Apply Your Knowledge
This chapter includes much needed information to help the nurse apply knowledge of immunologic disorders to the NCLEX exam. The following questions test your knowledge regarding the safe, effective care and management of the client with immunologic disorders.
The client is seen in the clinic requesting screening for HIV. Which of the following is a screening test for HIV?
- Viral load
- Viral culture
- CD4/CD8 count
The nurse has just taken a report and is preparing for the day’s activities. Which client with AIDS should be seen first?
- The client with Kaposi’s sarcoma
- The client with oral leukoplakia
- The client with vaginal candidiasis
- The client with Pneumocystis carinii pneumonia
The client with AIDS has a CD4 +T-cell count of 175 cu.mm/liter. The nurse is aware that:
- He is relatively free of HIV.
- He is at risk for opportunistic infections.
- He is likely to be asymptomatic.
- He is in remission with his disease.
Which medication is usually prescribed for the pregnant client with AIDS to prevent transmission of the virus from mother to infant?
- Acyclovir (Zovirax)
- Sulfamethaxazole (Bactrim)
- Zidovudine (AZT)
- Fluconazole (Diflucan)
The pregnant client with AIDS asks whether she should try to breast feed her baby after delivery. Which response is most appropriate?
- You can breast feed after the third day post-partum.
- Breast milk can cause cross contamination, leading to HIV infection in the infant.
- There is no risk with breast-feeding your infant when you have HIV infection.
- What did your doctor tell you about breast-feeding?
Which statement, if made by a client with AIDS, indicates understanding of the illness?
- I need to eat yogurt every day to provide needed calcium for my bones.
- I should peel and cook fruits before eating them.
- I can enjoy foods from the salad bar at my local restaurant.
- I might have to floss my teeth more often to prevent gum disease.
The client has been prescribed metronidazole (Flagyl) for Pneumocystis carinii pneumonia and candida. Which instruction should be given to the client taking Flagyl?
- Take the medication with water only.
- Arise slowly after taking the medication.
- Abstain from drinking alcohol while taking the medication.
- Remain supine for 30 minutes after taking the medication.
The client has a viral load of 1500 copies per mL. The nurse recognizes that this finding indicates the client is:
- At risk for opportunistic infections
- Relatively free of HIV infection
- In remission with his HIV infection
- Within the normal limits for viral load results
The nurse should use which solution to destroy HIV?
- Mild soap and water
- A hypochlorite solution
- Water only
- Bath oil
The client infected with HIV might be prescribed several medications to control replication of the AIDS virus. The combination of drug therapy is known by the abbreviation:
Answers to Exam Questions
- Answer C is correct. Answers A, B, and D are incorrect because these tests are used to track the progression of the illness, not to screen for the presence of HIV. Answer C is correct because the ELISA test is done on two occasions; if they are positive, a Western Blot assay is done to confirm the diagnosis.
- Answer D is correct. Answer A is incorrect because Kaposi’s sarcoma is a cancer of the connective tissue. The multifocal lesions are purplish in color and somewhat painful; however, there is no indication that this client is unstable. Answer B is incorrect because oral leukoplakia is a precancerous lesion that is not life-threatening. Answer C is incorrect because vaginal candidiasis or yeast is also not life threatening. Answer D is correct because Pneumocystis carinii pneumonia often causes airway closure and alterations in oxygen perfusion.
- Answer B is correct. The client with a CD4 +T-cell count of less than 200 is at risk for opportunistic diseases so B is correct. Answers A, C, and D are incorrect statements.
- Answer C is correct. The pregnant client with AIDS is treated with zivovudine (AZT) during pregnancy, and the infant is treated after delivery. Acyclovir, sulfamethazole, and fluconazole are not used to prevent transmission of the virus from mother to baby, so answers A, B, and D are incorrect.
- Answer B is correct. Breast-feeding your infant when you are HIV positive is contraindicated. Answer A is incorrect because it does not matter whether the mother breast-feeds immediately after delivery or waits to begin breast-feeding for three days. The breast milk is still likely to be contaminated. Answer C is incorrect because there is a risk with breast-feeding. Answer D is incorrect because this answer does not help the client to make an informed decision regarding breast-feeding with HIV.
- Answer B is correct. Fruits should be washed thoroughly and peeled before eating because they often contain bacteria. Answer A is incorrect because yogurt contains live cultured bacteria and can lead to opportunistic infections. Answer C is incorrect because the client should avoid eating from the salad bar; bacteria grows in foods that are not kept refrigerated. In addition, foods grown in or on the ground should be avoided. Answer D is incorrect because flossing the teeth might cause bleeding and infection. Use of soft toothbrushes and frequent dental check-ups help to prevent oral disease.
- Answer C is correct. Alcohol taken with Flagyl can cause extreme nausea; therefore, it should not be consumed by this client. Answer A is incorrect because Flagyl can be taken with juice or other liquids. Answers B and D are incorrect because Flagyl is not affected by position.
- Answer A is correct. A viral load greater than 400 copies/mL indicates the client is at risk for development of opportunistic infections. Answers B, C, and D are incorrect because they are untrue statements.
- Answer B is correct. A hypochlorite solution is 1 part bleach to 10 parts water. This solution has been found to effectively kill the virus that causes AIDS. Answer A is incorrect because hot water and strong soaps should be used, but these are not the most effective solution for killing HIV. Answers C and D are incorrect because water only and bath oil have not been shown to kill the virus that causes AIDS.
- Answer D is correct. HAART stands for Highly Active Retroviral Therapy. This therapy combines two or three different categories of drugs to combat HIV. Answer A is incorrect because ELISA stands for Enzyme Linked Immunosuppressant Assay. Answer B is incorrect because RIPA stands for Radiommunoprecipitation Assay, a screening test. Answer C is incorrect because IFA stands for Immunofluoruescence Assay, another screening test.