Lewis: Medical Surgical Nursing in Canada Test Bank Chapter 14: Human Immunodeficiency Virus Infection

MULTIPLE CHOICE 1. A recently divorced woman seeks health care for vague symptoms of fatigue and headache. During her examination, she agrees to human immunodeficiency virus (HIV) testing and is found to have a positive enzyme immunoassay (EIA) for HIV antibodies. In discussing the test results with the client, what should the nurse inform the client? 1. The EIA test will need to be repeated to verify the results. 2. A viral culture will be done to determine the progress of her disease. 3. It will probably be ten or more years before she develops acquired immunodeficiency syndrome (AIDS). 4. The EIA test is frequently false-positive, and a more specific Western blot test will determine whether she has AIDS. ANS: 1 PTS: 1 REF: Text Reference: p. 275 DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

2. Four years after seroconversion, an HIV-infected client has a CD4+ T cell count of 800/ L and a low viral load. What does the nurse recognize at this time? 1. The client is at risk for development of opportunistic infections because of CD4+ T cell destruction. 2. The client is in a clinical and biological latent period during which very few viruses are being replicated. 3. The body currently is able to produce an adequate number of CD4++ T cells to replace those destroyed by viral activity. 4. Anti-HIV antibodies produced by B cells enter CD4+ T cells infected with HIV to stop replication of viruses in the cells. ANS: 3 PTS: 1 REF: Text Reference: p. 271 DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis

3. A client who tested positive for HIV three years ago is admitted to the hospital with Pneumocystis carinii pneumonia. Based on diagnostic criteria established by the Centers for Disease Control and Prevention, what is the client diagnosed as having? 1. AIDS 3. Early chronic infection 2. HIV infection 4. Intermediate chronic infection ANS: 1 PTS: 1 REF: Text Reference: p. 272 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

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2 4. To evaluate the effect of HIV infection in a client, the nurse assesses the client with the knowledge that in addition to lymphocytes, the virus also commonly infects which of the following? 1. Osteocytes 3. Hepatocytes 2. Astrocytes 4. Erythrocytes ANS: 2 PTS: 1 REF: Text Reference: p. 271 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

5. During post-test counselling for a client who has tested positive for HIV, the client is very anxious and does not appear to hear what the nurse is saying. To promote the clients adjustment to HIV infection, what is it important that the nurse does? 1. Inform the client how to protect sexual and needle-sharing partners. 2. Teach the client about the medications that are available for treatment. 3. Identify the need to test others who have had risk contact with the client. 4. Discuss retesting to verify the results, which will ensure continuing contact with the health care system. ANS: 4 PTS: 1 REF: Text Reference: p. 281 DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

6. A client who is diagnosed with AIDS with the development of Kaposis sarcoma tells the nurse she worries about dying and wonders whether she is being overly morbid. What is the most appropriate response by the nurse? 1. Thinking about dying will not change the prognosis of your disease. 2. Although your diagnosis is serious, research may give us a cure any day. 3. You should focus on the good things in your life because stress impairs the immune system. 4. It is realistic to think about death. There is a very high and consistent mortality rate with your diagnosis. ANS: 4 PTS: 1 REF: Text Reference: p. 288 DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

7. A young mother with a history of intravenous drug use and HIV infection delivered a baby who has tested positive for HIV. The mother will not care for the baby because she believes the baby will die soon. In counselling the mother about the care of her infant, what is an appropriate approach by the nurse? 1. Confirm with the mother that the baby will develop AIDS and refer her to a local AIDS support group. 2. Remind her that she has not yet developed AIDS and that it is possible the baby will not develop AIDS for many years. 3. Inform her that if the infant is started on zidovudine (AZT) within the first month after delivery, AIDS can be prevented. 4. Inform her that although infants of HIV-infected mothers always test positive for HIV antibodies, most infants are not infected with the virus. ANS: 4 PTS: 1 DIF: Cognitive Level: Application

Test Bank REF: Text Reference: pp. 283284

3 TOP: Nursing Process: Implementation

8. Interventions such as promotion of nutrition, exercise, and stress reduction should be promoted by the nurse in clients who have HIV infection primarily because these interventions will do which of the following? 1. Improve immune function 2. Prevent transmission of the virus to others 3. Promote a feeling of well-being in the client 4. Increase the clients strength and ability to care for himself or herself ANS: 1 PTS: 1 REF: Text Reference: p. 287 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning

9. In health care workers, what is the highest risk activity of acquiring HIV from an HIV-infected client? 1. A needle stick with a suture needle 2. Contamination of open skin lesions with vaginal secretions 3. A needle stick with a needle and syringe used to draw blood 4. A needle stick with a needle and syringe used to administer an IM injection ANS: 3 PTS: 1 REF: Text Reference: p. 269 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

10. A client has recently tested positive for HIV and asks the nurse about drug therapy for HIV infection. What should the nurse inform the client about drug therapy? 1. Drug therapy for HIV is indicated only when CD4++ T cell counts are abnormal. 2. Drug therapy is delayed as long as possible to prevent development of viral resistance to the drugs. 3. When to start drug therapy is controversial and treatment decisions are individualized for each client. 4. Zidovudine (AZT) is administered initially to all clients who test positive for HIV to slow viral growth. ANS: 3 PTS: 1 REF: Text Reference: p. 268 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation

11. Drug therapy is being considered for an HIV-infected client who has asymptomatic HIV infection with a CD4+ T cell count of 400/ L. What nursing assessment is most important in determining whether therapy will be used? 1. The clients social support system offered by significant others and family 2. The clients socio-economic status and availability of medical insurance 3. The clients understanding of the multiple side effects that the drugs may cause 4. The clients willingness and ability to comply with stringent schedules and dietary prescriptions ANS: 4 PTS: 1 REF: Text Reference: p. 276 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

Copyright 2007 Elsevier Canada Ltd. All rights reserved.

4 12. A client with recent HIV seroconversion and early chronic infection asks the nurse what to expect in terms of disease progression. Although the disease can vary greatly among individuals, what should the nurse tell the client about the usual pattern of progression? 1. There will be about a ten-year period of vague and non-specific symptoms before the onset of AIDS. 2. There will be eight to twelve years of chronic flu-like symptoms before the development of serious opportunistic infections or tumours. 3. There will be an eight-year period of normal to slightly decreased T cell counts followed by about two years of symptoms before AIDS occurs. 4. There will be an eight- to ten-year period of asymptomatic infection in which the virus is in remission before it becomes active and causes opportunistic diseases. ANS: 3 PTS: 1 REF: Text Reference: p. 271 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation

13. When teaching a client with HIV infection about antiretroviral therapy, what should the nurse explain that these drugs do? 1. They inhibit the enzymes that are necessary for viral replication in the cell. 2. They alter the cellular surface of cells with CD4 receptors, preventing viral attachment. 3. They destroy the viral envelope, enabling monocyte and macrophage phagocytosis of the viral RNA. 4. They stimulate the activity of B lymphocytes to produce antibodies that react with the virus in the blood. ANS: 1 PTS: 1 REF: Text Reference: pp. 275, 286 DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis

14. What early manifestations of HIV infection should the nurse assess for in both the nursing history and physical examination? 1. Ataxia and confusion 3. Lesions of the mouth and tongue 2. Rectal lesions and bleeding 4. Weight loss and wasting syndrome ANS: 3 PTS: 1 REF: Text Reference: p. 272 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

15. While teaching community groups about AIDS, what should the nurse inform people that the most common method of transmission of the HIV virus currently is? 1. Non-sexual exposure to saliva and tears 2. Sharing equipment to inject illegal drugs 3. Transfusions with HIV-contaminated blood 4. Sexual contact with an HIV-infected partner ANS: 4 PTS: 1 REF: Text Reference: p. 268269 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

Test Bank

16. A 24-year-old woman who uses injectable, illegal drugs asks the nurse about preventing AIDS. Which of the following activities should the nurse inform the client can eliminate the risk of HIV infection from drug use? 1. Participating in a needle exchange program 2. Cleaning drug injection equipment before use 3. Asking those she shares equipment with to be tested for HIV 4. Not having sexual intercourse when under the influence of the drugs ANS: 1 PTS: 1 REF: Text Reference: p. 283 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Planning

17. At the health promotion level of care for HIV infection, what should the nurse assess for? 1. Symptoms the client may be experiencing 2. Drug side effects or interactions that may be present 3. The clients need for assistance from the community 4. Behaviours that place the client at risk for HIV infection ANS: 4 PTS: 1 REF: Text Reference: p. 285 DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

18. A client with HIV infection has developed Mycobacterium avium complex. What is an appropriate outcome for the nurse to expect for the client? 1. The client will be free from injury. 2. The client will maintain intact perineal skin. 3. The client will maintain adequate oxygenation. 4. The client will contact agencies that provide services for the visually impaired. ANS: 2 PTS: 1 REF: Text Reference: p. 288 DIF: Cognitive Level: Application TOP: Nursing Process: Planning

19. A client who has been treated for HIV infection for seven years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. What should the nurse explain to the client that this development of metabolic disorders usually requires? 1. Treatment with antifungal agents 2. A change in antiretroviral therapy 3. A change to a high-calorie, high-carbohydrate diet 4. The addition of anabolic steroids to the medication regimen ANS: 2 PTS: 1 REF: Text Reference: p. 289 DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis

20. What is one of the most important ways that the nurse can assist the client with acute HIV infection? 1. Provide post-test counselling. 2. Promote health maintenance measures. 3. Assist with funeral plans and estate planning. 4. Establish a long-term, trusting relationship with the client, family, and significant

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6 others. ANS: 4 PTS: 1 REF: Text Reference: p. 282 MULTIPLE RESPONSE 1. Which of the following prophylactic measures should the nurse explain to the client newly diagnosed with HIV should be taken as early as possible during the course of the infection? (Select all answers that apply.) 1. Hepatitis A vaccine 2. Hepatitis B vaccine 3. Pneumococcal vaccine 4. Influenza virus vaccine 5. Trimethoprim-sulfamethoxazole 6. Varicella zoster immune globulin ANS: 1, 2, 3, 4 PTS: 1 REF: Text Reference: p. 279 DIF: Cognitive Level: Application TOP: Nursing Process: Implementation DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation