Nokea
The nurse administers an injection to a client with AIDS. When finished, the nurse attempts to recap the needle and sustains a needlestick to the finger. What is the priority action by the nurse?
- A. Obtain counseling.
- B. Call the lab to draw the nurse's blood.
- C. Fill out a risk management report.
- D. Report the incident to the supervisor.
Correct Answer: D
Rationale: Because post exposure protocols can reduce the risk of HIV infection if initiated promptly, nurses must immediately report any needlestick or sharp injury to a supervisor. Obtaining counseling will occur after all other procedures are adhered to. The lab will draw blood from the client if required for documentation and other blood transmitted disorders.
You may also like to solve these questions
What does the nurse understand is the goal of antiretroviral therapy?
- A. Reverse the HIV+ status to a negative status.
- B. Treat mycobacterium avium complex.
- C. Eliminate the risk of AIDS.
- D. Bring the viral load to a virtually undetectable level.
Correct Answer: D
Rationale: The goal of antiretroviral therapy is to bring the viral load to a virtually undetectable level. This level is no more than 500 or 50 copies, depending on the sensitivity of the selected viral load test. It is not possible to reverse the status to a negative, and it cannot eliminate the risk of AIDS but can help with prolonging the asymptomatic stage of HIV. Antiretroviral therapy does not treat mycobacterium avium complex.
A client who is HIV positive is taking zidovudine. Which adverse effects should the nurse closely monitor for in this client?
- A. Peripheral neuropathy
- B. Circumoral paresthesia
- C. Alterations in the renal function
- D. Pancreatitis
Correct Answer: A
Rationale: A common adverse effect associated with the administration of zidovudine is peripheral neuropathy. The drug does not cause circumoral paresthesia, alterations in the renal function, or pancreatitis.
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 healthcare worker has been exposed to the blood of an HIV-positive client and is awaiting the results of an HIV test. In the meantime, what precautions must the healthcare worker take to prevent the spread of infection?
- A. Limit interactions with people who are not HIV infected.
- B. Limit interactions with people who are already HIV infected.
- C. Follow the same sexual precautions as someone who has been diagnosed with AIDS.
- D. Quit the healthcare job and get admitted to a hospital or a cancer treatment center.
Correct Answer: C
Rationale: The healthcare worker will be tested for HIV at regular intervals and treated with antiretrovirals depending on the results of the tests or the potential for infection. While awaiting the results, the healthcare worker should follow the same sexual precautions as someone who has been diagnosed with AIDS. The healthcare worker should not limit interactions with either non-HIV-infected or HIV-infected people. In addition, the healthcare worker should not quit and be admitted to a hospital for treatment. Treatment, if required, can begin if the result of the test is positive.
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.