Nokea
A nurse is traveling to a third-world country with a medical volunteer group to work with people who are infected with human immune deficiency virus (HIV). The nurse should recognize that which of the following might be a barrier to the treatment of perinatal HIV transmission? (Select all that apply.)
- A. Client drinking water.
- B. Cultural beliefs about illness.
- C. Lack of antiviral medications.
- D. Lack of water.
- E. Unknown transmission routes.
Correct Answer: A,B,C,D
Rationale: Treatment and prevention of HIV is complex, and in third-world countries barriers exist that one might not otherwise think of. Mothers must have access to clean drinking water if they are to use formula. Cultural beliefs about illness, lack of available medications, and lack of water are possible barriers. Perinatal transmission is well known to occur across the placenta, during birth, from exposure to blood and body fluids during birth, and through breast-feeding.
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A client with HIV wasting syndrome has inadequate nutrition. What assessment finding by the nurse best indicates that the goals for this client problem have been met?
- A. Chooses high-protein food.
- B. Has decreased oral discomfort.
- C. Eats 90% of meals and snacks.
- D. Has a weight gain of 2 pounds in 1 month.
Correct Answer: D
Rationale: The weight gain is the best indicator that goals for this client problem have been met because it demonstrates that the client not only is eating well but also is able to absorb the nutrients.
A nurse works on a unit that has admitted its first client with acquired immune deficiency syndrome. The nurse overhears staff members talking about the 'AIDS guy' and wondering how the client contracted the disease. What action by the nurse is best?
- A. Confront the staff members about unethical behavior.
- B. Ignore the behavior to avoid confrontation.
- C. Report the behavior to the unit's nursing management.
- D. Tell the client that other staff members are talking about him or her.
Correct Answer: A
Rationale: The professional nurse should be able to confront unethical behavior assertively. The staff should not be talking about clients unless they have a need to do so for client care. Ignoring the behavior may be more comfortable, but the nurse is abdicating responsibility. The behavior may need to be reported, but not as a first step. Telling the client that others are talking about him or her does not accomplish anything.
A client with HIV/AIDS asks the nurse why gabapentin (Neurontin) is part of the drug regimen when the client does not have a history of seizures. What response by the nurse is best?
- A. Gabapentin can be used as an antidepressant too.
- B. I have no idea why you should be taking this drug.
- C. This drug helps treat the pain from nerve irritation.
- D. You are at risk for seizures due to fungal infections.
Correct Answer: C
Rationale: Many classes of medications are used for neuropathic pain, including gabapentin. It is not being used as an antidepressant or to prevent seizures from fungal infections. If the nurse does not know the answer, he or she should find out for the client, not admit ignorance.
A client with human immune deficiency virus (HIV) has had a sudden decline in status with a large increase in viral load. What action should the nurse take first?
- A. Ask the client about travel to any foreign countries.
- B. Assess the client about adherence to the drug regimen.
- C. Determine if the client has any new sexual partners.
- D. Gather more information about new living quarters or pets.
Correct Answer: B
Rationale: Adherence to the complex drug regimen needed for HIV treatment can be daunting. Clients must take their medications on time and correctly at a minimum of 90% of the time. Since this client's viral load has increased dramatically, the nurse should first assess this factor. After this, the other assessments may or may not be needed.
A client with acquired immune deficiency syndrome (AIDS) is hospitalized with Pneumocystis jiroveci pneumonia and is started on the drug of choice for this infection. What laboratory values should the nurse report to the provider as a priority? (Select all that apply.)
- A. Opportunistic infections and cancer are leading causes of death.
- B. Positive enzyme-linked immunosorbent assay (ELISA) test for human immune deficiency virus (HIV).
- C. Taking antiretroviral medications.
- D. Elevated liver enzymes.
- E. Serum sodium: 120 mEq/L.
Correct Answer: A,D,E
Rationale: The drug of choice to treat Pneumocystis jiroveci pneumonia is trimethoprim with sulfamethoxazole (Septra). Side effects of this drug include hepatitis, hyponatremia, and thrombocytopenia. The elevated liver enzymes and low serum sodium should all be reported. Opportunistic infections and cancer are not laboratory values, and a positive ELISA test and antiretroviral medications are expected in this context.