Chapter 19: Care of Patients with HIV Disease and Other Immune Deficiencies

Chapter 19: Care of Patients with HIV Disease and Other Immune Deficiencies

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The nurse is caring for a client diagnosed with human immune deficiency virus. The client’s CD4+ cell count is 399/mm³. What action by the nurse is best?
   1. Counsel the client on safer sex practices/abstinence.
   2. Encourage the client to abstain from alcohol.
   3. Facilitate genetic testing for CD4+ CCR5/CXCR4 co-receptors.
   4. 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: 328                     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?
   1. Anal intercourse
   2. Masturbation
   3. Oral sex
   4. 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: 330                     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?
   1. Consistent use of Standard Precautions
   2. Double-gloving before body fluid exposure
   3. Labeling charts and armbands “HIV+”
   4. 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: 332                     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 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?
   1. Initiate Droplet Precautions for the client.
   2. Notify the provider about the CD4+ results.
   3. Place the client under Airborne Precautions.
   4. Use Standard Precautions to provide care.

ANS:           C

Since this client’s 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: 334          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