable items for eating so that no cleanup is needed. Bathing before breakfast would not help conserve energy. Resting after every third major activity is not individualized to what each client can tolerate.

DIF: Application/Applying REF: p. 2110 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Rest and Sleep

15. A client with AIDS has the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements. The nurse should

a.

encourage sweet foods and desserts that appeal to the taste.

b.

encourage the client to dine alone to focus on food intake.

c.

instruct the client to prepare meals, then divide and freeze them.

d.

tell the client to eat large meals to result in greater intake.

ANS: C

Interventions include eating small meals frequently throughout the day; preparing meals ahead of time so they can be divided into individual servings and frozen until ready to use; encouraging the client to dine with family and friends; and consuming more nutrient-dense foods and beverages rather than filling up on low-calorie items. Sweet foods, while providing calories, do not provide the nutrition a client with AIDS needs. Dining alone may seem depressing to some clients as eating is a social activity. Clients may not be able to tolerate large meals.

DIF: Application/Applying REF: pp. 2110-2111

OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

16. When a client with AIDS experiences pain while swallowing, the nurse could suggest

a.

avoiding the use of straws while drinking.

b.

drinking acidic juices such as orange juice.

c.

eating very cold foods.

d.

increasing the intake of well-cooked eggs and noodle dishes.

ANS: D

Encourage the client to eat foods at room temperature; choose mild foods and drinks, such as apple juice rather than orange juice; eat nonabrasive foods that are easy to swallow (well-cooked eggs, noodle dishes); and use a straw while drinking.

DIF: Analysis/Analyzing REF: p. 2111 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

17. The situation that would be least helpful to manage pain in the AIDS client who is an injecting drug user is

a.

carefully rationing narcotic prescriptions.

b.

having multiple practitioners prescribing medications.

c.

limiting rescue doses of narcotic analgesics on a monthly basis.

d.

refusing to fill lost prescriptions.

ANS: B

Helpful guidelines include having a single practitioner prescribe medications. Rationing medications is unethical as clients who are drug addicts still experience pain and need to be treated for it. Rescue pain medications need to be available for breakthrough pain. Clients who frequently lose prescriptions can be managed by phoning in prescriptions if the provider is worried about abuse. The major point is that clients deserve to have their pain managed.

DIF: Application/Applying REF: p. 2112 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Palliative/Comfort Care

18. When the AIDS client refuses pain medication because he or she is not in pain presently, the nurse should explain that

a.

refraining from using the medication makes its effectiveness last longer.

b.

skipping a dose will decrease diarrhea.

c.

taking the medication on schedule keeps the blood level constant.

d.

using the drug will increase the appetite.

ANS: C

Taking pain medication on a schedule keeps the blood level constant and incidentally helps control diarrhea by the side effect of constipation. Refraining from using the medications will not make its effects last longer, and skipping a dose does not cause diarrhea. Side effects of most pain medications do not include increased appetite.

DIF: Application/Applying REF: p. 2112 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Palliative/Comfort Care

19. The nurse counsels other co-workers that the suggested treatment for HIV exposure is

a.

a single retroviral medication for 2 weeks.

b.

combination retroviral medications for 2 weeks.

c.

determined by the severity of the exposure and other factors.

d.

watching and waiting for 12 weeks post-exposure.

ANS: C

The current response to occupational exposures is determined by the severity of the exposure and patient-related factors. The U.S. Public Health Service has a stratified algorithm for treatment, with most cases requiring a two-drug approach for 4 weeks.

DIF: Analysis/Analyzing REF: p. 2094 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Potential for Alteration in Body Systems

20. The client who has a positive enzyme immunoassay test asks the nurse if that means that he is HIV positive. The nurses most helpful response would be

a.

No, many people have positive enzyme immunoassays.

b.

No, you need to have the Western blot test to confirm that you are positive.

c.

Yes, but antiretrovirals will probably combat the infection now.

d.

Yes, you should seek medical care for antiretroviral drugs.

ANS: B

If the enzyme immunoassay is positive, the Western blot test is needed to confirm an HIV-positive status.

DIF: Analysis/Analyzing REF: p. 2098 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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