HIV and TB Case Review

The nurse welcomes Jeff to a private room at the end of the hall. According to hospital protocol the nurse puts on a mask before starting the admission process. Jeff tells the nurse that his partner is downstairs and he would like his partner to stay in the room with him. The nurse response:

A. Your healthcare provider wants you to get some rest.
B. Your partner may stay but only after we have the results of his tuberculin test
C. Your partner may stay, but he needs to wear a mask.
D. You don’t want to risk infecting your partner with TB too do you?

C. Your partner may stay, but he needs to wear a mask.
Jeff’s partner wants to know why a mask is necessary for people entering his room. What teaching should the nurse implement?
a. Explain the use of a private room and mobile high-efficiency particle fibers placed in the room
b. Explain that the TB organism is most often spread through the air. When an infected person coughs or sneezes, they produce infectious droplets that can be breathed in by another person
c. Tell Jeff that TB will not be spread to others, and everything will be okay if the mask is worn
d. Tell Jeff that masks are required for those people who do not agree to be vaccinated with BCG vaccine
Explain that the TB organism is most often spread through the air. When an infected person coughs or sneezes, they produce infectious droplets that can be breathed in by another person
The UAP asks why Jeff can’t be in an empty semiprivate room closer to the nurse’s station. What info should the nurse provide on infection control practices?
a. The client needs to be at the end of the hall because he requires privacy
b. The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment
c. A private room is required to implement contact precautions for possible TB
d. The client needs to be at the end of the hall for confidentiality
The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment
The nurse notices the UAP about to enter Jeff’s room to deliver a meal tray without wearing any PPE. What info should the nurse provide to the UAP?
a. A mask is required for healthcare workers entering the room of someone suspected of having active TB
b. Wearing a mask, gown, and gloves is required for healthcare workers entering Jeff’s room for any reason
c. The UAP will only be in the room for a brief moment to deliver the tray, so no intervention is needed by the nurse
d. Non-sterile gloves are necessary to deliver the meal and prevent the spread of TB
A mask is required for healthcare workers entering the room of someone suspected of having active TB
Which tasks may the nurse delegate to the UAP? (SAA)
a. Tell Jeff that the specimen must be collected in the early morning
b. Provide Jeff with 3 Sterile specimen cups at his bedside
c. Teach the client how to cough to obtain sputum from deep in the bronchi
d. Document the time and date that each sputum specimen was collected
e. Assess Jeff’s ability to expectorate a sputum specimen
Tell Jeff that the speciment must be collected in the early morning
Provide Jeff with 3 Sterile specimen cups at his bedside
Document the time and date that each sputum specimen was collected
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What activity should Jeff perform first upon awakening?
a. Eat a nutritionally dense, early morning snack sent from the food services department
b. Obtain the first of 3 sputum specimens for lab testing
c. Take a shower and get ready to go to radiology for a chest x-ray
d. Weigh to determine if weight loss from the disease is continuing
Obtain the first of 3 sputum specimens for lab testing
A female staff nurse tells the supervisor that she doesn’t want to care for an HIV pt. The nursing supervisor should base her response on what information about the right of a nurse to refuse to care for clients with HIV?
a. The RN has the right and responsibility to protect the health of self and family and may therefore refuse to care for clients with contagious diseases
b. The RN may refuse to care for the pt in circumstances where risk to the nurse outweighs the nurse’s responsibility to care for a client or if the assignment conflicts with the nurse’s ethical standards
c. Refusal to treat or care for a pt based on race, gender, or age is discrimination, which the federal government prohibits
d. The required staffing ratio of licensed personnel to client population does not allow for professional nurses to refuse to care for a client
The RN may refuse to care for the pt in circumstances where risk to the nurse outweighs the nurse’s responsibility to care for a client or if the assignment conflicts with the nurse’s ethical standards
How should the nursing supervisor respond to the staff nurse who does not want to care for Jeff?
a. “I understand. I will assign you to a different client and give Jeff to one of the other nurses”
b. “I understand you are concerned, but I am concerned about you losing your job over this.”
c. “I understand your fears, but do you realize this will cause a hardship on your fellow staff members?”
d. “I understand you want to protect your children. Please tell me your concerns regarding caring for a client with HIV”
“I understand you want to protect your children. Please tell me your concerns regarding caring for a client with HIV”
Which statement by Jeff indicates that he understands why he is at risk for TB?
a. “I realize my helper T cells are diminished from HIV. Those are the cells needed to fight TB.”
b. “I may get TB because my viral load count is diminished”
c. “I am at risk for developing TB because I was born with a low number of helper T cells”
d. “I realize I am at risk for acquiring TB because I used intravenous drugs in the past”
“I realize my helper T cells are diminished from HIV. Those are the cells needed to fight TB”
Jeff’s TB skin test reaction measured 5 mm in diameter and positive for TB. A 10 mm induration is the minimum size for a positive reading, so a new graduate nurse expresses confusion. How should the nurse preceptor respond?
a. “This confuses me too. I think we need to consult with the HCP”
b. “That is not always true. A 5 mm induration is considered positive for TB in a person with HIV”
c. “It may be that you are confusing induration with inflammation in skin testing results.”
d. “Let’s ask the NP who specializes in caring for clients who are HIV positive.”
“That is not always true. A 5 mm induration is considered positive for TB in a person with HIV”
The nurse brings Jeff his HIV meds due in the morning and he states that he takes all his meds at once at home. How should the nurse reply?
a. “To be most effective, HIV medications are prescribed on different schedules.”
b. “All right. I will give the rest to the UAP to bring in as soon as possible”
c. “We are just trying to provide you with the best nursing care possible on this unit.”
d. “We need your cooperation to help fight this disease.”
“To be most effective, HIV medications are prescribed on different schidules.”
Jeff agrees to take his medications as prescribed, but does not know what they do. How should the nurse respond?
a. “I honestly do not know, but I would give it a try. What is there to lose?”
b. “The main purpose of these medicines is to block the replication of the HIV virus”
c. “You should talk to your healthcare provider about your medications.”
d. “Tell me about the experiences your friends have had with these medicines.”
“The main purpose of these medicines is to block the replication of the HIV virus”
What information is important to teach Jeff about the use of Rifater? (SAA)
a. Rifampin stains urine, stool, saliva, sweat, and tears reddish orange
b. Liver function tests should be routinely conducted and monitored.
c. There is no need to wear sunscreen when exposed to sunlight while taking Rifater
d. Supplemental Vitamin B6 may be prescribed. Avoid eating tyramine-rich foods while taking rifampin
e. Rifater has been known to cure HIV within a few months of taking it.
Rifampin stains urine, stool, saliva, sweat, and tears reddish orange
Liver function tests should be routinely conducted and monitored.
Supplemental Vitamin B6 may be prescribed. Avoid eating tyramine-rich foods while taking rifampin
Jeff has experienced weight loss and has a CD4 count of 240 cells/mm^3 and is moved to infection stage 3 (AIDS). What is the priority nursing dx for Jeff at this time?
a. Risk for new opportunistic infections r/t decreased immune function
b. Social isolation r/t worsening of condition
c. Imbalanced nutrition, less than body requirements r/t medication side effects
d. Fatigue r/t altered body chemistry
Risk for new opportunistic infections r/t decreased immune function
The UAP suggests putting signs on Jeff’s door to warn the staff of his condition of symptomatic AIDS. What information should the nurse give the UAP?
a. Following standard precautions will minimize the exposure to blood and body fluids
b. Reverse isolation procedures should be implemented to protect the staff.
c. Resp precautions are all that are needed, and those are already posted on the door.
d. Staff members caring for Jeff should begin prophylaxis medications
Following standard precautions will minimize the exposure to blood and body fluids
The UAP has been assigned to help bathe Jeff, who is an AIDS pt. She puts on a gown, gloves, mask, and goggles. What sould the nurse say to the UAP?
a. “I see you are putting on a gown, gloves, mask, and goggles to go into the client’s room. Help me understand this choice.”
b. “Don’t you know all that equipment is not necessary?”
c. “Wearing all that equipment is a waste of hospital supplies”
d. “Wearing all that equipment may frighten Jeff”
“I see you are putting on a gown, gloves, mask, and goggles to go into the client’s room. Help me understand this choice.”
Jeff has barely touched his food, and when the nurse offers to order something different, he replies that his mouth is sore and he just doesn’t feel like eating. Which assessment finding by the nurse would be indicative of oral candidiasis, a common secondary infection in pts with compromised immune systems?
a. Blisters on the tongue or oral mucosa
b. Inflammation of the gums
c. Painless white lesions on the lateral surface of the tongue
d. White-yellow patches on the tongue or oral mucosa
White-yellow patches on the tongue or oral mucosa
What instruction should the nurse give Jeff about the use of liquid nystatin for oral candidiasis?
a. Place all of the suspension in the mouth, then swish and swallow immediately
b. Sip the suspension over 5 minutes, swishing and swallowing after each sip
c. Place the suspension in the mouth, then swish for several minutes before swallowing
d. Use the applicator to paint the medication on the infected sites and swallow the remaining dose
Place the suspension in the mouth, then swish for several minutes before swallowing
Jeff realizes that he should eat, but he doesn’t have the energy or appetite to do so. The nurse identifies the diagnosis of “Imbalanced Nutrition: less than body requirements.” To achieve the goal of improving Jeff’s nutrition, which nursing intervention should the nurse perform?
a. Consult with Jeff to assess his food preferences
b. Request a prescription for TPN
c. Inform Jeff that adequate nutrition is essential
d. Instruct hi to focus on breakfast, the most important meal of the day
Consult with Jeff to assess his food preferences
Since Jeff now has thrush, in addition to fatigue and anorexia, which food best contributes to improving Jeff’s nutrition?
a. Broiled steak
b. Milk shake
c. Tomato soup
d. Lettuce salad with raw vegetables
Milk shake
Which task should be delegated to the UAP? (SAA)
a. Weigh Jeff each morning before breakfast
b. Measure the urine output
c. Count and record the number of watery stools.
d. Evaluate the rate and quality of Jeff’s pulse
e. Check Jeff’s skin turgor to determine if he is dehydrated
Weigh Jeff each morning before breakfast
Measure the urine output
Count and record the number of watery stools
Jeff’s weight is 2 lbs less than yesterday morning, and he has a weak, rapid pulse, decreased skin turgor, and dry, sticky oral mucous membranes. What is the priority nursing diagnosis?
a. Fatigue
b. Disturbed sleep pattern
c. Deficit Fluid Volume
d. Situational low self esteem
Deficit Fluid Volume
Which action should the nurse take first when a pt has a fluid volume deficit?
a. Hold the pt’s breakfast tray to provide bowel rest
b. Perform oral care and moisten mucous membranes
c. Take the pt’s BP to assess for postural hypotension
d. Notify the HCP of the pt’s weak, rapid pulse
Take the pt’s BP to assess for postural hypotension
The HCP prescribes 1000 mL of Normal Saline to run over 6 hours. The drop factor tubing is 15 drops per min. How many drops/min will the IV run.
42

1000 x 15 = 15000 / 360 = 41.6 rounded = 42
volume x drop factor / minutes

360 = 6 hours x 60 minutes to get total minutes of time running.

When discussing infection control practices with the nurse, Jeff says, “I heard that condoms don’t always prevent HIV.” How should the nurse respond?
a. “If used correctly and consistently, latex condoms are highly effective in preventing the transmission of HIV”
b. “I know you would feel terrible if you passed HIV to someone because you did not use a condom”
c. “I will have an AIDS educator discuss condom use with you”
d. “What is your source of information about condom failure?”
“If used correctly and consistently, latex condoms are highly effective in preventing the transmission of HIV”
Jeff expresses concern about becoming dehydrated again. What resources can the nurse give him?

A. Meals on Wheels
B. HIV/Aids Support Group
C. Access to a registered dietitian
D. Access to a nurse on a hospital unit

C. Access to a registered dietitian
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