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1. To what is the increase in emerging and untreatable infections attributed (select all that apply)?
a. The evolution of new infectious agents b. Use of antibiotics to treat viral infections
c. Human population encroachment into wilderness areas d. Transmission of infectious agents from humans to animals
e. An increased number of immunosuppressed and chronically ill people
2. The three antibiotic-resistant bacteria that are of most current concern in North America are ____________________, ____________________, and ____________________.
3. What are the recommended measures to prevent the transmission of health care–associated infections (HAIs) (select all that apply)?
a. Empty bedpans as soon as possible d. Use personal protective equipment b. Limit fresh flowers in patient rooms e. Hand washing or alcohol-based sanitizing c. Remove urinals from bedside tables f. Have patients wear sandals in the shower
4. A patient with diarrhea has been diagnosed with Clostridium difficile. Along with standard precautions, which kind of transmission-based precautions will be used when the nurse is caring for this patient?
a. Droplet precautions c. Isolation precautions b. Contact precautions d. Airborne precautions
5. A 78-year-old patient has developed Haemophilus influenzae. In addition to standard precautions, what should the nurse use to protect herself and other patients when working within 3 feet of the patient?
a. Mask c. Gloves
b. Gown d. Shoe covers
6. An 82-year-old male patient with pneumonia who is in the intensive care unit (ICU) is beginning to have decreased cognitive function. What should the nurse first suspect as a potential cause of this change?
a. Fatigue c. ICU psychosis
b. Infection d. Medication allergy
7. The nurse realizes that the patient understands the teaching about decreasing the risk for antibiotic-resistant infection when the patient says which of the following?
a. “I know I should take the antibiotic for one day after I feel better.”
b. “I want an antibiotic ordered for my cold so I can feel better sooner.”
c. “I always save some pills because I get the illness again after I first feel better.”
d. “I will follow the directions for taking the antibiotic so I will get over this infection.”
8. In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission?
a. Transmission to women OR to men during sexual intercourse
b. Hollow-bore needle used for vascular access OR used for IM injection c. First 2 to 6 months of infection OR 1 year after infection
d. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy OR HIV-infected mothers using no therapy
e. A splash exposure of HIV-infected blood on skin with an open lesion OR a needle-stick exposure to HIV-infected blood
Infection and Human Immunodeficiency
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9. Place the following events of HIV infection of a cell in sequence from 1 (first) to 7 (last).
_______ a. Viral RNA is converted to single-stranded viral DNA with assistance of reverse transcriptase _______ b. Viral DNA is spliced into cell genome using the enzyme integrase
_______ c. gp 120 proteins on viral envelope combine with CD4 receptors of body cells _______ d. Cell replicates infected daughter cells and makes more HIV
_______ e. Viral RNA and reverse transcriptase enzyme enter host CD4+ T cell _______ f. Long strands of viral RNA are cut in the presence of protease _______ g. Single-stranded viral DNA replicates into double-stranded DNA
10. Indicate below which event (from Question 9) of HIV infection of a cell is controlled by each drug. This would also be the mechanism of action of the drug.
Drug Mechanism of Action
Entry inhibitors
Reverse transcriptase inhibitors Integrase inhibitors
Protease inhibitors
11. What is a primary reason that the normal immune response fails to contain the HIV infection?
a. CD4+ T cells become infected with HIV and are destroyed.
b. The virus inactivates B cells, preventing the production of HIV antibodies.
c. Natural killer cells are destroyed by the virus before the immune system can be activated.
d. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues.
12. Which characteristic corresponds with the acute stage of HIV infection?
a. Burkitt’s lymphoma c. Persistent fevers and night sweats b. Temporary fall of CD4+ T cells d. Pneumocystis jiroveci pneumonia
13. What finding supports the diagnosis of acquired immunodeficiency syndrome (AIDS) in the individual with HIV?
a. Flu-like symptoms c. CD4+ T cells 200–500/µL b. Oral hairy leukoplakia d. Cytomegalovirus retinitis 14. Why do opportunistic diseases develop in an individual with AIDS?
a. They are side effects of drug treatment of AIDS.
b. They are sexually transmitted to individuals during exposure to HIV.
c. They are characteristic in individuals with stimulated B and T lymphocytes.
d. These infections or tumors occur in a person with an incompetent immune system.
15. Which characteristics describe Pneumocystis jiroveci infection, an opportunistic disease that can be associated with HIV?
a. May cause fungal meningitis b. Diagnosed by lymph node biopsy
c. Pneumonia with dry, nonproductive cough
d. Viral retinitis, stomatitis, esophagitis, gastritis, or colitis
16. Which opportunistic disease associated with AIDS is characterized by hyperpigmented lesions of skin, lungs, and gastrointestinal (GI) tract?
a. Kaposi sarcoma c. Herpes simplex type 1 infection b. Candida albicans d. Varicella-zoster virus infection
Chapter 15 Infection and Human Immunodeficiency Virus Infection 53 17. A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is most
important for the nurse to do?
a. Ask the patient to identify all sexual partners
b. Determine when the patient thinks exposure to HIV occurred c. Explain that all test results must be repeated at least twice to be valid d. Discuss prevention practices to prevent transmission of the HIV to others
18. The “rapid” HIV antibody testing is performed on a patient at high risk for HIV infection. What should the nurse explain about this test?
a. The test measures the activity of the HIV and reports viral loads as real numbers.
b. This test is highly reliable, and in 5 minutes the patient will know if HIV infection is present.
c. If the results are positive, another blood test and a return appointment for results will be necessary.
d. This test detects drug-resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs.
19. Treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI) is prescribed for a patient with HIV infection who has a CD4+ T-cell count of <400/µL. The patient asks why so many drugs are necessary for treatment. What should the nurse explain as the primary rationale for combination therapy?
a. Cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination.
b. Combinations of antiretroviral drugs decrease the potential for development of antiretroviral-resistant HIV variants.
c. Side effects of the drugs are reduced when smaller doses of three different drugs are used rather than large doses of one drug.
d. When CD4+ T-cell counts are <500/µL, a combination of drugs that have different actions is more effective in slowing HIV growth.
20. What is one of the most significant factors in determining when to start antiretroviral therapy in a patient with HIV infection?
a. Whether the patient has high levels of HIV antibodies b. Confirmation that the patient has contracted HIV infection
c. The patient’s readiness to commit to a complex, lifelong, uncomfortable drug regimen
d. Whether the patient has a support system to help manage the costs and side effects of the drugs
21. After teaching a patient with HIV infection about using antiretroviral drugs, the nurse recognizes that further teaching is needed when the patient says
a. “I should never skip doses of my medication, even if I develop side effects.”
b. “If my viral load becomes undetectable, I will no longer be able to transmit HIV to others.”
c. “I should not use any over-the-counter drugs without checking with my health care provider.”
d. “If I develop a constant headache that is not relieved with aspirin or acetaminophen, I should report it within 24 hours.”
22. Prophylactic measures that are routinely used as early as possible in HIV infection to prevent opportunistic and debilitating secondary problems include administration of
a. isoniazid (INH) to prevent tuberculosis
b. trimethoprim/sulfamethoxazole (TMP/SMX) for toxoplasmosis
c. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B d. varicella-zoster immune globulin (VZIG) to prevent chickenpox or shingles
23. A patient identified as HIV antibody–positive 1 year ago manifests acute HIV infection but does not want to start antiretroviral therapy at this time. What is an appropriate nursing intervention for the patient at this stage of illness?
a. Assist with end-of-life issues
b. Provide care during acute exacerbations c. Provide physical care for chronic diseases d. Teach the patient about immune enhancement
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24. Identify three methods to eliminate or reduce the risk for HIV transmission related to sexual intercourse and drug use and two methods to reduce the risk for perinatal transmission.
Sexual Intercourse Drug Use Perinatal Transmission
a. a. a.
b. b. b.
c. c.
25. A patient with advanced AIDS has a nursing diagnosis of impaired memory related to neurologic changes. In planning care for the patient, what should the nurse set as the highest priority?
a. Maintain a safe patient environment
b. Provide a quiet, nonstressful environment to avoid overstimulation c. Use memory cues such as calendars and clocks to promote orientation
d. Provide written instructions of directions to promote understanding and orientation CASE STUDY
HIV Infection Patient Profile
A.K., a 28-year-old single man, had HIV antibody screening performed 2 weeks ago when he was seen at a health clinic for flu-like symptoms. At that time he revealed that he had a history of multiple sexual partners. He has returned to the clinic for the results of his screening.
Subjective Data
• Vague symptoms of fatigue and headache
• Reports occasional night sweats Objective Data
• Positive Western blot test for HIV
• Temp: 100°F (37.8°C)
• Enlarged cervical and femoral lymph nodes
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. Priority Decision: What are the priority posttest counseling activities that should be performed by the nurse during A.K.’s visit?
2. A.K.’s CD4+ T-cell count is 650/µL. What stage of HIV infection is he most likely experiencing?
3. What additional diagnostic tests might be performed at this visit?
4. What prophylactic treatments should be used at this time to prevent the development of opportunistic diseases?
5. The health care provider encourages A.K. to consider starting combination antiretroviral therapy. What can the nurse tell A.K. about the expected effect of this therapy?
6. If A.K. does not respond to treatment with an increased CD4+ T-cell count and a decreased viral load, what tests could be used to identify resistance to the antiretroviral agents?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
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1. The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both women and men?
a. Smoking cessation b. Routine colonoscopies
c. Protection from ultraviolet light
d. Regular examination of reproductive organs
2. What defect in cellular proliferation is involved in the development of cancer?
a. A rate of cell proliferation that is more rapid than that of normal body cells b. Shortened phases of cell life cycles with occasional skipping of G1 or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition
3. What does the presence of carcinoembryonic antigens (CEAs) and α-fetoprotein (AFP) on cell membranes indicate has happened to the cells?
a. They have shifted to more immature metabolic pathways and functions.
b. They have spread from areas of original development to different body tissues.
c. They produce abnormal toxins or chemicals that indicate abnormal cellular function.
d. They have become more differentiated as a result of repression of embryonic functions.
4. What factor differentiates a malignant tumor from a benign tumor?
a. It causes death.
b. It grows at a faster rate.
c. It is often encapsulated.
d. It invades and metastasizes.
5. A patient is admitted with acute myelogenous leukemia and a history of Hodgkin’s lymphoma. What is the nurse likely to find in the patient’s history?
a. Work as a radiation chemist
b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime
d. Alkylating agents for treating the Hodgkin’s lymphoma
6. Which mutated tumor suppressor gene is most likely to contribute to many types of cancer, including bladder, breast, colorectal, and lung?
a. p53 b. APC c. BRCA1 d. BRCA2
7. Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)?
a. Obesity is an example of a promoting factor.
b. The stage is characterized by increased growth rate and metastasis.
c. Withdrawal of promoting factors will reduce the risk of cancer development.
d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion.
e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell’s DNA.