Final

Question 1

safe sex

Answer 1

ABC (abstinence, be faithful, condoms)… I did not make this up… its in the book
Anal intercourse is a high risk behavior for transmission because mucous membranes of the rectum are likely to tear easily
Women: have your partner use a condom, or use a dental dam/female condom
Condom use points:
use latex or polyurethane rather than natural membrane condoms
use water based lubricants over oil
put a condom on before making any genital contact

Question 2

a protease inhibitor
HIV specific drug that blocks the HIV protease enzyme, which prevents viral replication and the release of viral particles
placing low doses of this drug with other PIs boosts the levels of the other PIs, which results in more effective drug responses at lower drug dosages, fewer side effects, and improved patient adherence
Drug may be taken with or without food
nausea, vomiting, diarrhea → these are common side effects
Should be checking:
LIVER FUNCTION TESTS: the drug is liver toxic and can cause elevations in transaminases and bilirubin
Lipids: elevated triglycerides are common
Assess for body shape changes: fat redistribution is common

Answer 2

Lopinavir (Kaletra)

Question 3

what kind of condom to use

Answer 3

polyurethane, or latex

Question 4

types of drugs aids patients use for treatment that can alter

Answer 4

anti depressants and psychotrophics

Question 5

normal CD4 range

Answer 5

500-1600

Question 6

causes of neurolgical changes in AIDs patients

Answer 6

Psychosocial stressors accompanying the disease

Organic disorders caused by opportunistic infections, cancer, or HIV encephalitis…ICP can cause long term brain damage

Question 7

how do you assess for neurological baseline

Answer 7

Glascow Coma Scale (motor, blinking , verbal), PERLA

Question 8

28 day course of prophylaxis for HIV exposure

Answer 8

PrEP truvada

Question 9

Post exposure protocol = 2 drug therapy:

Answer 9

Retrovir (zidovudine) and Epivir (lamivudine) for 28 days

Question 10

bacteriacidal food to compensate for low lymphocytes

Answer 10

raw fruits and vegetables

Question 11

S&S: fever, headache, blurred vision, nuchal rigidity, confusion, and other mental status changes
some patients have seizure and other focal neurological problems, or mild symptoms of malsaise and fever w/ or w/o headaches: what is this disease

Answer 11

Cryptococcal meningitis in aids patients caused by Cryptococcus neoformans

Question 12

liver functioning tests for Lopinavir

Answer 12

Liver enzyme testing includes ALT, AST, alkaline phosphatase; true liver function tests (LFTs) include PT, INR, albumin, and bilirubin.

Question 13

Opportunistic infections that come along with aids

Answer 13

Opportunistic infections: Pneumocystis jiroveci, carinii, Toxmoplasma gondii, Crytosporidum. Candida ablicans, Crytopcoccosis, TB, etc.
Malignancies: Kaposi’s sarcoma, lymphomas (swollen lymph nodes, weight loss, fever and night sweats)

Question 14

S&S of HIV client progressing to AIDS (365)

Answer 14

CD4 count less than 200cells/mm^3
Poor wound healing, night sweats, cough, SOB, diarrhea, weight loss, nausea and vommiting, confusion, dementia, headache, fever, visual changes memory loss, pain, seizures

Question 15

Pneumocystitis jroveci pneumonia, do they need to be in transmission-based precautions

Answer 15

No, Standard precautions are fine
Pneumocystis jiroveci pneumonia is an opportunistic infection that will not cause disease in staff with healthy immune systems
Do not room with an immunocompromised patient

Question 16

Examples of ways to prevent infection for a client with immunosuppression
Monitor vital signs, including temperature, every how many hours?

Inspect open areas, such as IV sites, for manifestations of infection every how many hours?

Answer 16

4 hours

Question 17

Examples of ways to prevent infection for a client with immunosuppression

Inspect the patient’s mouth at least every ? hours?
_ Inspect skin and mucous membranes for fissures and abscesses every ? hours?

Answer 17

8 hours

Question 18

reinforce client’s self-esteem. Employ empathetic sharing and acknowledge of grief, and identify the degree of depression and develop appropriate strategies.

Answer 18

Depression:

Question 19

reduce environmental stressors by limiting personnel contact; provide safe, private area to express grief.

Answer 19

Hysteria:

Question 20

Can skin protection products protect you from radiation skin reactions?

Answer 20

no

Question 21

Where does bone metastasis occur

Answer 21

all upper body bones above the femur bone

Question 22

nursing goals for Cryptococcal meningitis

Answer 22

S&S: fever, headache, blurred vision, nuchal rigidity, confusion, and other mental status changes
some patients have seizure and other focal neurological problems, or mild symptoms of malsaise and fever w/ or w/o headaches
Nursing goals: recognize the signs and symptoms of this opportunistic infection, treat early to avoid septicemia, combination drug therapy, maintain nutritional balance (avoid anorexia)

Question 23

Three things for a person to qualify doing an advanced directive

Answer 23

1) receive information (but not necessarily oriented x 4)
2) evaluate, deliberate, and mentally manipulate information
3) communicate a treatment preference

Question 24

2 kinds of advanced directives

Answer 24

two kinds of advanced directives: 1) instructions (amount and type of care a person would want if they became incapacitated), which include living wills and medical directives, 2) durable power of attorney (this appoints someone else to make the health care decisions in case they lose the ability)

Question 25

How do Motor and sensory deficits occur

Answer 25

when cancers invade bone or the brain or compress nerves

Question 26

hours to avoid sun to get skin cancer

Answer 26

10am-4pm

Question 27

Who shouldn’t visit patients that are receiving Radiation implant (encapsulated/sealed)

Answer 27

pregnant women and children under 16, visitors stay 6 feet away and stay for only 30 minutes per visit

Question 28

Motor and sensory deficits occur when cancers invade bone or the brain or compress nerves : what is the nursing diagnosis

Answer 28

risk for injury and falls

Question 29

intervention for risk for injury and falls

Answer 29

Provide care for motor deficits (to reduce falls)
Walkers, canes etc.
provide care r/t sensory deficits
educate the client to use thermometer for bath water
wear shoes for peripheral neuropathy

Question 30

Bone metastasis causes

Answer 30

pain, fractures, spinal cord compression, and hypercalcemia, each of which reduces mobility.

Question 31

Bone metastasis causes pain, fractures, spinal cord compression, and hypercalcemia, each of which reduces mobility. What is the nursing intervention
Nursing intervention:

Answer 31

Use lift sheets for brittle / painful bones

Question 32

Does chemotherapy cause bone marrow suppression? What are the implications of bone marrow suppression?

Answer 32

e.g., neutropenia, anemia, thrombocytopenia (low platelets)

Question 33

If a patient has chemotherapy, what should the nurse do r/t interventions of anemia, thrombocytopenia, and neutropenia

Answer 33

prevent bleeding and injury (wear shoes)
Use lift sheet when moving or repositioning patient
· Avoid IM and venipunctures (or use smallest gauge when possible)
· Apply firm pressure to needle sticks for 10 minutes (or until oozing stops)
· Apply ice to area of trauma
· Test urine/stool for presence of occult blood.
· Observe patient’s IV sites every 4 hours for bleeding
· Instruct patient to notify nursing personnel immediately if injury, trauma, bleeding or bruising noticed.
· Avoid trauma to rectal tissue (don’t use enemas, If suppository needed, use lubricant first)
· Measure patient’s abdominal girth daily
· Use electric razors, mouth care with soft bristled toothbrush, tooth sponge (don’t use water pressure cleaner), make sure denture fits well (no rubbing)
· Instruct patient not to blow their nose or insert objects into the nose
· Patient should wear shoes with firm soles whenever ambulating.
· Keep pathway and walkways clear and uncluttered to prevent falls and injuries.

Question 34

side effects of oral opiodes used to manage pain with cancer patients (hiv patients that have cancer too)

Answer 34

dizziness, vomitting, nausea, inability to void,

note: check respiration and sedation level every two hours

Question 35

types of PCA used for cancer patients

Answer 35

Dilaudid (Hydromorphone), Fentora Lozenge (stronger than Dilaudid)

Question 36

How long does photosensitivity last for in Photo Dynamic Therapy (laser treatment) for cancer?

Answer 36

12 weeks, but the most intense period is 48 hours after injection and before the PDT treatment

Question 37

radiation therapy which client does not emit radiation?

Answer 37

external beam therapy (teletherapy)

Question 38

what is considered an oncological emergency

Answer 38

Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression.

Question 39

Colorectal cancer risk factors

Answer 39

include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.

Question 40

Risk factors for breast cancer include

Answer 40

nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries.

Question 41

the nurse should teach the client how to care for the stoma, depending on the type of laryngectomy performed he should teach

Answer 41

Interventions include to obtain a Medic-Alert bracelet, to prevent debris from entering the stoma, to avoid exposure to people with infections, and to avoid swimming and use care when showering. Additional interventions include wearing a stoma guard or high-collared clothing to protect the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep the secretions thin.

Question 42

The nurse is teaching a client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. Which statement should the nurse include in the teaching?

Answer 42

There are two types–one is held at the side of the neck and the other is inserted into the mouth.

Question 43

accurate teachings for cervical radiation discharge

Answer 43

“Cream may be used to relieve dryness or itching.”

“Some vaginal bleeding is expected for 1 to 3 months.”

“Sexual intercourse may be resumed after 7 to 10 days.”

“Foul-smelling vaginal discharge is expected.”

Question 44

Hodgkin’s disease characteristics

Answer 44

is a chronic progressive neoplastic disorder of lymphoid tissue. It is characterized by painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss rather than weight gain is most likely to be noticed. The client also may have a decreased appetite rather than an increased appetite. Weakness, fatigue, and complaints of lack of energy are other possible findings, but these are not specifically related to the disease.

Question 45

how do you diagnose leukemia

Answer 45

bone biopsy, WBC test is not definitive enough

Question 46

What is Cachexia

Answer 46

Cancer cachexia describes a syndrome of progressive weight loss, anorexia, and persistent erosion of host body cell mass in response to a malignant growth

Question 47

low fiber diet causes what?

Answer 47

low bowel movement (less poo) good to prevent diarrhea in cancer patients

Question 48

what are risk factors for breast cancer?

Answer 48

Early menarche, family history of breast cancer, high dose radiation exposure to breast, previous cancer to the breast, ovaries or uterus

Question 49

risk factors for cervical cancer

Answer 49

smoking, sex before 17, multiple partners, Human papillomavirus infection