Chapter 015

Lewis: Medical-Surgical Nursing, 7
th
Edition
Test Bank
Chapter 15: Infection and Human Immunodeficiency Virus Infection
MULTIPLE CHICE
1. A patient who seeks health care for a!ue symptoms of fati!ue and headaches has
HIV testin! and is found to hae a positie en"yme immunoassay #$IA% for HIV
anti&odies. In discussin! the test results with the patient' the nurse informs the patient
that
a. the en"yme immunoassay test will need to &e repeated to erify the results.
&. a iral culture will &e done to determine the pro!ress of the disease.
c. it will pro&a&ly &e 1( or more years &efore the patient deelops AI)*.
d. the +estern &lot test will need to &e done to determine whether AI)* has
deeloped.
Correct !nswer: A
"ationale: After an initial positie $IA test' the $IA is repeated &efore more specific
testin! such as the +estern &lot is done. Viral cultures are not part of HIV testin!.
Because the nurse does not know how recently the patient was infected' it is not
appropriate to predict the time frame for AI)* deelopment. The +estern &lot tests for
HIV anti&odies' not for AI)*.
Cogniti#e Le#el: Application Te$t "e%erence: p. ,5-
Nursing Process: Implementation NCLE&: .hysiolo!ical Inte!rity
,. /our years after seroconersion' an HIV0infected patient has a C)1
2
cell count of
3((45l and a low iral load. The nurse teaches the patient that
a. the patient is at risk for deelopment of opportunistic infections &ecause of C)1
2

cell destruction.
&. the patient is in a clinical and &iolo!ic latent period' durin! which ery few iruses
are &ein! replicated.
c. anti0HIV anti&odies produced &y B cells enter C)1
2
cells infected with HIV to stop
replication of iruses in the cells.
d. the &ody currently is a&le to produce an ade6uate num&er of C)1
2
cells to replace
those destroyed &y iral actiity.
Correct !nswer: )
"ationale: The patient is the early chronic sta!e of infection' when the &ody is a&le to
produce enou!h C)1
2
cells to maintain the C)1
2
count at a normal leel. The risk for
opportunistic infection is low &ecause of the normal C)1
2
count. Althou!h the iral load
in the &lood is low' intracellular reproduction of irus still occurs. Anti0HIV anti&odies
produced &y B cells attack the iruses in the &lood' &ut not intracellular iruses.
Copyri!ht 7 ,((8 &y 9os&y' Inc.' an affiliate of $lseier Inc.
Test Bank
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5,' ,58
:. A patient who tested positie for HIV : years a!o is admitted to the hospital with
Pneumocystis jiroveci pneumonia #.C.%. Based on dia!nostic criteria esta&lished &y
the Centers for )isease Control and .reention #C)C%' the patient is dia!nosed as
hain!
a. early chronic infection.
&. HIV infection.
c. AI)*.
d. intermediate chronic infection.
Correct !nswer: C
"ationale: )eelopment of .C. pneumonia meets the dia!nostic criterion for AI)*. The
other responses indicate an earlier sta!e of HIV infection than is indicated &y the .C.
infection.
Cogniti#e Le#el: Comprehension Te$t "e%erence: p. ,5:
Nursing Process: Assessment NCLE&: .hysiolo!ical Inte!rity
1. )urin! posttest counselin! for a patient who has positie testin! for HIV' the patient
is an;ious and does not appear to hear what the nurse is sayin!. At this time' it is most
important that the nurse
a. inform the patient how to protect se;ual and needle0sharin! partners.
&. teach the patient a&out the medications aaila&le for treatment.
c. ask the patient to notify indiiduals who hae had risky contact with the patient.
d. remind the patient a&out the need to return for retestin! to erify the results.
Correct !nswer: )
"ationale: After an initial positie anti&ody test' the ne;t step is retestin! to confirm the
results. A patient who is an;ious is not likely to &e a&le to take in new information or &e
willin! to disclose information a&out HIV status of other indiiduals.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5-' ,-1
Nursing Process: Implementation NCLE&: .sychosocial Inte!rity
5. A patient who is dia!nosed with AI)* and has deeloped <aposi=s sarcoma tells the
nurse' >I hae lots of thou!hts a&out dyin!. )o you think I am ?ust &ein! mor&id@A
+hich response &y the nurse is most appropriate@
a. >Thinkin! a&out dyin! will not improe the course of AI)*.A
&. >Althou!h your dia!nosis is serious' there are more treatments aaila&le now.A
c. >Try to focus on the !ood thin!s in life &ecause stress impairs the immune system.A
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d. >Tell me what kind of thou!hts you hae a&out dyin!.A
Correct !nswer: )
"ationale: 9ore assessment of the patient=s psychosocial status is needed &efore takin!
any other action. The statements' >Thinkin! a&out dyin! will not improe the course of
AI)*A and >Try to focus on the !ood thin!s in life BA discoura!e the patient from
sharin! any further information with the nurse and decrease the nurse=s a&ility to deelop
a trustin! relationship with the patient. The statement' >Althou!h your dia!nosis is
serious' there are more treatments aaila&le nowA is correct' &ut without further
assessment' it is impossi&le to know whether this responds to the patient=s concerns.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,-(' ,-5' ,-8
Nursing Process: Implementation NCLE&: .sychosocial Inte!rity
-. A pre!nant woman with a history of asymptomatic HIV infection is seen at the clinic.
+hich information will the nurse include when teachin! the patient@
a. Althou!h infants of HIV0infected mothers always test positie for HIV anti&odies'
most infants are not infected with the irus.
&. Because she has not deeloped AI)*' the infant will not contract HIV durin!
intrauterine life.
c. The infant will &e started on "idoudine #ACT% after deliery to preent HIV
infection.
d. It is likely that her new&orn will deelop HIV infection unless she takes
antiretroiral dru!s durin! the pre!nancy.
Correct !nswer: A
"ationale: Because anti&odies are transmitted from the mother to the fetus durin!
intrauterine life' all infants of HIV0positie mothers will test positie at &irth. Dn!oin!
anti&ody #or iral% testin! is needed to determine whether the infant is infected with HIV.
Transmission of the irus can occur durin! fetal life een if the mother does not hae
AI)*. Infants of HIV0positie mothers are not routinely started on antiretroiral therapy
#AET%. Dnly ,5F of infants &orn to HIV0positie mothers deelop HIV infection' een
when the mother does not use AET durin! pre!nancy.
Cogniti#e Le#el: Application Te$t "e%erence: p. ,5(
Nursing Process: Implementation
NCLE&: Health .romotion and 9aintenance
8. Interentions such as promotion of nutrition' e;ercise' and stress reduction should &e
promoted &y the nurse for patients who hae HIV infection' primarily &ecause these
interentions will
a. promote a feelin! of well0&ein! in the patient.
&. preent transmission of the irus to others.
c. improe the patient=s immune function.
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d. increase the patient=s stren!th and self0care a&ility.
Correct !nswer: C
"ationale: The primary !oal for the patient with HIV infection is to increase immune
function' and these interentions will promote a healthy immune system. They may also
promote a feelin! of well0&ein! and increase stren!th' &ut these are not the priority !oals
for HIV0positie patients. These actiities will not preent the risk for transmission to
others &ecause the patient will still &e HIV positie.
Cogniti#e Le#el: Comprehension Te$t "e%erence: p. ,-5
Nursing Process: .lannin! NCLE&: .hysiolo!ical Inte!rity
3. The occupational health nurse will teach the nursin! staff that the hi!hest risk of
ac6uirin! HIV from an HIV0infected patient is
a. a needlestick with a suture needle durin! a sur!ical procedure.
&. contamination of open skin lesions with a!inal secretions.
c. a needlestick with a needle and syrin!e used to draw &lood.
d. splashin! the eyes when emptyin! a &edpan containin! stool.
Correct !nswer: C
"ationale: .uncture wounds are the most common means for workplace transmission of
&lood0&orne diseases' and a needle with a hollow &ore that had &een contaminated with
the patient=s &lood would &e a hi!h0risk situation. The other situations descri&ed would
&e much less likely to result in transmission of the irus.
Cogniti#e Le#el: Comprehension Te$t "e%erence: p. ,5(
Nursing Process: Assessment
NCLE&: *afe and $ffectie Care $nironment
G. A patient has recently tested positie for HIV and asks the nurse a&out dru! therapy
for HIV infection. The nurse informs the patient that
a. dru! therapy for HIV is indicated only for patients whose C)1
2
cell counts indicate
that AI)* has deeloped.
&. medication therapy is delayed as lon! as possi&le to preent deelopment of iral
resistance to the dru!s.
c. treatment is indiiduali"ed &ased on C)1
2
counts' the amount of irus in the &lood'
and the patient=s wishes.
d. AET is typically started soon after HIV dia!nosis to preent pro!ression of the
disease.
Correct !nswer: C
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"ationale: AET is typically considered when the C)1
2
count drops &elow normal leels
or the iral load is hi!h in patients who are appropriate for AET and desire AET. AET is
used to preent the pro!ression to AI)* and is used in patients who hae AI)*. AET is
not delayed as lon! as possi&le &ut can &e started when the C)1
2
counts are relatiely
hi!h in some patients. AET is not started soon after HIV dia!nosisH rather' it is started
when C)1
2
count' iral load' or patient symptoms indicate that it will &e &eneficial.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5-0,58
1(. )ru! therapy is &ein! considered for an HIV0infected patient who has a C)1
2
cell
count of 1((45l. The nursin! assessment that is most important in determinin!
whether therapy will &e used is the patient=s
a. social support system offered &y si!nificant others and family.
&. socioeconomic status and aaila&ility of medical insurance.
c. understandin! of the multiple side effects that the dru!s may cause.
d. willin!ness and a&ility to comply with strin!ent medication schedules.
Correct !nswer: )
"ationale: )ru! resistance deelops 6uickly unless the patient takes multiple dru!s on a
strin!ent schedule' and this endan!ers &oth the patient and the community. The other
information is also important to consider' &ut patients who are una&le to mana!e and
follow a comple; dru! treatment re!imen should not &e considered for AET.
Cogniti#e Le#el: Comprehension Te$t "e%erence: pp. ,-10,-5
11. +hich of these patients will the nurse workin! in an HIV testin! and treatment clinic
anticipate teachin! a&out AET@
a. A patient who is HIV ne!atie &ut has unprotected se; with multiple partners
&. A patient who has &een HIV positie for 5 years and has cytome!aloirus #C9V%
retinitis
c. A patient who was infected with HIV 15 years a!o and has a C)1 count of 81(45l
d. An HIV0positie patient with a C)1 count of 1,(45l who drinks a fifth of whiskey
daily
Correct !nswer: B
"ationale: C9V retinitis is an AI)*0definin! illness and indicates that the patient is
appropriate for AET een thou!h the HIV infection period is relatiely short. An HIV0
ne!atie patient would not &e offered AET. A patient with a C)1
2
count in the normal
ran!e would not re6uire AET. A patient who drinks alcohol heaily would &e unlikely to
&e a&le to mana!e the comple; dru! re!imen and would not &e appropriate for AET
despite the low C)1
2
count.
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Cogniti#e Le#el: Application Te$t "e%erence: p. ,5:
1,. +hen teachin! a patient with HIV infection a&out AET' the nurse e;plains that these
dru!s
a. work in arious ways to decrease iral replication in the &lood.
&. &oost the a&ility of the immune system to destroy the irus.
c. destroy intracellular irus as well as lowerin! the iral load.
d. increase the num&er of C)1
2
cells aaila&le to fi!ht the HIV.
Correct !nswer: A
"ationale: The three !roups of antiretroiral dru!s work in different ways to decrease the
a&ility of the irus to replicate. The dru!s do not work &y &oostin! the a&ility of the
immune system or C)1 cells to fi!ht the irus. The iral load detected in the &lood is
decreased with effectie therapy' &ut intracellular irus is still present.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5-0,58
1:. +hen assessin! an indiidual who has &een dia!nosed with early chronic HIV
infection and has a normal C)1
2
count' the nurse will
a. ask a&out pro&lems with diarrhea.
&. e;amine the oral mucosa for lesions.
c. check neurolo!ic orientation.
d. palpate the re!ional lymph nodes.
Correct !nswer: )
"ationale: .ersistent !enerali"ed lymphadenopathy is common in the early sta!e of
chronic infection. )iarrhea' oral lesions' and !ait a&normalities would occur in the later
sta!es of HIV infection.
Cogniti#e Le#el: Application Te$t "e%erence: p. ,5,
Nursing Process: Assessment NCLE&: .hysiolo!ical Inte!rity
11. +hile teachin! community !roups a&out AI)*' the nurse informs people that the
most common method of transmission of the HIV irus currently is
a. perinatal transmission to the fetus.
&. sharin! e6uipment to in?ect ille!al dru!s.
c. transfusions with HIV0contaminated &lood.
d. se;ual contact with an infected partner.
Correct !nswer: )
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"ationale: *e;ual contact with an infected partner is currently the most common mode
of transmission' althou!h HIV is also spread throu!h perinatal transmission' throu!h
sharin! dru! in?ection e6uipment' and throu!h transfusions with HIV0infected &lood.
Cogniti#e Le#el: Comprehension Te$t "e%erence: p. ,5(
15. A ,10year0old woman who uses in?ecta&le ille!al dru!s asks the nurse a&out
preentin! AI)*. The nurse informs the patient that the &est way to reduce the risk of
HIV infection from dru! use is to
a. participate in a needle0e;chan!e pro!ram.
&. clean dru! in?ection e6uipment &efore use.
c. ask those who share e6uipment to &e tested for HIV.
d. aoid se;ual intercourse when usin! in?ecta&le dru!s.
Correct !nswer: A
"ationale: .articipation in needle0e;chan!e pro!rams has &een shown to control the rate
of HIV infection. Cleanin! dru! e6uipment &efore use also reduces risk' &ut it mi!ht not
&e consistently practiced &y indiiduals in withdrawal. HIV anti&odies do not appear for
seeral weeks to months after e;posure' so testin! dru! uses would not &e ery effectie
in reducin! risk for HIV e;posure. It is difficult to make appropriate decisions a&out
se;ual actiity when under the influence of dru!s.
Cogniti#e Le#el: Comprehension Te$t "e%erence: pp. ,-,0,-:
Nursing Process: .lannin!
1-. At the health promotion leel of care for HIV infection' which 6uestion is most
appropriate for the nurse to ask@
a. >Are you hain! any symptoms such as seere wei!ht loss or confusion@A
&. >Are you e;periencin! any side effects from the antiretroiral medications@
c. >)o you need any assistance to o&tain antiretroiral dru!s or other treatments@A
d. >)o you use any in?ecta&le dru!s or hae se;ual actiity with multiple partners@A
Correct !nswer: )
"ationale: At the health0promotion leel' the nurse screens for &ehaiors that mi!ht
increase the risk for HIV infection and implements interentions to preent infection #or'
in the case of an already infected patient' implement interentions to preent pro!ression
of the disease to AI)*%. The other 6uestions would &e appropriate at the acute
interention leel' when the patient already has si!nificant immune compromise.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,-(0,-1
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18. A patient with HIV infection has deeloped Mycobacterium avium comple; infection.
An appropriate outcome for the patient is that the patient will
a. &e free from in?ury.
&. maintain intact perineal skin.
c. hae ade6uate o;y!enation.
d. receie immuni"ations.
Correct !nswer: B
"ationale: The ma?or manifestation of M. avium infection is loose' watery stools' which
would increase the risk for perineal skin &reakdown. The other outcomes would &e
appropriate for other complications #pneumonia' dementia' influen"a' etc% associated with
HIV infection.
Cogniti#e Le#el: Analysis Te$t "e%erence: p. ,55
13. A patient who has &een treated for HIV infection for 8 years has deeloped fat
redistri&ution to the trunk' with wastin! of the arms' le!s' and face. The nurse will
anticipate teachin! the patient a&out
a. treatment with antifun!al a!ents.
&. a chan!e in antiretroiral therapy.
c. foods that are hi!her in protein.
d. the &enefits of daily e;ercise.
Correct !nswer: B
"ationale: A fre6uent first interention for meta&olic disorders is a chan!e in AET.
Treatment with antifun!al a!ents would not &e appropriate &ecause there is no indication
of fun!al infection. Chan!es in diet or e;ercise hae not proen helpful for this pro&lem.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,--0,-8
1G. The nurse is preparin! to !ie the followin! medications to an HIV0positie patient
who is hospitali"ed with .C.. +hich is most important to administer at the ri!ht
time@
a. Iystatin #9ycostatin% ta&let for a!inal candidiasis
&. Aerosoli"ed pentamadine #Ie&u.ent% for .C. infection
c. Dral acycloir ##Coira; to treat systemic herpes simple;
d. Dral sa6uinair #Inerase% to suppress HIV infection
Correct !nswer: )
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"ationale: It is important that antiretroirals &e taken at the prescri&ed time eery day to
aoid deelopin! dru!0resistant HIV. The other medications should also &e !ien as close
as possi&le to the correct time' &ut they are not as essential to receie at the same time
eery day.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,53' ,-10,-5
,(. To ealuate the effectieness of AET' the nurse will schedule the patient for
a. iral load testin!.
&. en"yme immunoassay.
c. rapid HIV anti&ody testin!.
d. immunofluorescence assay.
Correct !nswer: A
"ationale: The effectieness of AET is measured &y the decrease in the amount of irus
detecta&le in the &lood. The other tests are used to detect for HIV anti&odies' which
remain positie een with effectie AET.
Cogniti#e Le#el: Application Te$t "e%erence: p. ,-5
,1. +hen desi!nin! a pro!ram to decrease the incidence of HIV infection in the
community' the nurse will prioriti"e education a&out
a. how to preent transmission &etween se;ual partners.
&. methods to preent perinatal HIV transmission.
c. ways to sterili"e needles used &y in?ecta&le dru! users.
d. means to preent transmission throu!h &lood transfusions.
Correct !nswer: A
"ationale: *e;ual transmission is the most common way that HIV is transmitted. The
nurse should also proide education a&out perinatal transmission' needle sterili"ation' and
&lood transfusion' &ut the rate of HIV infection associated with these situations is lower.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5(' ,-(0,-:
MULTIPLE "ESPNSE
1. The nurse e;plains to the patient newly dia!nosed with HIV that prophylactic
measures that should &e taken as early as possi&le durin! the course of the infection
include which the followin! #*elect all that apply.%@
a. Hepatitis A accine
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Test Bank
&. Hepatitis B accine
c. .neumococcal accine
d. Influen"a irus accine
e. Trimethoprim0sulfametho;a"ole
f. Varicella "oster immune !lo&ulin
Correct !nswer: A' B' C' )
"ationale: .reention of other infections is an important interention in patients who are
HIV positie' and these accines are recommended as soon as the HIV infection is
dia!nosed. Anti&iotics and immune !lo&ulin are used to preent and treat infections that
occur later in the course of the disease' when the C)1 count has dropped or when
infection has occurred.
Cogniti#e Le#el: Application Te$t "e%erence: pp. ,5:0,55
Nursing Process: Implementation
1501(

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