Chapter 15: Infection
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition
MULTIPLE CHOICE
1. The nurse is advising a patient who was exposed 4 days ago to HIV
through unprotected sexual intercourse. The patient‘s antigen-antibody
test has just been reported as negative for HIV. Which information would
the nurse give to this patient?
a. “You will need to be retested in 2 weeks.”
b. “You don’t need to fear infecting others.”
c. “We won’t know for about 10 years if you have HIV infection.”
d. “With no symptoms and this negative test, you don’t have HIV.”
ANS: A
HIV screening tests detect HIV-specific antibodies or antigens. However, there may be a
delay between infection and the time a screening test is able to detect HIV. The typical
“window period” for antigen-antibody combination assays is approximately 3 weeks. It
would be best practice to have the patient return for repeat testing in approximately 2
weeks. It is not known based on this information whether the patient is infected with HIV
or can infect others.
2. A patient who has a positive test for HIV antibodies is admitted to the
hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of
less than 200 cells/mL. Based on diagnostic criteria established by the
CDC, which interpretation is correct?
a. “The patient meets the criteria for a diagnosis of acute HIV infection.”
b. “The patient will be diagnosed with asymptomatic chronic HIV infection.”
c. “The patient will likely develop symptomatic HIV infection within 1 year.”
d. “The patient has developed AIDS.”
ANS: D
Development of PCP meets the diagnostic criteria for AIDS. The other responses
indicate earlier stages of HIV infection than is indicated by the PCP infection.
3. A patient informed of a positive rapid screening test result for HIV is
anxious and does not appear to hear what the nurse is saying. Which
action by the nurse is most important at this time?
a. Inform the patient about the available treatments.
b. Teach the patient how to manage a possible drug regimen.
c. Remind the patient to return for retesting to verify the results.
d. Ask the patient to identify those persons who had intimate contact.
ANS: C
After an initial positive antibody test result, the next step is retesting to confirm the
results. A patient who is anxious is not likely to be able to take in new information or be
willing to disclose information about the HIV status of other individuals.
4. A patient who is diagnosed with AIDS tells the nurse, “I feel obsessed with
morbid thoughts about dying.” Which response by the nurse is
appropriate?
a. “Thinking about dying will not improve the course of AIDS.”
b. “Do you think that taking an antidepressant might be helpful?”
c. “Can you tell me more about the thoughts that you are having?”
d. “It is important to focus on the good things about your life now.”
ANS: C
More assessment of the patient‘s psychosocial status is needed before taking any other
action. The statements, “Thinking about dying will not improve the course of AIDS” and
“It is important to focus on the good things in life” or suggesting an antidepressant
discourage the patient from sharing any further information with the nurse and decrease
the nurse‘s ability to develop a trusting relationship with the patient.
5. A pregnant woman with asymptomatic chronic HIV infection is seen at the
clinic. The patient states, “I am very nervous about making my baby sick.”
Which information will the nurse include when teaching the patient?
a. The antiretroviral medications used to treat HIV infection are teratogenic.
b. Most infants born to HIV-positive mothers are not infected with the virus.
c. Because it is an early stage of HIV infection, the infant will not contract
HIV.
d. Her newborn will be born with HIV unless she uses antiretroviral therapy
(ART).
ANS: B
Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the
mother does not use ART during pregnancy. The percentage drops to 1% when ART is
used. Perinatal transmission can occur at any stage of HIV infection (although it is less
likely to occur when the viral load is lower). ART can safely be used in pregnancy,
although some ART drugs should be avoided.
6. Which exposure by the nurse is most likely to require postexposure
prophylaxis when the patient’s HIV status is unknown?
a. Bite to the arm that does not result in open skin.
b. Splash into the eyes while emptying a bedpan containing stool.
c. Needle stick with a needle and syringe used for a venipuncture.
d. Contamination of open skin lesions with patient vaginal secretions.
ANS: C
Puncture wounds are the most common means for workplace transmission of blood-
borne diseases, and a needle with a hollow bore that had been contaminated with the
patient‘s blood would be a high-risk situation. The other situations described would be
much less likely to result in transmission of the virus.
7. A patient who is human immunodeficiency virus (HIV)-infected has a CD4+
cell count of 400/L. Which factor is most important for the nurse to
determine before the initiation of antiretroviral therapy (ART) for this
patient?
a. CD4+ cell count.
b. How the patient obtained HIV.
c. Patient‘s tolerance for potential medication side effects.
d. Patient‘s ability to follow a complex medication regimen.
ANS: D
Drug resistance develops quickly unless the patient takes ART medications on a strict,
regular schedule. In addition, drug resistance endangers both the patient and
community. The other information is also important to consider, but patients who are
unable to manage and follow a complex drug treatment regimen should not be
considered for ART.
8. Which patient would benefit from education about HIV preexposure
prophylaxis (PrEP)?
a. A 23-year-old woman living with HIV infection.
b. A 52-year-old recently single woman just diagnosed with chlamydia.
c. A 33-year-old hospice worker who received a needle stick injury 3 hours
ago.
d. A 60-year-old male in a monogamous relationship with an uninfected
partner.
ANS: B
Preexposure prophylaxis (PrEP) is used to prevent HIV infection. Persons who would
be good candidates for PrEP include individuals with a recent diagnosis of an STI and
those with more than one partner. Individuals who are not on PrEP but who have a
recent high-risk exposure (such as a needle stick) would be better candidates for
postexposure prophylaxis (PEP). A person in a monogamous relationship with an HIV-
uninfected partner is considered low-risk for HIV infection.
9. The nurse palpates enlarged cervical lymph nodes on a patient diagnosed
with acute HIV infection. Which action would the nurse take?
a. Instruct the patient to apply ice to the neck.
b. Tell the patient a secondary infection is present.
c. Explain to the patient that this is an expected finding.
d. Request that an antibiotic be prescribed for the patient.
ANS: C
Persistent generalized lymphadenopathy is common in the early stages of HIV infection.
No antibiotic is needed because the enlarged nodes are probably not caused by
bacteria. Lymphadenopathy is common with acute HIV infection and is therefore not
likely to represent an additional infection. Ice will not decrease the swelling in persistent
generalized lymphadenopathy.
10. A patient who uses injectable illegal drugs asks the nurse how to prevent
AIDS. Which response by the nurse would be most useful in preventing HIV
infection?
a. “Consider a needle and syringe exchange program.”
b. “Ask those who share equipment to be tested for HIV.”
c. “Clean your drug injection equipment before each use.”
d. “Avoid sexual intercourse when using injectable drugs.”
ANS: A
Participation in needle and syringe-exchange programs has been shown to decrease
and control the rate of HIV infection. Cleaning drug equipment before use also reduces
risk, but it might not be consistently practiced. HIV antibodies do not appear for several
weeks to months after exposure, so testing drug users would not be very effective in
reducing risk for HIV exposure. HIV can be transmitted through both intercourse and
injection.
11. Which nursing action will be most useful in assisting a young adult to
adhere to a newly prescribed antiretroviral therapy (ART) regimen?
a. Give the patient detailed information about possible medication side
effects.
b. Remind the patient of the importance of taking the medications as
scheduled.
c. Help the patient develop a schedule to decide when the drugs would be
taken.
d. Encourage the patient to join a support group for adults who are HIV
positive.
ANS: C
The best approach to improve adherence is to learn about important activities in the
patient’s life and adjust the ART around those activities. The other actions are also
useful, but they will not improve adherence as much as individualizing the ART to the
patient‘s schedule.
12. A patient with HIV infection has developed Cryptosporidium parvum
infection. Which expected outcome would the nurse include in the plan of
care?
a. The patient will be free from injury.
b. The patient will receive immunizations.
c. The patient will have adequate oxygenation.
d. The patient will maintain intact perineal skin.
ANS: D
The major manifestation of C. parvum infection is loose, watery stools, which would
increase the risk for perineal skin breakdown. The other outcomes would be appropriate
for other complications (e.g., pneumonia, dementia, influenza) associated with HIV
infection.
13. A patient treated for HIV infection for 6 years has developed fat
redistribution to the trunk with wasting of the arms, legs, and face. Which
recommendation would the nurse provide?
a. Consider the benefits of daily exercise.
b. Review foods that are higher in protein.
c. Discuss a change in antiretroviral therapy.
d. Talk about treatment with antifungal agents.
ANS: C
A frequent intervention for metabolic disorders is a change in antiretroviral therapy
(ART). Treatment with antifungal agents would not be appropriate because there is no
indication of fungal infection. Changes in diet or exercise have not proven helpful for this
problem.
14. The nurse prepares to administer the following medications to a
hospitalized patient with HIV infection. Which medication is most important
to administer at the scheduled time?
a. Nystatin tablet.
b. Oral acyclovir (Zovirax).
c. Aerosolized pentamidine (NebuPent).
d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy).
ANS: D
It’s important that antiretrovirals be taken at the prescribed time every day to avoid
developing drug-resistant HIV. The other medications would also be given as close as
possible to the correct time, but they are not as essential to receive at the same time
every day.
15. To evaluate the effectiveness of antiretroviral therapy (ART), which
laboratory test result will the nurse review?
a. Viral load.
b. Rapid HIV antibody.
c. Enzyme immunoassay.
d. Immunofluorescence assay.
ANS: A
The effectiveness of ART is measured by the decrease in the amount of virus detectable
in the blood. The other tests are used to detect HIV antibodies, which remain positive
even with effective ART.
16. The nurse is caring for a patient who is living with HIV and taking
antiretroviral therapy (ART). Which information is most important for the
nurse to address when planning care?
a. The patient reports feeling “constantly tired.”
b. The patient reports having no side effects from the medications.
c. The patient is unable to explain the effects of atorvastatin (Lipitor).
d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
ANS: D
Because missing doses of ART can lead to drug resistance, this patient statement
indicates the need for interventions such as teaching or changes in the drug scheduling.
Fatigue is a common side effect of ART. The nurse should discuss medication actions
and side effects with the patient, but this is not as important as addressing the skipped
doses of Descovy.
17. Eight years after seroconversion, a patient with HIV infection has a CD4+
cell count of 800/L and an undetectable viral load. Which intervention
would the nurse include in the plan of care?
a. Encourage adequate nutrition, exercise, and sleep.
b. Teach about the side effects of antiretroviral agents.
c. Explain opportunistic infections and antibiotic prophylaxis.
d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
ANS: A
The CD4+ level for this patient is in the normal range, indicating that the patient is the
stage of asymptomatic chronic infection when the body is able to produce enough CD4+
cells to maintain a normal CD4+ count. Maintaining healthy lifestyle behaviors is an
important goal in this stage. AIDS and increased incidence of opportunistic infections
typically develop when the CD4+ count is much lower than normal. Although the
initiation of ART is highly individual, it would not be likely that a patient with a normal
CD4+ level would receive ART.
18. Which patient who has arrived at the human immunodeficiency virus (HIV)
clinic would the nurse assess first?
a. Patient whose rapid HIV-antibody test is positive.
b. Patient whose latest CD4+ count has dropped to 250/L.
c. Patient who has had 10 liquid stools in the last 24 hours.
d. Patient who has nausea from prescribed antiretroviral drugs.
ANS: C
The nurse should assess the patient who has diarrhea for dehydration and
hypovolemia. The other patients also will require assessment and possible
interventions, but do not require immediate action to prevent complications such as
hypovolemia and shock.
19. An older adult who takes medications for coronary artery disease and
hypertension is newly diagnosed with HIV infection and is starting
antiretroviral therapy. Which information will the nurse include in patient
teaching?
a. Many drugs interact with antiretroviral medications.
b. HIV infections progress more rapidly in older adults.
c. Less frequent CD4+ level monitoring is needed in older adults.
d. Hospice care is available for patients with terminal HIV infection.
ANS: A
The nurse will teach the patient about potential interactions between antiretrovirals and
the medications that the patient is using for chronic health problems. Treatment and
monitoring of HIV infection is not affected by age. A patient beginning early ART is not a
candidate for hospice. Progression of HIV is not affected by age although it may be
affected by chronic disease.
20. The RN is caring for a patient who is living with HIV and admitted with
tuberculosis. Which task can the RN delegate to assistive personnel (AP)?
a. Teach the patient how to dispose of tissues with respiratory secretions.
b. Stock the patient‘s room with the necessary personal protective
equipment.
c. Interview the patient to obtain the names of family members and close
contacts.
d. Tell the patient‘s family members the reason for the use of airborne
precautions.
ANS: B
A patient diagnosed with tuberculosis would be placed on airborne precautions.
Because all health care workers are taught about the various types of infection
precautions used in the hospital, the UAP can safely stock the room with personal
protective equipment. Obtaining contact information and patient teaching are higher-
level skills that require RN education and scope of practice.
21. The nurse designs a program to decrease the incidence of HIV infection in
the adolescent and young adult populations. Which information would the
nurse assign as the highest priority for these populations?
a. Methods to prevent perinatal HIV transmission.
b. Ways to sterilize needles used by injectable drug users.
c. Prevention of HIV transmission between sexual partners.
d. Means to prevent transmission through blood transfusions.
ANS: C
Sexual transmission is the most common way that HIV is transmitted. The nurse should
also provide teaching about perinatal transmission, needle sterilization, and blood
transfusion, but the rate of HIV infection associated with these situations is lower.
22. Which infection control actions would the nurse include in the use of
standard precautions?
a. Gloving before wiping pink sputum off the bedrail.
b. Gowning prior to delivering a food tray to a patient.
c. Masking before interviewing a patient about health history.
d. Applying goggles before helping a patient to ambulate in the hall.
ANS: A
Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions;
(3) non-intact skin; and (4) mucous membranes. Standard precautions are designed to
reduce the risk for transmission of microorganisms in hospitals. They should be applied
to all patients regardless of diagnosis or presumed infection status. Transmission-based
precautions are used for patients known to be or suspected of being infected with highly
transmissible or epidemiologically important pathogens that require additional
precautions to interrupt transmission and prevent infection. Transmission-based
precautions include airborne precautions, droplet precautions, and contact precautions.
23. A patient is diagnosed with both HIV and active TB disease. Which
information obtained by the nurse is most important to communicate to the
health care provider?
a. The Mantoux test had an induration of 7 mm.
b. The chest x-ray showed infiltrates in the lower lobes.
c. The patient has a cough that is productive of blood-tinged mucus.
d. The patient is being treated with antiretrovirals for HIV infection.
ANS: D
Drug interactions can occur between the antiretrovirals used to treat HIV infection and
the medications used to treat TB. The other data are expected in a patient with HIV and
TB.
24. Which action should the nurse take before administering gentamicin
(Garamycin) to a patient with a wound infection?
a. Ask the patient about any nausea.
b. Obtain the patient‘s oral temperature.
c. Change the prescribed wet-to-dry dressings.
d. Review the patient‘s serum creatinine results.
ANS: D
Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient‘s
serum creatinine. Monitoring the patient‘s temperature before gentamicin administration
is not necessary. Nausea is not a common side effect of IV gentamicin. There is no
need to change the dressing before gentamicin administration.
MULTIPLE RESPONSE
1. The nurse is caring for a patient living with asymptomatic chronic HIV
infection. Which prophylactic measures will the nurse include in the plan of
care? (Select all that apply.)
a. Hepatitis B vaccine.
b. Pneumococcal vaccine.
c. Influenza virus vaccine.
d. Trimethoprim-sulfamethoxazole.
e. Varicella zoster immune globulin.
ANS: A, B, C
Asymptomatic chronic HIV infection is a stage between acute HIV infection and a
diagnosis of symptomatic chronic HIV infection. Although called asymptomatic,
symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur.
Prevention of other infections is an important intervention in patients who are living with
HIV, and these vaccines are recommended as soon as the HIV infection is diagnosed.
Antibiotics and immune globulin are used to prevent and treat infections that occur later
in the course of the disease when the CD4+ counts have dropped or when infection has
occurred.
2. According to the CDC guidelines, which personal protective equipment will
the nurse put on before assessing a patient who is on contact precautions
for Clostridium difficile diarrhea? (Select all that apply.)
a. Mask.
b. Gown.
c. Gloves.
d. Shoe covers.
e. Eye protection.
ANS: B, C
Because the nurse will have substantial contact with the patient and bedding when
doing an assessment, gloves and gowns are needed. Eye protection and masks are
needed for patients in contact precautions only when spraying or splashing is
anticipated. Shoe covers are not recommended in the CDC guidelines.
3. The nurse plans a presentation for community members about how to
decrease the risk for antibiotic-resistant infections. Which information will
the nurse include in the teaching plan? (Select all that apply.)
a. Antibiotics may sometimes be prescribed to prevent infection.
b. Continue taking antibiotics until all of the prescription is gone.
c. Unused antibiotics from previous illnesses should be discarded.
d. Antibiotics are effective in treating influenza associated with high fevers.
e. Hand washing is effective in preventing many viral and bacterial infections.
ANS: A, B, C, E
In some situations, such as before surgery, antibiotics are prescribed to prevent
infection. All prescribed doses of antibiotics should be taken. There should not be any
leftover antibiotics because all prescribed doses should be taken. However, if there are
leftover antibiotics, they should be discarded at once because the number left will not be
enough to treat a future infection. Hand washing is considered the single most effective
action in decreasing infection transmission. Antibiotics are ineffective in treating viral
infections such as influenza.
4. In which ways would the nurse identify that individuals locally and globally
may be at risk for contracting new or remerging infectious diseases?
(Select all that apply.)
a. Biologic warfare.
b. Low population density.
c. Direct contact with animals.
d. Development of antibiotic resistance strains.
e. Changes in characteristics of known diseases.
ANS: A, C, D, E
Emerging infectious diseases can originate from unknown sources, from contact with
animals, changes in known diseases, or biologic warfare. COVID-19 (caused by SARS-
CoV-2), Ebola virus, and Chikungunya are examples of emerging infections. Other
emerging infections occur when a previously treatable organism develops resistance to
antibiotics, such as carbapenum-resistant enterobacteriaceae (CRE). Some diseases
thought to be under control, such as TB, measles, and pertussis, have reemerged.
Factors such as global travel, population density, encroachment into new environments,
antibiotic misuse, lack of immunizations, and bioterrorism have increased the risk for
widespread distribution of these infections.
5. A group of seniors who experienced the COVID-19 pandemic asks the
nurse to speak about preventing illness during future respiratory
epidemics. Which information would the nurse include? (Select all that
apply.)
a. Frequent handwashing is effective in preventing transmission of many
infectious diseases.
b. Receiving a vaccine, when available, can prevent or modulate specific
infectious illnesses.
c. Older adults can eliminate the risk of respiratory infection through health-
related behaviors.
d. Maintaining general health through regular activity and good nutrition
helps prevent infections.
e. Avoiding large crowds during periods of high transmission limits exposure
to infectious disease.
ANS: A, B, D, E
Handwashing, vaccines, good general health, and avoiding crowds can decrease the
risk of contracting a contagious respiratory illness. Older adults are susceptible to
infection due to age-related changes in immune function and the frequent presence of
comorbidities: following infection prevention behavior guidelines reduces the risk for all
age groups but does not eliminate the risk of contracting an infectious disease.