Common Immunological Disorders: Ch 48 In Critical Care Nursing: A Holistic Approach

Front 1

The test(s) most widely used to evaluate HIV disease progression is:
A. enzyme-linked immunoassay (ELISA)
B. viral load
C. p24 antigen
D. single-use diagnotic system (SUDS)

Back 1

B. Viral load

Viral load is the measure of HIV RNA in the person's body and is currently the standard test used to determine and monitor an individual's disease progression. Pts with higher viral loads have more advanced disease. The enzyme-linked immunosorbent assay (ELISA), single use diagnostic system (SUDS), and p24 antigen tests are used to detect the presence of HIV.

Front 2

The average time from exposure to HIV and conversion to seropositivity in most people is:
A. 10-14 days
B. 2-6 weeks
C. 6 weeks to 3 months
D. 6-12 months

Back 2

A. 10-14 days

For most people, seroconversion occurs within 10-14 days after exposure to HIV. Some people may take longer to convert.

Front 3

The 4 body fluids that have been implicated in the tranmission of HIV are:
A. blood, saliva, semen, vaginal fluid
B. tears, saliva, urine, sweat
C. blood, semen, vaginal fluid, breast milk
D. urine, semen, vaginal fluid, breast milk

Back 3

C. Blood semen, vaginal fluid, and breast milk

The 4 body fluids that have beem implicated in the transmission of HIV are blood, semen, vaginal fluid, and breast milk. HIV has been isolated in a variety of other fluids, but none have been implicated in the transmission of the virus.

Front 4

A male pt is diagnosed with Pneumocystits jiroveci pneumonia. When teaching the pt about his treatment, you explain that:
A. he will be receiving therapy for the rest of his life.
B. his CD4 count is too low to start therapy.
C. he must be isolated from others during his acute illness to prevent exposing others.
D. his therapy will be stopped if his CD4 count rises above 200 cells/mm3 for more than 3 months

Back 4

D. his therapy will be stopped if his CD4 cound rises above 200 cells/mm3 for more than 3 months.

The current standard for treating opportunistic infections is to stop therapy when the individual's immune system has become competent and can fight off potential infections. Pneumocystis jiroveci can produce an infection when the CD4 count drops below 200 cell/mm3. This level is used as the "goalpost" for discontinuing treatment.

Front 5

A 65 yo man with head and neck cancer calls the nurs to his room complaining of indigetsion and a taste of blood in his mouth. He has a dry, nonproductive cough. He is most likely experiencing:
A. tracheal obstruction
B. carotid artery rupture
C. cardiac tamponade
D. superior vena cava syndrome

Back 5

B. carotid artery rupture

Indigestion, a taste of blood in the mouth, and dry, nonproductive cough are signs and symptoms of carotid artery rupture.

Front 6

Hypercalcemia can be prevented or lessened by which intervention?
A. Allopurinol
B. Urinary alkalinization
C. Increasing fluid intake
D. Limiting activity

Back 6

C. Increased fluid intake

Hypercalcemia can be prevented or lessened by increasing fluid intake.

Front 7

A 59 yo pt with small cell lung cancer is admitted with severe dyspnea and upper body edema. The first diagnostic test performed probably is:
A. chest CT scan
B. Echo
C. ECG
D. multigated acquisition (MUGA) scan

Back 7

A. CT scan

A chest CT scan would most likely be the first diagnostic test performed for a pt with small cell lung cancer who is admitted wtih severe dyspnea and upper body edema, to evaluate for superior vena cava syndrome (SCVS).

Front 8

Pts with acute leukemia are at greatest risk for which of the following complication?
A. caridac tamponade, syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B. Hypercalcemia, carotid artery rupture
C. Pleural effusion, superior vena cava syndrome (SVCS)
D. Cytokine release syndrome, tumor lysis syndrome

Back 8

D. Cytokine release syndrome, tumor lysis syndrome.

Pts with acute leukemia are at greatest risk for cytokine release syndrome and tumor lysis syndrome.

Front 9

A critically ill oncology patient is experiencing severe hypercalcemia. Medical management would include:
A. administering high doses of phosphorous.
B. withholding the oncological agents.
C. administering aggressive hydration.
D. transfusing the patient with packed cells.

Back 9

C. administering aggressive hydration.

Medical management of hypercalcemia involves the use of IV fluids and drug therapy to enhance renal excretion of calcium and to decrease bone resorption.

Front 10

An oncological patient who complains of back pain should start physical therapy to treat the pain.
a. True
b. False

Back 10

B. False

When a primary tumor presses on the spinal cord, sign and symptoms usually develop slowly. Problems develop more rapidly with metastatic disease. MRI is highly sensitive for neurological tissues and can clearly demonstrate all epidural deposits as well as complete or partial block of the spinal cord.

Front 11

A nurse has an ELISA test for HIV after an accidental needlestick. The test is negative. The nurse knows he
A. has not been infected with HIV.
B. probably doesn't have HIV but will need to retest in 6 weeks.
C. really won't know until he is retested in 6 weeks.
D. probably does have it and will know in 3 months.

Back 11

C. really won't know until he is retested in 6 weeks

There is a 2- to 12-week period when a person can unknowingly transmit the virus because his or her ELISA may not be positive. Health care workers exposed to HIV should have serological testing at the time of exposure and 6 weeks, 3 months, and 6 months afterward.

Front 12

CD4 counts decline as AIDS progresses.
a. True
b. False

Back 12

A. True

CD4 counts decline as AIDS progresses.

Front 13

High-risk patients can be vaccinated to protect against AIDS.
a. True
b. False

Back 13

B. False

Vaccine research is progressing, and many phase 1, 2, and 3 clinical trials have taken place, but no vaccine is currently FDA approved for use.

Front 14

HIV infects primarily which of the following cell types?
A. T lymphocytes
B. B lymphocytes
C. T4 helper cells
D. IgG antibodies

Back 14

C. T4 helper cells

Like all viruses, HIV cannot reproduce on its own. It must attach to and invade other cells, such as helper T4 lymphocytes, to reproduce.

Front 15

In assessing a patient infected with AIDS, the patient's history will include
A. night sweats and lymphadenopathy.
B. high fever and peripheral edema. C. hemoptysis and seizures. D. diplopia and mental confusion.

Back 15

A. night sweats and lymphadenopathy.

Symptoms of HIV infection include memory loss, disorientation, headaches, high fever, night sweats, and swollen lymph nodes to name a few.

Front 16

It is difficult to differentiate between engraftment syndrome and sepsis in the oncological patient.
a. True
b. False

Back 16

A. True

There is no clearly definitive diagnostic test that can differentiate engraftment syndrome from sepsis.

Front 17

Jane has had an occupational exposure to body fluids while irrigating a patient's wound. Her first ELISA test is positive. Jane
A. has AIDS.
B. should have a second ELISA performed to confirm the first test.
C. start antibiotic therapy with trimethoprim and sulfamethoxazole (Bactrim, Septra).
D. plan to find a new job where she will not expose others to HIV.

Back 17

B. should have a second ELISA performed to confirm the first test.

A positive ELISA is always repeated.

Front 18

Mrs. Z has oat cell carcinoma of the lung. She is currently admitted with acute mental status changes and a sodium level of 118 mEq/L. Her diagnosis most likely is
A. hypothyroidism.
B. Graves' disease.
C. syndrome of inappropriate antidiuretic hormone secretion (SIADH).
D. diabetes insipidus.

Back 18

C. syndrome of inappropriate antidiuretic hormone secretion (SIADH).

SIADH causes the patient to have an improved cardiac output but leaves the patient with a relative sodium deficit.

Front 19

Standard precautions were designed to protect health care workers from occupational exposure to pathogens. Standard precautions includes all the following except
A. Limit movement of patient out of the room.
B. Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items.
C. Wear mask, eye protection, or face shield during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids.
D. Handle, transport, and process linen soiled with blood and body fluids, excretions, and secretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms.

Back 19

A. Limit movement of patient out of the room.

Limiting movement of patient out of the room is part of contact precautions.

Front 20

The most common opportunistic infection to cause an admission to the ICU for a patient with AIDS is
A. hepatitis C.
B. Pneumocystis pneumonia.
C. Mycobacterium tuberculosis.
D. Candida

Back 20

B. Pneumocystis pneumonia.

The most common opportunistic infection requiring admission to the ICU is Pneumocystis pneumonia.

Front 21

The nurse is caring for a patient who has neoplastic disease and is exhibiting signs of cardiac tamponade. An emergency pericardiocentesis is the intervention of choice when:
A. the patient becomes cyanotic and shocky.
B. the pulsus paradoxus is between 20 and 30% of the pulse pressure.
C. there is an increase of more than 20 mmHg in pulse pressure.
D. the peripheral venous pressure is below 10 mmHg.

Back 21

A. the patient becomes cyanotic and shocky.

Acute or life-threatening symptoms are indications for emergent pericardial drainage by needle or catheter pericardiocentesis.

Front 22

Viral load decreases as AIDS progresses.
a. True
b. False

Back 22

B. False

Viral load increases as AIDS progresses.

Front 23

When teaching the AIDS patient about the pharmacological treatment zidovudine (AZT, ZDV, Retrovir), the nurse should instruct the patient about the most serious side effect, which is:
A. cardiac arrhythmia.
B. bone marrow suppression.
C. bleeding disorders.
D. dehydration.

Back 23

B. bone marrow suppression.

Side effects of zidovudine are neutropenia, anemia, nausea, malaise, headache, insomnia, myalgia, and asthenia.