Nokea
A female client comes to the clinic and tells the nurse, 'I think I have another vaginal infection and I also have some wart-like lesions on my vagina. This is happening quite often.' Which nursing action is the priority for this client?
- A. Recommend abstinence or safer-sex practices.
- B. Offer information on human immunodeficiency virus (HIV) testing.
- C. Provide a prescribed topical antifungal agent to treat the client's vaginal infection.
- D. Refer the client to a support group with others experiencing the same symptoms.
Correct Answer: B
Rationale: In women, gynecologic problems may be the focus of the chief complaint for clients who are HIV positive but not yet diagnosed. Abnormal results of Papanicolaou tests, genital warts, pelvic inflammatory disease, and persistent vaginitis may also correlate with HIV infection. Based on this information, the priority nursing action is to offer information on HIV testing to the client. Although recommending abstinence or safer-sex practices, providing a prescribed topical antifungal agent to treat the client's vaginal infection, and referring to a support group may be appropriate, the priority is to determine the source of the client's symptoms.
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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 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.
A client who had sexual contact with a partner who is HIV+ recently develops flulike symptoms such as a low grade fever, headache, and muscle pain. What does the nurse suspect this client is experiencing?
- A. Pneumocystis pneumonia
- B. Influenza
- C. AIDS
- D. Acute retroviral syndrome
Correct Answer: D
Rationale: At the time of primary HIV infection, one third to more than one half of those infected develop acute retroviral syndrome, also called acute HIV syndrome, which often is mistaken for flu or some other common illness. Some manifestations include fever; swollen and tender lymph nodes; pharyngitis; rash about the face, trunk, palms, and soles; muscle and joint pain; headache; nausea and vomiting; and diarrhea. In addition, there may be enlargement of the liver and spleen, weight loss, and neurologic symptoms such as visual changes or cognitive and motor involvement. It is too soon after exposure for the client to develop Pneumocystis pneumonia or AIDS.
A client with suspected exposure to HIV has been tested with the enzyme-linked immunosorbent assay (ELISA) with positive results twice. The next step for the nurse to explain to the client for confirmation of the diagnosis is to perform what?
- A. p24 antigen test for confirmation of diagnosis.
- B. Western blot test for confirmation of diagnosis.
- C. polymerase chain reaction test for confirmation of diagnosis.
- D. T4-cell count for confirmation of diagnosis.
Correct Answer: B
Rationale: The enzyme-linked immunosorbent assay (ELISA) test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. The p24 antigen test and the polymerase chain reaction test determine the viral load, and the T4-cell count is not used for diagnostic confirmation of the presence of HIV in the blood.
A male client is having sexual relations with another male as well as using methamphetamine and has contracted HIV. What concern does the nurse have for this client?
- A. The client is a drug addict and needs to stop using.
- B. The client may infect other people because of the drug use.
- C. The client may develop AIDS in a shorter period of time.
- D. The client will remain HIV positive for a longer period of time.
Correct Answer: C
Rationale: A new strain of HIV, identified as 3-DCR HIV, was detected in a gay man in New York. Scientists consider this new strain highly virulent because it converted the man's initial HIV infection to full-blown AIDS in a matter of months; the new strain is highly drug resistant. The infected man also used methamphetamine, which scientists believe can accelerate the replication of the virus, especially in the brain. Although the drug addiction and the transmission of HIV to other people is a concern, it does not relate to what the question is asking. A positive outcome would be the client maintaining HIV status longer and not converting to AIDS.