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Medical Surgical Nursing 6th Edition Lewis Heitkemper Dirksen Test Bank

ISBN-13: 978-0323016100

ISBN-10: 0323016103

 

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Lewis: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 6^th Edition

 

Test Bank

 

Chapter 14: Human Immunodeficiency Virus Infection

 

1. A recently divorced woman seeks health care for vague symptoms of fatigue and headache. During her examination, she agrees to HIV testing and is found to have a positive enzyme immunoassay (EIA) for HIV antibodies. In discussing the test results with the patient, the nurse informs the patient that
   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 10 or more years before she develops AIDS.
   4. the EIA test is frequently false positive, and a more specific Western blot test will determine whether she has AIDS.

 

Answer: 1

Nursing Process: Implementation

Cognitive Level: Application

NCLEX: Physiologic Integrity

Text Reference: p. 271

 

2. Four years after seroconversion, an HIV-infected patient has a CD4+ T cell count of 800/ml and a low viral load. The nurse recognizes that at this time
   1. the patient is at risk for development of opportunistic infections because of CD4+ T cell destruction.
   2. the patient is in a clinical and biologic 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.

 

Answer: 3

Nursing Process: Diagnosis

Cognitive Level: Application

NCLEX: Physiologic Integrity

Text Reference: p. 267

 

3. A patient who tested positive for HIV 3 years ago is admitted to the hospital with Pneumocystis carinii pneumonia. Based on diagnostic criteria established by the Centers for Disease Control and Prevention, the patient is diagnosed as having
   2. HIV infection.

3. early chronic infection.
4. intermediate chronic infection.

 

Answer: 1

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 268

 

4. To evaluate the effect of HIV infection in a patient, the nurse assesses the patient with the knowledge that in addition to lymphocytes, the virus also commonly infects

 

Answer: 2

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 267

 

5. During posttest counseling for a patient who has positive testing for HIV, the patient is very anxious and does not appear to hear what the nurse is saying. To promote the patient’s adjustment to HIV infection, it is important that the nurse
   1. inform the patient how to protect sexual and needle-sharing partners.
   2. teach the patient about the medications that are available for treatment.
   3. identify the need to test others who have had risk contact with the patient.
   4. discuss retesting to verify the results, which will ensure continuing contact with the health care system.

 

Answer: 4

Nursing Process: Implementation

Cognitive Level: Application

NCLEX: Psychosocial Integrity

Text Reference: p. 281

 

6. A patient who is diagnosed with AIDS with the development of Kaposi’s sarcoma tells the nurse she worries about dying and wonders whether she is being overly morbid. The most appropriate response by the nurse is
   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.”

 

Answer: 4

Nursing Process: Implementation

Cognitive Level: Application

NCLEX: Psychosocial Integrity

Text Reference: pp. 285-286

 

7. A young mother with a history of IV 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 counseling the mother about the care of her infant, an appropriate approach by the nurse is to
   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.

 

Answer: 4

Nursing Process: Implementation

Cognitive Level: Application

NCLEX: Health Promotion and Maintenance

Text Reference: p. 270

 

8. Interventions such as promotion of nutrition, exercise, and stress reduction should be promoted by the nurse in patients who have HIV infection primarily because these interventions will
   1. improve immune function.
   2. prevent transmission of the virus to others.
   3. promote a feeling of well-being in the patient.
   4. increase the patient’s strength and ability to care for himself or herself.

 

Answer: 1

Nursing Process: Planning

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 283

 

9. In health care workers, the highest risk of acquiring HIV from an HIV-infected patient is
   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.

 

Answer: 3

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Safe and Effective Care Environment

Text Reference: p. 265

 

10. A patient has recently tested positive for HIV and asks the nurse about drug therapy for HIV infection. The nurse informs the patient that
    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 patient.
    4. zidovudine (AZT) is administered initially to all patients who test positive for HIV to slow viral growth.

 

Answer: 3

Nursing Process: Implementation

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 271

 

11. Drug therapy is being considered for an HIV-infected patient who has asymptomatic HIV infection with a CD4+ T cell count of 400/ml. The nursing assessment that is most important in determining whether therapy will be used is the patient’s
    1. social support system offered by significant others and family.
    2. socioeconomic status and availability of medical insurance.
    3. understanding of the multiple side effects that the drugs may cause.
    4. willingness and ability to comply with stringent schedules and dietary prescriptions.

 

Answer: 4

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Health Promotion and Maintenance

Text Reference: p. 273

 

12. A patient with recent HIV seroconversion and early chronic infection asks the nurse what to expect in terms of disease progression. The nurse tells the patient that although the disease can vary greatly among individuals, the usual pattern of progression includes
    1. about a 10-year period of vague and nonspecific symptoms before the onset of AIDS.
    2. 8 to 12 years of chronic flulike symptoms before the development of serious opportunistic infections or tumors.
    3. an 8-year period of normal to slightly decreased T cell counts followed by about 2 years of symptoms before AIDS occurs.
    4. an 8- to 10-year period of asymptomatic infection in which the virus is in remission before it becomes active and causes opportunistic diseases.

 

Answer: 3

Nursing Process: Implementation

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 268

 

13. When teaching a patient with HIV infection about antiretroviral therapy, the nurse explains that these drugs
    1. inhibit the enzymes that are necessary for viral replication in the cell.
    2. alter the cellular surface of cells with CD4 receptors, preventing viral attachment.
    3. destroy the viral envelope, enabling monocyte and macrophage phagocytosis of the viral RNA.
    4. stimulate the activity of B-lymphocytes to produce antibodies that react with the virus in the blood.

 

Answer: 1

Nursing Process: Diagnosis

Cognitive Level: Application

NCLEX: Physiologic Integrity

Text Reference: p. 282

 

14. Early manifestations of HIV infection that should be assessed by the nurse in both the nursing history and physical examination include
    1. ataxia and confusion.
    2. rectal lesions and bleeding.
    3. lesions of the mouth and tongue.
    4. weight loss and wasting syndrome.

 

Answer: 3

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Physiologic Integrity

Text Reference: p. 269

 

15. While teaching community groups about AIDS, the nurse informs people that the most common method of transmission of the HIV virus currently is
    1. nonsexual 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.

 

Answer: 4

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Health Promotion and Maintenance

Text Reference: p. 265

 

16. A 24-year-old woman who uses injectable, illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the risk of HIV infection from drug use can be eliminated by
    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.

 

Answer: 1

Nursing Process: Planning

Cognitive Level: Comprehension

NCLEX: Health Promotion and Maintenance

Text Reference: p. 279

 

17. At the health promotion level of care for HIV infection, the nurse assesses for
    1. symptoms the patient may be experiencing.
    2. drug side effects or interactions that may be present.
    3. the patient’s need for assistance from the community.
    4. behaviors that place the patient at risk for HIV infection.

 

Answer: 4

Nursing Process: Assessment

Cognitive Level: Comprehension

NCLEX: Health Promotion and Maintenance

Text Reference: p. 278

 

18. A patient with HIV infection has developed Mycobacterium avium complex. An appropriate outcome for the patient is that the patient will
    1. be free from injury.
    2. maintain intact perineal skin.
    3. maintain adequate oxygenation.
    4. contact agencies that provide services for the visually impaired.

 

Answer: 2

Nursing Process: Planning

Cognitive Level: Application

NCLEX: Physiologic Integrity

Text Reference: pp. 284-285

 

19. A patient who has been treated for HIV infection for 7 years has developed fat redistribution to the trunk, with wasting of the arms, legs, and face. The nurse explains to the patient 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.

 

Answer: 2

Nursing Process: Diagnosis

Cognitive Level: Application

NCLEX: Physiologic Integrity

Text Reference: p. 285

 

20. One of the most important ways the nurse can assist the patient with acute HIV infection is to
    1. provide posttest counseling.
    2. promote health maintenance measures.
    3. assist with funeral plans and estate planning.
    4. establish a long-term, trusting relationship with the patient, family, and significant others.

 

Answer: 4

Nursing Process: Implementation

Cognitive Level: Comprehension

NCLEX: Psychosocial Integrity

Text Reference: p. 278

 

21. The nurse explains to the patient newly diagnosed with HIV that prophylactic measures which should be taken as early as possible during the course of the infection include (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.

 

Answers: 1, 2, 3, 4

Nursing Process: Implementation

Cognitive Level: Application

NCLEX: Health Promotion and Maintenance

Text Reference: p. 275