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A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
- A. Sign a refusal of blood transfusion form so the client will not receive the transfusion.
- B. Bank autologous blood.
- C. Ask people to donate blood.
- D. Use volume expanders in case blood is needed.
Correct Answer: B
Rationale: Banking autologous blood that is self-donated is the safest option for the client. Signing the refusal form does not give the client any information about the options that are available and places the client at risk. Directed donor blood may be no safer than blood collected from public donors. Those who support this belief say that directed donors may not reveal their high-risk behaviors that put the potential recipient at risk for blood-borne pathogens such as HIV.
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A client with acquired immune deficiency syndrome (AIDS) is brought to the clinic by a family member. The family member tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?
- A. Distal sensory polyneuropathy (DSP)
- B. Candidiasis
- C. AIDS dementia complex (ADC)
- D. Cytomegalovirus (CMV)
Correct Answer: C
Rationale: AIDS dementia complex, or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.
A client requires a blood transfusion for anemia and tells the nurse, 'I don't want a transfusion because I don't want to get AIDS.' Which is the best response from the nurse to the client?
- A. It's always a possibility.'
- B. You don't want to die, do you?'
- C. The blood is screened, and your risk is one in two million.'
- D. If you don't have the transfusion, you are taking a greater risk.'
Correct Answer: C
Rationale: Before 1984, blood and blood products were a major source of HIV transmission. Since then, an HIV screening test known as nucleic acid testing (NAT) is performed on all blood and plasma donations. Although screening donated blood for HIV antibodies reduces the risk of transfusion-related infection with HIV, it is not flawless. The Verywell Health's website states that the risk for HIV infection in the United States from a blood transfusion is approximately one in two million units of blood. Informing the client that transmission is always a possibility does not provide any information that will be relevant to the decision. The other responses are nontherapeutic and, therefore, should not be used as a response to the client's statement.
A client with cytomegalovirus (CMV) infection reports difficulty seeing. The physician determines that the client is developing CMV retinitis. What medication does the nurse anticipate the client will receive for this?
- A. zidovudine
- B. fluconazole
- C. azithromycin
- D. foscarnet
Correct Answer: D
Rationale: The drug foscarnet is used to treat CMV retinitis. Alterations in renal function, nausea, anemia, headaches, seizures, and diarrhea are the most common adverse effects. Zidovudine is used in antiretroviral therapy to prevent the conversion of HIV to AIDS. Azithromycin is an antibiotic and not used to treat CMV retinitis.
A client tells the nurse, 'You know I have AIDS. I still cannot afford to tell my employer because they will probably cancel my health insurance, then what would I do?' What is the best response by the nurse?
- A. An employer cannot cancel your currently active health insurance on the basis of AIDS.'
- B. I just wouldn't tell them. It is none of their business.'
- C. You have to tell them, it is not your right to allow them exposure to you. What if you give it to someone?'
- D. I understand your dilemma, but I think you should tell them. I would want to know.'
Correct Answer: A
Rationale: Despite HIV-specific confidentially laws, clients infected with AIDS fear that disclosure of their condition will affect employment, health insurance coverage, and even housing. An employer cannot cancel a client's currently active health insurance policy on the basis of AIDS. However, employers are more apt to dismiss a worker with a known HIV-positive status from employment to reduce future insurance premiums and death payments. The other answers are nontherapeutic and not based in fact.
The nurse is gathering data from laboratory studies for a client who has HIV. The client's T4-cell count is 200/mm3, and the client has been diagnosed with Pneumocystis pneumonia. What does this indicate to the nurse?
- A. The client has converted from HIV infection to AIDS.
- B. The client has advanced HIV infection.
- C. The client's T4-cell count has decreased due to the Pneumocystis pneumonia.
- D. The client has another infection present that is causing a decrease in the T4-cell count.
Correct Answer: A
Rationale: AIDS is the end stage of HIV infection. Certain events establish the conversion of HIV infection to AIDS: a markedly decreased T4 cell count from a normal level of 800 to 1200/mm3 and the development of certain cancers and opportunistic infections. The client does not have advanced HIV; they meet the criteria for the development of AIDS. The T4-cell count is not decreasing due to an infection.