Chapter 18 – Immune System Function, Data Collection, and Therapeutic Measures

AUDIO CASE STUDY

Listen to the audio case study available on Davis Advantage and then answer the following questions.
Scott and Anaphylaxis
1.​ How might those with food allergies be exposed to the food allergen?
2.​ What should someone with a food allergy always have as a precaution?
3.​ What symptoms of an allergic reaction did Scott experience?
4.​ What actions did Scott and his brother take that put Scott’s health in jeopardy?
5.​ Develop an SBAR for a handoff report on Scott.​
S:
B:
A:
R:

STRUCTURES OF THE IMMUNE SYSTEM

Label the following structures:
VOCABULARY
Fill in the blank:
1.​ ANTIGENS are chemical markers that identify cells or molecules.​
2.​ IMMUNITY is the ability to destroy pathogens or other foreign material and to prevent further cases of certain
infectious diseases.​
3.​ NATURAL KILLER CELL, T-CELL, and B-CELL are the three types of lymphocytes.​
4.​ T-CELL LYMPHOCYTES mature in the thymus gland.​
5.​ IMMUNOGLOBUINS are also called antibodies.​
6.​ CELL-MEDIATED IMMUNITY immunity is the type of immunity that involves only T cells.​
7.​ NATURALLY, ACQUIRED, ACTIVE immunity is the type of immunity in which a person has recovered from a
disease and now has antibodies and memory cells specific for that pathogen.​
8.​ IMMUNOSENESCENCE refers to the decline in the immune system, especially as usually seen in older adults.​
9.​ Lymph node enlargement with tenderness is usually indicative of INFLAMATION and infection.​
10.​ The NEUTROPHILS of a white blood cell differential are increased in bacterial infections.
IMMUNE SYSTEM CELLS
Match each cell with the correct description:
Cell Description
1. Memory cells 4. Initiate a rapid immune response if the pathogen reenters the
body
2. Helper T cells 7. Participate in antigen recognition and activate B cells
3. Cytotoxic T cells 5. Destroy cells directly by lysing their membranes
4. Plasma cells 2. Produce antibodies
5. Suppressor T cells 3. Limit the immune response once the pathogen has been
destroyed
6. Macrophages 1. Phagocytize pathogens labeled with antibodies
7. B cells 6. May become plasma cells or memory cells

ANTIBODIES
Name the proper class of antibodies for each function:
1.​ Found in mucous membrane secretions: IGA
2.​ Provides long-term immunity: IGG
3.​ Forms the receptors on B cells: IGD
4.​ Important in allergic reactions: IGE
5.​ Crosses the placenta to fetal circulation: IGG
6.​ Found in breast milk: IGA
7.​ The first antibody produced in an infection: IGM
IMMUNE SYSTEM
Match the word with the definition:
Term Definition

1. Allergy shots Immunotherapy

2. Differentiates between HIV-1 and HIV-2 antibodies Antibody differentiation
immunoassay
3. Produces one’s own antibodies Active immunity
4. Swelling around the eyes Periorbital edema
5. Confirms a diagnosis, determines a prognosis, or evaluates treatment Biopsy
6. Antibodies are not self-produced but are obtained from another source Passive immunity
7. Itching Pruritus
8. Abnormal protein found in plasma during acute inflammation C-reactive protein
9. Detects both HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen Antigen/antibody
combination
immunoassay
10. Confirmation test for HIV-1 if antigen/antibody combination Nucleic acid test
immunoassay is positive but antibody differentiation immunoassay is
nonreactive or inconclusive

DATA COLLECTION—HISTORY
Find and correct the four errors in the following paragraph:
Food, medication, and environmental allergies should include those that the patient experiences and those present in
the family history. With a family history, a previous exposure to a substance is required before a severe reaction
occurs. Conditions such as allergic rhinitis, systemic lupus erythematosus, ankylosing spondylitis, and asthma are
thought to be either familial or have a congenital predisposition. If the patient’s thymus gland has been removed
(thymectomy), B-cell production may be altered. Corticosteroids and immunosuppressants enhance the immune
response.
CRITICAL THINKING AND CLINICAL JUDGMENT
Case Study: David, age 29
David is visiting his health-care provider because he has been extremely fatigued for several months and now has
swollen lymph nodes in his neck. On palpation, the area feels enlarged, nontender, hard, and fixed.
Critical Thinking (The Why)
1.​ What might the palpation findings indicate?
Clinical Judgment (The Do)
2.​ What data collection does the nurse obtain?
3.​ What data collection categories does the nurse explore in greater detail?

REVIEW QUESTIONS
Choose the best answer unless directed otherwise.
1. A mother asks if her baby is protected from infections, and the nurse explains that a baby has temporary
immunity to the infections to which the mother is immune. The nurse would evaluate the mother as understanding
if she stated that this is:​
a. Naturally acquired active immunity​
b. Artificially acquired active immunity​
c. Naturally acquired passive immunity​
d. Artificially acquired passive immunity

2. Which of the following vaccines would the nurse correctly recommend be given annually during a teaching
session on health maintenance with an older patient?​
a. Diphtheria tetanus​
b. Influenza​
c. Pneumococcal​
d. Polio

3. The nurse is assisting with data collection on a patient. Which of the following past surgeries would alert the
nurse to possible immune system dysfunction? (Select all that apply)​
a. Appendectomy​
b. Parathyroidectomy​
c. Pneumonectomy​
d. Splenectomy​
e. Thymectomy​
f. Thyroidectomy

4. During data collection, the patient reports tenderness in the cervical lymph nodes. The nurse recognizes that
enlarged and tender lymph nodes usually indicate: (Select all that apply)​
a. Arthritis​
b. Cancer​
c. Infection​
d. Inflammation​
e. Tetanus

5. The nurse teaches a patient about vaccines. The patient correctly identifies that a vaccine provides which type
of immunity?​
a. Naturally acquired passive immunity​
b. Artificially acquired passive immunity​
c. Naturally acquired active immunity​
d. Artificially acquired active immunity

6. Autoimmunity is best defined as:​

a. “Production of endotoxins that destroy B lymphocytes”​
b. “Inability to differentiate self from nonself”​
c. “Overproduction of reagin antibody”​
d. “Depression of the immune response”

7. Which patient test results would indicate inflammation? (Select all that apply)​
a. IgM assay​
b. CD4+ count​
c. Western blot​
d. C-reactive protein​
e. Erythrocyte sedimentation rate

8. A mother with chickenpox asks about caring for her sick children. The nurse’s teaching should include:​
a. “Because you have an active natural immunity to chickenpox, you can safely take care of your children at
home.”​
b. “You will need to wear a mask while caring for the children to prevent contamination.”​
c. “You will need a booster chickenpox vaccination to ensure you don’t get reinfected.”​
d. “Since your children are ill, you should monitor yourself for signs or symptoms of chickenpox for the next 2
weeks.”

9. Stimuli that trigger antibody production include: (Select all that apply)​
a. Cold virus​
b. Plant pollen​
c. Transplanted organ​
d. Bacterial toxins​
e. Measles vaccine​
f. Influenza vaccine
 10. The nurse is caring for a patient undergoing a biopsy. Which action is appropriate for the nurse to take?​
a. Ask whether the patient has a contrast allergy​
b. Ask the patient about environmental allergies and the type of reaction that occurs​
c. Ensure that informed consent is obtained before the procedure​
d. Review patient’s eosinophil value

11. While working with patients in an autoimmune disease clinic, the nurse recognizes that which of the following
individuals is at most risk for systemic lupus erythematosus?​
a. A Black male who works in the construction industry​
b. A White female who works as a medical secretary​
c. An Asian female who is attending college​
d. An American Indian male who works as a lawyer

12. The nurse is caring for a patient suspected to be infected with HIV. The patient asks what type of test will be
done first to diagnose it. Which response by the nurse would be appropriate?​
a. “Antibody differentiation immunoassay”​
b. “Antigen/antibody combination immunoassay”​
c. “Lymphocyte count”​
d. “Nucleic acid test”

13. Clarithromycin (Biaxin) 200 mg oral suspension is ordered for a patient. The nurse has 125 mg/5 mL
available. How many milliliters should the nurse give?​
Answer: _______ mL

Chapter 19
Nursing Care of Patients With
Immune Disorders
Name: __________________________________
Date: __________________________________
Course: __________________________________
Instructor: __________________________________
AUDIO CASE STUDY
Listen to the audio case study available on Davis Advantage and then
answer the following questions.
Ayla and Systemic Lupus Erythematosus
1. What are three types of lupus in adults?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. Who is more prone to developing systemic lupus erythematosus (SLE)?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. What precautions will Ayla need to take to help control SLE and its
symptoms?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
VOCABULARY
Match the term with its definition.
1. ____________ An anaphylactic-type reaction
2. ____________ The type of antibodies that attach to mast cells
3. ____________ Results from antigen-antibody reaction
4. ____________ Very dry, pruritic, edematous skin
5. ____________ Sudden reaction with smooth muscle spasms and capillary
permeability
6. ____________ Raised, pruritic, nontender, and erythematous wheals on
the skin
7. ____________ A form of lupus that affects only the skin
8. ____________ Types of medications used to prevent transplant rejection
9. ____________ Submucosal and subcutaneous edema due to vascular
permeability
0. ____________ Requires lifelong vitamin B12
1. ____________ Red blood cell fragments seen with microscope
2. ____________ Absence or deficiency of immunoglobulin(s) from
defective B cells
3. ____________ Antimalarial and immunosuppressant medication used in
treatment
4. ____________ Patient teaching: range of motion, hard mattress, thin
pillow
5. ____________ Lifelong thyroid hormone therapy required
1. Discoid lupus erythematosus
2. Angioedema
3. Anaphylaxis
4. Pernicious anemia
5. Hashimoto’s thyroiditis
6. Idiopathic autoimmune hemolytic anemia
7. Hypogammaglobulinemia
8. Allergic rhinitis
9. Urticaria
0. Type 1 hypersensitivity reaction
1. IgE
2. Ankylosing spondylitis
3. Atopic dermatitis
4. Immunosuppressive
5. Systemic lupus erythematosus
IMMUNE DISORDERS
Fill in the blank.
1. Hypersensitivity reactions are classified as ____________________,
____________________, ____________________,
and____________________.
2. When allergic rhinitis occurs seasonally, it is called
____________________.
3. Complications of allergic rhinitis are ____________________,
____________________, ____________________, and
____________________.
4. ____________________ is a complication of atopic dermatitis.
5. The first medication of choice for anaphylaxis is
____________________.
6. Urticaria is commonly called ____________________.
7. Angioedema differs from urticaria in that angioedema is
____________________ and lasts ____________________.
8. The ____________________ is used to diagnose a hemolytic transfusion
reaction.
9. ____________________ and ____________________ kidney injury are
two complications that can occur with a hemolytic transfusion reaction.
0. Serum sickness causes include ____________________,
____________________, and ____________________.
1. ____________________ glutamate and ____________________ are two
food additives that can trigger an anaphylactic reaction.
2. ____________________ is the most common cause of contact dermatitis.
3. Patients with pernicious anemia are unable to absorb
____________________.
4. __________________________________________ is a process whereby
abnormal red blood cells are removed and replaced with normal red blood
cells.
5. Ankylosing spondylitis is a chronic progressive inflammatory disease of
the ____________________, ____________________ area,
____________________, and large ____________________ joints.
IMMUNE WORD SEARCH
Figure out what words the clues represent. Then find the words in the grid.
Words can go horizontally, vertically, and diagonally in all eight directions.
IMMUNE PUZZLE
Across down
1. A type of anemia that will
develop in patients with
autoimmune gastritis.
3. The number of minutes a nurse
should stay with a patient at the
beginning of a blood transfusion.
6. This is a very serious type 1
hypersensitivity reaction.
8. An antibody-mediated response
produced by B lymphocytes.
9. One of the causes of urticaria.
13. Hashimoto’s thyroiditis begins
with this effect.
15. These are a complication of
repeated episodes of allergic
rhinitis.
17. Transient vascular permeability
that occurs within the
submucosal and subcutaneous
layers.
1. One of the types of antibiotics
that may cause anaphylaxis.
2. A respiratory finding that is
considered an emergency in a
patient with angioedema.
4. Medication of choice during an
anaphylactic reaction.
5. This can overwhelmingly affect
the activities of daily living of a
patient with SLE.
7. This disorder is due to defective[1]functioning B cells.
10. One group of joints that is
affected in ankylosing
spondylitis.
11. IgE antibodies attach to these
cells in a type 1 hypersensitivity
reaction.
12. A significant type of contact
dermatitis.
19. The substance that is required in
order for vitamin B12 to be
absorbed in the small intestine.
20. Facial rash appearance in SLE
patients.
21. This form of lupus
erythematosus affects only the
skin.
14. Ankylosing spondylitis is
attributed to this cause.
16. A foreign protein or cell capable
of causing an immune response.
18. An SLE flare trigger.
WORDS FOR IMMUNE PUZZLE
Allergen
Anaphylaxis
Angioedema
Autoimmunity
Butterfly
Discoid
Epinephrine
Fatigue
Fifteen
Humoral
Hypogammaglobulinemia
Hypothyroidism
Intrinsic factor
Latex allergy
Mast cells
Medicines
Nasal polyps
Obstruction
Penicillins
Pernicious
Sacroiliac
Stress
CLINICAL JUDGMENT
Read the case study and answer the questions.
An LPN is inserting a urinary catheter for a newly admitted male patient,
age 59, with new onset urinary retention of 825 mL after 12 hours and no
known allergies. During the procedure, the patient develops facial swelling,
urticaria, pruritus, and blood pressure of 98/78 mm Hg. The nurse stops the
procedure and maintains the patient in a supine position.
1. What priority data does the LPN collect first?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. With whom does the LPN collaborate?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
The patient is given epinephrine and diphenhydramine. The LPN continues
to monitor him. Airway is patent. Vital signs remain stable.
3. What actions will the LPN take in order to provide patient care and
relieve the urinary retention?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. What education will the LPN reinforce for the patient upon discharge?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
5. Develop an SBAR for the handoff report of this patient at the end of the
LPN’s shift.
S: _______________________________________________________
_______________________________________________________
B: _______________________________________________________
_______________________________________________________
A: _______________________________________________________
_______________________________________________________
R: _______________________________________________________
_______________________________________________________
REVIEW QUESTIONS
Choose the best answer unless directed otherwise.
1. As the nurse collects data on a patient experiencing anaphylaxis, which of
the following would require the nurse to take immediate action?
1. Temperature 99°F (37.2°C)
2. Not oriented to time
3. Red, dry rash on arm
4. Wheezing
2. The nurse is reinforcing teaching to a 36-year-old patient who was
working in the garden and was stung by a bee about always having which
of these medications on hand in the event of another incident?
1. Epinephrine
2. Digoxin (Lanoxin)
3. Furosemide (Lasix)
4. Theophylline (Theo-Dur)
3. The nurse is educating the patient on his newly diagnosed disease process
characterized by a chronic progressive inflammation of the sacroiliac and
costovertebral joints and adjacent soft tissue. The nurse would evaluate
the patient as understanding the educational session if he stated the name
of the condition as which of these?
1. Ankylosing spondylitis
2. Kyphosis
3. Rheumatoid arthritis
4. Scoliosis
4. A patient asks the nurse how an allergy can develop to a medication that
has been taken before without problems. Which of the following is the
most appropriate response by the nurse?
1. “It probably is due to your age, because as we age, the body becomes
more sensitive to environmental stimuli, which leads to
hypersensitivities.”
2. “Viral illnesses and exposure to various chemicals and environmental
substances can alter the immune system and its response to previously
benign stimuli.”
3. “What have you eaten in the last 24 hours? Most medications are altered
by food, thereby producing different effects in the body.”
4. “Patients who have autoimmune disorders such as lupus or arthritis tend
to develop sensitivities to common medications.”
5. In planning care for a patient who has allergic rhinitis, the nurse
understands that without adherence to the treatment regimen, the patient is
at risk for developing which of the following?
1. Anaphylaxis
2. Angioedema
3. Lymphadenopathy
4. Sinusitis
6. A patient reports on admission being “very sick” after taking
erythromycin in the past. The patient is to receive erythromycin now.
Which of the following actions should the nurse take regarding the
antibiotic?
1. Give the antibiotic.
2. Give half of the dose.
3. Do not give the antibiotic.
4. Discontinue the antibiotic.
7. A patient is being given penicillin via intravenous infusion and develops
signs and symptoms of an anaphylactic reaction. Which of the following
should be the nurse’s first action?
1. Call the HCP.
2. Call for help.
3. Administer epinephrine.
4. Turn off the antibiotic.
8. A patient is admitted with a 2-month history of fatigue, shortness of
breath, pallor, and dizziness. The patient is diagnosed with idiopathic
autoimmune hemolytic anemia. On reviewing the laboratory results, the
nurse notes the presence of which of the following that would confirm this
diagnosis?
1. Red blood cell fragments
2. Macrocytic, normochromic red blood cells
3. Microcytic, hypochromic red blood cells
4. Hemoglobin molecules
9. A portion of a patient’s stomach was removed, so the patient is to take
vitamin B12. Which of the following patient statements would indicate
patient understanding to the nurse after an educational session?
1. “I will develop iron-deficiency anemia if I do not take vitamin B12.”
2. “Pernicious anemia is a complication of this surgery, so I need lifelong
vitamin B12.”
3. “Patients who do not take the vitamin B12 replacement develop sickle
cell anemia.”
4. “Taking vitamin B12 is important if I want to prevent acquired hemolytic
anemia.”
0. A patient is diagnosed with Hashimoto thyroiditis and asks what causes it.
The nurse would respond that destruction of thyroid cells in this condition
is due to which of the following?
1. Antigen–antibody complexes
2. Autoantibodies
3. Bacterial infection
4. Viral infection
1. A patient who was walking in the woods disturbed a beehive, was stung
two times, and was taken to the emergency department immediately due
to allergies to bee stings. Which of the following data collected by the
nurse would support a diagnosis of anaphylaxis? Select all that apply.
1. Pallor around the areas stung
2. Numbness and tingling in the extremities
3. Respiratory stridor
4. Retinal hemorrhage
5. Tachycardia
6. Dyspnea
2. A patient has a long-standing history of allergies to pollen. Which of the
following patient action statements indicates to the nurse that further
teaching is necessary?
1. “I stay indoors on dry, windy days.”
2. “I drive with the windows open.”
3. “I avoid walking outside in the spring.”
4. “I work in the garden on sunny days.”
3. The nurse would evaluate that the patient understands what triggers
allergic rhinitis by which of the following patient responses?
1. “Injected medications.”
2. “Topical creams and ointments.”
3. “Ingested food and medications.”
4. “Airborne pollens and molds.”
4. In collecting data for a patient with angioedema, the nurse understands
angioedema differs from urticaria because angioedema is characterized by
which of the following?
1. Angioedema has a deeper and more widespread edema.
2. Angioedema has small, fluid-filled vesicles that crust.
3. Angioedema lasts a shorter time.
4. Angioedema is more pruritic.
5. Which of the following is a common nursing diagnosis that the nurse will
include in the plan of care for a patient with systemic lupus
erythematosus?
1. Fatigue
2. Impaired Physical Mobility
3. Impaired Swallowing
4. Impaired Tissue Integrity
6. The nurse is caring for a patient who asks what ankylosing spondylitis is.
Which of the following responses by the nurse is appropriate?
1. “There is formation of antigen–antibody complexes leading to
inflammation.”
2. “Autoantibodies lyse red blood cells.”
3. “It is a chronic progressive inflammatory disease of the spine and large
limb joints.”
4. “Production of immunoglobulin E antibodies occurs.”
7. The nurse is collecting data on a patient with suspected pernicious
anemia. Which of these signs or symptoms would the nurse expect to find
for this patient? Select all that apply.
1. Back spasms
2. Dry cough
3. Glossitis
4. Itching
5. Pallor
6. Weakness
8. A patient who has been diagnosed with systemic lupus erythematosus is
being discharged. The patient reports she is leaving shortly for a 3-week
tour of the Grand Canyon and whitewater rafting. Which of the following
patient statements would convey the patient’s understanding of the plan of
care to the nurse? Select all that apply.
1. “I will wear clothing on all exposed skin.”
2. “As long as I wear sunscreen, I can be in the sun all day.”
3. “I will use sunscreen on exposed skin at all times.”
4. “If I develop a rash, I should avoid the sun.”
5. “I will wear a hat.”
6. “The early morning sun presents the strongest danger.”
9. The nurse is caring for a patient with allergic rhinitis. Which of the
following interventions should the nurse anticipate will be included in the
treatment plan for this patient? Select all that apply.
1. Anticholinergics
2. Antihistamines
3. Avoiding environmental stimuli
4. Decongestants
5. Immunotherapy
6. Steroids
0. The nurse is collecting data from a patient with contact dermatitis. Which
data is essential for the nurse to obtain?
1. Appearance of skin lesions
2. Appetite
3. Presence of fatigue
4. Weight
1. A patient is admitted with an autoimmune disease and asks the nurse what
autoimmune means. Which response by the nurse would be appropriate?
1. “Immune cells produce too many immature antibodies.”
2. “Immune cells grow and multiply too rapidly, so they are defective.”
3. “Immune cells are not able to distinguish between ‘self’ and ‘not self.’”
4. “Immune cells are not produced in sufficient amounts to be effective.”
2. A patient is receiving cefuroxime (Zinacef) intravenously. Fifteen minutes
after the cefuroxime is started, the patient reports an uneasy feeling, as
well as feeling very warm. Which actions would the nurse take now?
Select all that apply.
1. Call for immediate assistance.
2. Discontinue the angiocath and apply pressure.
3. Stay with the patient.
4. Immediately turn off the intravenous infusion.
5. Offer the patient ice water.
6. Monitor vital signs frequently.
3. The nurse is collecting data on a patient who has allergic rhinitis. Mark
the area where the nurse would look for the presence of allergic shiners.
Chapter 20
Nursing Care of Patients With
HIV and AIDS
Name: __________________________________
Date: __________________________________
Course: __________________________________
Instructor: __________________________________
AUDIO CASE STUDY
Listen to the audio case study available on Davis Advantage and then
answer the following questions.
Mrs. Harris and HIV
1. For what age and ethnic groups is HIV increasing?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. What are sexual risk factors for HIV?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. Can you get HIV/AIDS from kissing or hugging someone?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
VOCABULARY
Fill in the blank.
1. _______________________ is the final phase of a chronic, progressive
immune function disorder caused by HIV.
2. The _______________________ cell is an important part of the human
immune system and helps defend the body against very primitive invaders
such as fungi, yeast, and other viruses.
3. _______________________ is a diagnostic test done to measure
resistance to currently available antiviral treatments.
4. _______________________ are a primary complication of HIV infection
and occur because of an impaired immune system.
5. _______________________ occurs in some patients with AIDS and is
characterized by an involuntary baseline body weight loss of more than
10%, with either weakness or fever for more than 30 days or chronic
diarrhea of two loose stools daily for more than 30 days.
6. _______________________ measures the amount of HIV RNA in plasma
and is extremely important for determining prognosis and for monitoring
the response to antiretroviral therapy and transmission risk.
DIAGNOSTIC TESTS
Describe the use of each of the following diagnostic tests.
1. HIV antigen/antibody combination (fourth-generation) immunoassay
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. CD4 T lymphocyte count
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. Viral load testing
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. Genotyping
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
HIV
Fill in the blanks.
1. HIV is transmitted through _______________________,
______________________, ______________________, and
_______________________.
2. HIV may stay latent for _______________________ years.
3. Fatigue, headache, fever, and generalized lymphadenopathy may be seen
during the _______________________ stage of HIV infection.
4. The time between HIV infection and developing HIV antibodies is called
the _______________________ period.
HIV AND AIDS
Indicate whether the following are true or false, and correct false
statements.
1. _________ HIV is caused by AIDS.
_______________________________________________________
_______________________________________________________
2. _________ If a health-care worker is stuck with a needle from a patient
with AIDS, exposure to the virus may occur even if gloves were worn.
_______________________________________________________
_______________________________________________________
3. _________ Individuals who are not men who have sex with men or who
are not intravenous (IV) drug users cannot become infected with HIV.
_______________________________________________________
_______________________________________________________
4. _________ If the nurse suctions a patient who is diagnosed with HIV and
has a fresh tracheostomy and blood-tinged sputum gets in the nurse’s
eyes, the nurse may contract HIV.
_______________________________________________________
_______________________________________________________
5. _________ Once a person is infected with HIV, diagnosis can be made
using laboratory tests within 1 to 2 days after becoming infected.
_______________________________________________________
_______________________________________________________
6. _________ A patient with AIDS should always be placed into isolation for
the protection of health-care workers.
_______________________________________________________
_______________________________________________________
CRITICAL THINKING AND CLINICAL
JUDGMENT
Answer the following questions.
1. Sam Donner, age 26, has been newly diagnosed as HIV positive. He asks,
“So do I have AIDS now, and am I going to die?” What should you say to
him?
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. When is the patient who is HIV positive considered to have developed
AIDS?
_______________________________________________________
_______________________________________________________
_______________________________________________________
3. Sam is started on a combination of trimethoprim-sulfamethoxazole (TMP[1]SMX [Bactrim, Septra, Cotrim])
medication. Why?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
4. Years later, Sam has been diagnosed with AIDS for a CD4 T lymphocyte
count of 200 cells/microL. You visit Sam at home as the home health
nurse. He reports that he has no appetite and is always fatigued. Your data
collection reveals that Sam is 6 feet tall and weighs 135 pounds.
(a) What is your concern and why?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
(b) Develop a CUS communication to report your concerns to the health[1]care provider.
C:
_______________________________________________________
_______________________________________________________
U:
_______________________________________________________
_______________________________________________________
S:
_______________________________________________________
_______________________________________________________
(c) What can you do to help improve Sam’s nutrition?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
5. Six months after being diagnosed with AIDS, Sam develops dementia.
Why?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
6. How can a nurse contract HIV from a patient?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
7. Sam is living with his parents so they can assist him. How should you
instruct Sam’s family members to clean and disinfect the home to reduce
transmission of HIV?
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CLINICAL JUDGMENT
Answer the following questions.
Mr. Munez is a 40-year-old cisgender (gender identity matches sex assigned
at birth) heterosexual man who is seen at the clinic for a 3-month HIV
follow-up. He is taking a single tablet regimen of
darunavir/cobicistat/emtricitabine/tenofovir alafenamide (Symtuza) and
reports not missing any doses. Mr. Munez shares that he has met a new
female partner and they are talking about becoming intimate.
1. What questions do you ask Mr. Munez about his Symtuza intake?
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2. What HIV risk-reduction methods for Mr. Munez’s new partner do you
discuss?
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3. What medications do you discuss with Mr. Munez that could interact with
Symtuza?
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4. Based on the evidence-based information in Chapter 20, for what
comorbidities do you collect data?
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REVIEW QUESTIONS
Choose the best answer unless directed otherwise.
1. The nurse would evaluate the patient as understanding modes of HIV
transmission if the patient stated that the modes of HIV transmission for a
person who has a detectable viral load include which of the following?
Select all that apply.
1. Contact with infected blood products
2. Fecal-oral contact
3. Sharing towels and eating utensils
4. Mosquito bites
5. Unprotected sex
6. Saliva and tears
2. The nurse is caring for a patient who is HIV positive and prescribed
antiretroviral therapy. At what timeframes does the nurse explain to the
patient that CD4 T lymphocyte testing is recommended to be done? Select
all that apply.
1. Before antiretroviral therapy
2. Every month
3. At 3 months
4. Every 2 months during antiretroviral therapy
5. Every 3 to 6 months for 2 years
6. Annually after 2 years
3. In planning an educational session for a patient with HIV, the nurse would
include that contact with which of the following body fluids can transmit
HIV? Select all that apply.
1. Saliva
2. Tears
3. Breast milk
4. Semen
5. Blood
6. Sweat
4. A patient who is being tested for HIV asks what types of diagnostic tests
are used. Which of the following diagnostic tests would the nurse state
can be used to identify an HIV infection? Select all that apply.
1. CD4 T lymphocyte count
2. Genotyping
3. HIV antibody/antigen combination immunoassay
4. Nucleic acid test
5. Urinalysis
5. The nurse is caring for a patient with HIV who has diarrhea. Which of the
following would be most therapeutic to explain to the patient to reduce
diarrhea?
1. Potassium-rich foods
2. High-fiber foods
3. Liquid nutritional supplements
4. Frozen food products
6. The nurse is explaining to a patient newly diagnosed with AIDS about
complications of the disease. Which of the following would the nurse
explain is a more common opportunistic infection in AIDS?
1. Candidiasis
2. Kaposi sarcoma
3. Mycoplasma pneumonia
4. Toxoplasmosis
7. The nurse is taking the vital signs of a pregnant woman during her first
prenatal visit. The patient asks the nurse if she needs to have an HIV test.
Which of the following is the nurse’s best response?
1. “Yes, all pregnant women must have an HIV test in their third
trimester.”
2. “If you do not have multiple sex partners or inject drugs, it is not
necessary.”
3. “Guidelines require an HIV test for all pregnant women.”
4. “After pretest counseling, you decide whether HIV testing should be
done.”
8. The nurse is caring for a patient with HIV. Which of the following foods
would the nurse inform the patient are safe to eat to reduce the risk of an
infection? Select all that apply.
1. Caesar dressing
2. Cooked vegetables
3. Feta cheese
4. Raw fruits
5. Raw vegetables
6. Self-peeled fruits
9. The nurse is caring for a patient with AIDS. Which of the following
interventions should the nurse implement for infection control?
1. Wear goggles at all times.
2. Wear gloves for blood/body fluid contact.
3. Wear gown at all times.
4. Wear a mask during patient contact.
0. The nurse is reinforcing teaching on the frequency of viral load testing for
a patient who has HIV and is to begin antiretroviral therapy. Which of the
following general viral load testing recommendations, for those with
consistently suppressed viral loads on antiretroviral therapy, would the
nurse include? Select all that apply.
1. Before antiretroviral therapy
2. On day 1 of antiretroviral therapy
3. Within 1 month
4. Every 2 months during antiretroviral therapy
5. Every 3 to 4 months for 2 years
6. Every 6 months after 2 years
1. The nurse is providing HIV risk-reduction reinforcement for a 55-year-old
patient. Which of the following information should the nurse provide to
the patient? Select all that apply.
1. Anal, oral, and vaginal sexual activity requires a latex barrier be used.
2. Condoms are needed only when a person discloses being HIV positive.
3. Having a sexually transmitted infection increases the risk of acquiring
HIV.
4. A new condom is needed for each sexual activity.
5. Petroleum jelly can be used as a lubricant during condom use.
6. Condoms are only useful for birth control.
2. The nurse recognizes that the patient may be having a reaction to abacavir
sulfate (Ziagen) when which of the following occurs?
1. Abdominal pain
2. Blurred vision
3. Edema
4. Flu-like symptoms
3. Margo Haiken, age 22, is newly diagnosed as HIV positive. Her mother,
who is seated at the bedside, is crying. Margo asks what to expect for her
future health status. Which of the following is the nurse’s best response?
1. “You have an acute disease that will resolve itself.”
2. “You will be able to chronically manage your disease.”
3. “You have a terminal disease.”
4. “You will experience remissions and exacerbations.”
4. The nurse would recognize that the patient understands antiretroviral
therapy if the patient states that the goals of highly active antiretroviral
therapy are which of these? Select all that apply.
1. “To increase viral load.”
2. “To improve survival rates.”
3. “To decrease CD4 T lymphocytes.”
4. “To delay progression of HIV disease.”
5. “To reduce HIV load to undetectable levels.”
6. “To suppress the immune system.”
5. What should the nurse include in a teaching plan for a 27-year-old female
patient who is 6 months pregnant in order to reduce the risk of HIV
infection? Select all that apply.
1. Abstain from sexual intercourse.
2. Test for HIV at time of labor.
3. Avoid injection drug use.
4. Plan for autologous blood transfusion.
5. Avoid use of female condoms.
6. The nurse is contributing to the teaching plan for a patient with HIV on
how to reduce infection risks. Which of the following should the patient
with HIV be taught to do to decrease risk of infections? Select all that
apply.
1. Wash hands before eating.
2. Reuse dishes.
3. Wash toothbrush.
4. Report signs of infection.
5. Buy prepared deli foods.
6. Share razor if no visible blood