TEST 2 - CHAPTER REVIEW QUESTIONS Flashcards

1
Q

A female patient’s complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient’s following statements demonstrates the need for further teaching about the disease?
A) “I’ll try my best to stay out of the sun this summer.”
B) “I know that I probably have a high chance of getting arthritis.”
C) “I’m hoping that surgery will be an option for me in the future.”
D) “I understand that I’m going to be vulnerable to getting infections.”

A

C

SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

chronic multisystem inflammatory disease with immune system abnormalities.

A

Systemic lupus erythematosus (SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The etiology of abnormal immune response is unknown; a ____________ influence is suspected.

A

genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SLE is extremely ____________ in its severity, ranging from a relatively mild disorder to rapidly progressive and affecting many __________ systems.

A

variable

organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Commonly affected tissues in SLE are:

A
  1. skin (butterfly rash over nose, cheeks),
  2. muscles (polyarthralgia with morning stiffness),
  3. lungs (tachypnea),
  4. heart (dysrhythmias),
  5. nervous tissue (seizures)
  6. kidneys (nephritis).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Other signs of SLE include ___________, mild ________________ , and _______________.

A

anemia
leukopenia
thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In SLE, _____________ is a major cause of death.

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The diagnosis of SLE is based on the presence of ___________ ___________ revealed through patient history, physical examination, and laboratory findings.

A

distinct criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A major treatment challenge is to manage ____________ ___________ while preventing treatment complications that cause long-term ____________ ____________.

A

active disease

tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

______________ are given for severe cutaneous SLE. Antimalarial agents and immunosuppressive drugs may also be used.

A

Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nursing care emphasizes health teaching and importance of patient cooperation for successful ___________ _____________.

A

home management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. In teaching a client with SLE about the disorder, what information about the pathophysiology of SLE would the nurse include?

a. The production of autoantibodies directed against constituents of cellular DNA
b. An autoimmune reaction resulting in degeneration, necrosis, and fibrosis of muscle fibres
c. A deposition in tissues of immune complexes formed from IgG autoantibodies reacting with IgG
d. Chronic inflammation and cytokine activity resulting in cartilage, bone, and muscle damage

A

d

Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse’s response is based on the knowledge that which of the following is a diagnostic criterion for AIDS?

a) Presence of HIV antibodies
b) CD4+ T cell count

A

b

Diagnostic criteria for AIDS include a CD4+ T-cell count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education?

a) “I will need to isolate any tissues I use so as not to infect my family.”
b) “I will notify all of my sexual partners so they can get tested for HIV.”
c) “Unprotected sexual contact is the most common mode of transmission.”
d) “I do not need to worry about spreading this virus to others by sweating at the gym.”

A

a

HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend?

a) Use of gloves during patient contact
b) Frequent and thorough hand washing
c) Prophylactic, broad-spectrum antibiotics
d) Fitting and appropriate use of N95 masks

A

b

Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Standard precautions should be used when providing care for

a) All patients regardless of diagnosis.
b) Pediatric and gerontologic patients.
c) Patients who are immunocompromised.
d) Patients with a history of infectious diseases.

A

a

Standard precautions are designed for all care of all patients in hospitals and health care facilities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The nurse is providing care for a patient who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease?

a) A new onset of polycythemia
b) Presence of mononucleosis-like symptoms
c) A sharp decrease in the patient’s CD4+ count
d) A sudden increase in the patient’s WBC count

A

c

A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient’s WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which of the following is NOT a source of emerging infections?

a. Plants
b. Animals
c. Biological warfare
d. Antibiotic resistance

A

a,b,c,d

An emerging infection is an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future. Examples include resistant organisms that emerged when a previously treatable organism developed resistance to antibiotics; criteria for starting antiretroviral drug therapy (ART) that have changed with new scientific discoveries; and limited resources or access to medications that make it difficult for some patients to get adequate treatment for infections.

19
Q
  1. Which of the following antibiotic-resistant organisms are resistant to normal hand soap?

a. Vancomycin-resistant enterococci
b. Methicillin-resistant Staphylococcus aureus
c. Penicillin-resistant Streptococcus pneumoniae
d. β-Lactamase–producing Klebsiella pneumoniae

A

a

Vancomycin-resistant enterococci (VRE) can remain viable on environmental surfaces for weeks. An antiseptic soap such as chlorhexidine is needed to kill these bacteria.

20
Q
  1. How does the transmission of HIV occur?

a. Most commonly as a result of sexual contact
b. In all infants born to women with HIV infection
c. Only when there is a large viral load in the blood
d. Frequently in health care workers with needle-stick exposures

A

d
Rationale: Unprotected sexual contact (semen, vaginal secretions, or blood) with a human immunodeficiency virus (HIV)–infected partner is the most common mode of HIV transmission.

21
Q
  1. Which is the common physiological change after HIV infection?

a. The virus replicates mainly in B lymphocytes before spreading to CD4+ T cells in lymph nodes.
b. The immune system is impaired predominantly by infection and destruction of CD4+ T cells.
c. Infection of monocytes may occur, but these cells are destroyed by antibodies produced by oligodendrocytes.
d. A long period develops during which the virus is not found in the blood and there is little viral replication.

A

c
Rationale: Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

22
Q
  1. Which of the following statements is false?
    a. Infection with HIV results in a chronic disease with acute exacerbations.
    b. Untreated HIV infection can remain in the early chronic stage for a decade or more.
    c. Late-stage infection is often called acquired immunodeficiency syndrome (AIDS).
    d. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.
A

a, b, c
Rationale: The typical course of untreated HIV infection follows a predictable pattern; however, disease progression is highly individualized, and treatment can significantly alter this pattern. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

23
Q
  1. When is a diagnosis of AIDS made?
    a. When an HIV-infected client has a CD4+ T cell count below 200/μL
    b. When an HIV-infected client has an increasing amount of HIV in the blood
    c. When an HIV-infected client has a reversal of the CD4:CD8 ratio to less than 2:1
    d. When an HIV-infected client has oral hairy leukoplakia, an infection caused by Epstein-Barr virus
A

a
Rationale: AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L. Other criteria are listed in Table 15-9.

24
Q
  1. What does screening for HIV infection generally involve?
    a. Laboratory analysis of blood to detect HIV antigen
    b. Electrophoretic analysis of HIV antigen in plasma
    c. Laboratory analysis of blood to detect HIV antibodies
    d. Analysis of lymph tissues for the presence of HIV RNA
A

c

Rationale: The most useful screening tests for HIV detect HIV-specific antibodies.

25
Q
  1. What is the indication for use of antiretroviral drugs?
    a. Cure acute HIV infection
    b. Treat opportunistic diseases
    c. Decrease viral RNA levels
    d. Supplement radiation and surgery
A

b
Rationale: The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV-related symptoms and opportunistic diseases.

26
Q
  1. Which of the follow statements about opportunistic diseases in HIV infection is correct?
    a. Usually occur one at a time
    b. Generally slow to develop and progress
    c. Occur in the presence of immunosuppression
    d. Curable with appropriate pharmacological intervention
A

c
Rationale: Management of HIV is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (see Table 15-10).

27
Q
  1. Which of the following statements about metabolic side effects of ART is false?
    a. These are an annoying set of symptoms that are ultimately harmless.
    b. Changes in body shape and size are often difficult for HIV-infected clients to accept.
    c. Lipid abnormalities include increases of triglycerides and decreases in high-density cholesterol.
    d. Insulin resistance and dyslipidemia can be treated with drugs to control blood glucose and decrease cholesterol.
A

b, c, d
Rationale: Some HIV-infected patients, especially those who have been infected and on ART for a long time, develop a set of metabolic disorders that include changes in body shape (i.e., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) due to lipodystrophy, hyperlipidemia (i.e., elevated triglycerides and decreases in high-density lipoproteins), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

28
Q
  1. Which of the following eliminates the risk of transmission of HIV?
    a. Using sterile equipment to inject drugs
    b. Cleaning equipment used to inject drugs
    c. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy
    d. Using latex barriers to cover genitals during sexual contact
A

a
Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when sharing equipment, but it takes time and may be difficult for a person in drug withdrawal.

29
Q
  1. Of the following, which is the most appropriate nursing intervention to help an HIV-infected client adhere to the treatment regimen?
    a. Give the client a DVD and a brochure to view and read at home.
    b. Volunteer to “set up” a drug pillbox for a week at a time.
    c. Inform the client that the side effects of the drugs are bad but that they go away after a while.
    d. Assess the client’s lifestyle and find adherence cues that fit into the client’s lifestyle.
A

d
Rationale: The best approach to improve adherence to a treatment regimen is to learn about the patient’s life and assist with problem solving within the confines of that life.

30
Q

Infection with the human immunodeficiency virus (HIV) is a global _____________.

A

pandemic

31
Q

HIV can only be transmitted under specific conditions that allow contact with infected body fluids, including the following 4:

A

blood,
semen,
vaginal secretions,
breast milk.

32
Q

__________ ___________ is the most common mode of transmission.

A

Sexual contact

33
Q

Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of ______ T cells (also known as T helper cells).

A

CD4+

34
Q

The major concern related to immune suppression is the development of _________ __________ (infections and cancers that occur in immunosuppressed patients that can lead to disability, disease, and death).

A

opportunistic diseases

35
Q

______________ (when HIV-specific antibodies develop) is often accompanied by a mononucleosis-like syndrome that may be mistaken for the flu. These symptoms, called acute HIV infection, generally occur 2 to 4 weeks after initial infection and last for 1 to 2 weeks.

A

Seroconversion

36
Q

____________ ____________ is the interval between untreated HIV infection and a diagnosis of acquired immunodeficiency syndrome (AIDS). Some symptoms, such as fatigue, headache, low-grade fever, and night sweats often occur.

A

clinical latency

37
Q

The most useful screening tests for HIV are those that detect HIV-specific _____________.

A

antibodies

38
Q

The major problem with these tests is that there is a median delay of ____ ______________ after infection before antibodies can be detected. This creates a window period during which an infected individual may not test HIV-antibody positive.

A

2 months

39
Q

Collaborative management of the HIV-infected patient focuses on

A

(1) monitoring HIV disease progression and immune function,
(2) initiating and monitoring antiretroviral therapy (ART),
(3) preventing the development of opportunistic diseases,
(4) detecting and treating opportunistic diseases,
(5) managing symptoms,
(6) preventing or decreasing the complications of treatment, and
(7) preventing further transmission of HIV.

40
Q

Management of HIV is _______________ by the many ______________ diseases that can develop as the immune system deteriorates.

A

complicated

opportunistic

41
Q

Since HIV infection is _____________, the nursing care for individuals not known to be infected with HIV should focus on ______________ disease transmission.

A

preventable

preventing

42
Q

The overriding goals of therapy for infected individuals are to keep the _______ _________ as low as possible for as long as possible, maintain or restore a functioning immune system, improve the patient’s ___________ of life, prevent ____________ disease, reduce HIV-related disability and __________, and prevent new ____________.

A
viral load
quality
opportunistic
death
infections
43
Q

Nursing care can assist the patient to:

8 things

A

(1) adhere to drug regimens;
(2) promote a healthy lifestyle that includes avoiding exposure to other sexual and blood-borne diseases;
(3) protect others from HIV;
(4) maintain or develop healthy and supportive relationships;
(5) maintain activities and productivity;
(6) explore spiritual issues;
(7) come to terms with issues related to disease, disability, and death; and
(8) cope with the frequent symptoms caused by HIV and its treatments.

44
Q

____________ related to HIV infection can lead to social isolation, dependence, frustration, low self-image, loss of control, and economic pressures.

A

Discrimination