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An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the patients increased risk for Mycobacterium avium complex (MAC disease). The nurse should anticipate the administration of what drug?
- A. Azithromycin
- B. Vancomycin
- C. Levofloxacin
- D. Fluconazole
Correct Answer: A
Rationale: HIV-infected adults and adolescents should receive chemoprophylaxis against disseminated Mycobacterium avium complex (MAC disease) if they have a CD4+ count less than 50 cells/L. Azithromycin (Zithromax) or clarithromycin (Biaxin) are the preferred prophylactic agents. Vancomycin, levofloxacin, and fluconazole are not prophylactic agents for MAC.
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The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient?
- A. Would you like me to have the chaplain come speak with you?
- B. Youll learn much about the promise of a cure for HIV.
- C. Can you tell me what concerns you most about dying?
- D. You need to maintain hope because you may live for several years.
Correct Answer: C
Rationale: The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the patient to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the patients expressed fears.
A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors?
- A. The nurse wears face protection, gloves, and a gown when irrigating a wound.
- B. The nurse washes the hands with a waterless antiseptic agent after removing a pair of soiled gloves.
- C. The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure.
- D. The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.
Correct Answer: C
Rationale: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same patient. Each of the other listed actions adheres to standard precautions.
A patient who has AIDS is being treated for Kaposis sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS?
- A. Risk for Disuse Syndrome Related to Kaposis Sarcoma
- B. Impaired Skin Integrity Related to Kaposis Sarcoma
- C. Diarrhea Related to Kaposis Sarcoma
- D. Impaired Swallowing Related to Kaposis Sarcoma
Correct Answer: B
Rationale: Kaposis sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.
A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results?
- A. Another EIA test
- B. Viral load test
- C. Western blot test
- D. CD4/CD8 ratio
Correct Answer: C
Rationale: The Western blot test detects antibodies to HIV and is used to confirm the EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but is not used to confirm results of EIA testing.
A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond?
- A. Complementary therapies generally have not been approved, so patients are usually discouraged from using them.
- B. Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available.
- C. Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks.
- D. Youll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach.
Correct Answer: C
Rationale: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.