Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Chapter 14: Infection
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. The nurse is advising a patient who was exposed 4 days ago to human immunodeficiency
virus (HIV) through unprotected sexual intercourse. The patient’s antigen-antibody test has
just been reported as negative for HIV. What information should the nurse give to this
patient?
a. “You will need to be retested in 2 weeks.”
b. “You do not need to fear infecting others.”
c. “We won’t know for about 10 years if you have HIV infection.”
d. “With no symptoms and this negative test, you do not have HIV.”
ANS: A
HIV screening tests detect HIV-specific antibodies or antigens. However, there may be a
delay between infection and the time a screening test is able to detect HIV. The typical
“window period” for antigen-antibody combination assays is approximately 2 weeks. It is not
known based on this information whether the patient is infected with HIV or can infect others.
It would be best practice to have him return for repeat testing in approximately 2 weeks.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
2. A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is
admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of
NURdiagnostic
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OMestablished by the Centers for Disease
less than 200 cells/L. Based on
criteria
Control and Prevention (CDC), which statement by the nurse is correct?
a. “The patient meets the criteria for a diagnosis of acute HIV infection.”
b. “The patient will be diagnosed with asymptomatic chronic HIV infection.”
c. “The patient will likely develop symptomatic HIV infection within 1 year.”
d. “The patient has developed acquired immunodeficiency syndrome (AIDS).”
ANS: D
Development of PCP meets the diagnostic criteria for AIDS. The other responses indicate
earlier stages of HIV infection than is indicated by the PCP infection.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. A patient informed of a positive rapid screening test result for human immunodeficiency virus
(HIV) is anxious and does not appear to hear what the nurse is saying. What action by the
nurse is most important at this time?
a. Inform the patient about the available treatments.
b. Teach the patient how to manage a possible drug regimen.
c. Remind the patient to return for retesting to verify the results.
d. Ask the patient to identify those persons who had intimate contact.
ANS: C
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
After an initial positive antibody test result, the next step is retesting to confirm the results. A
patient who is anxious is not likely to be able to take in new information or be willing to
disclose information about the HIV status of other individuals.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
4. A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse,
“I feel obsessed with morbid thoughts about dying.” Which response by the nurse is
appropriate?
a. “Thinking about dying will not improve the course of AIDS.”
b. “Do you think that taking an antidepressant might be helpful?”
c. “Can you tell me more about the thoughts that you are having?”
d. “It is important to focus on the good things about your life now.”
ANS: C
More assessment of the patient’s psychosocial status is needed before taking any other action.
The statements, “Thinking about dying will not improve the course of AIDS” and “It is
important to focus on the good things in life” or suggesting an antidepressant discourage the
patient from sharing any further information with the nurse and decrease the nurse’s ability to
develop a trusting relationship with the patient.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
5. A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV)
infection is seen at the clinic. The patient states, “I am very nervous about making my baby
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sick.” Which information will
the
nurse
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OM teaching the patient?
a. The antiretroviral medications used to treat HIV infection are teratogenic.
b. Most infants born to HIV-positive mothers are not infected with the virus.
c. Because it is an early stage of HIV infection, the infant will not contract HIV.
d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
ANS: B
Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the
mother does not use ART during pregnancy. The percentage drops to 2% when ART is used.
Perinatal transmission can occur at any stage of HIV infection (although it is less likely to
occur when the viral load is lower). ART can safely be used in pregnancy, although some
ART drugs should be avoided.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
6. Which exposure by the nurse is most likely to require postexposure prophylaxis when the
patient’s human immunodeficiency virus (HIV) status is unknown?
a. Bite to the arm that does not result in open skin
b. Splash into the eyes while emptying a bedpan containing stool
c. Needle stick with a needle and syringe used for a venipuncture
d. Contamination of open skin lesions with patient vaginal secretions
ANS: C
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Puncture wounds are the most common means for workplace transmission of blood-borne
diseases, and a needle with a hollow bore that had been contaminated with the patient’s blood
would be a high-risk situation. The other situations described would be much less likely to
result in transmission of the virus.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
7. A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of
400/µL. Which factor is most important for the nurse to determine before the initiation of
antiretroviral therapy (ART) for this patient?
a. CD4+ cell count
b. How the patient obtained HIV
c. Patient’s tolerance for potential medication side effects
d. Patient’s ability to follow a complex medication regimen
ANS: D
Drug resistance develops quickly unless the patient takes ART medications on a strict, regular
schedule. In addition, drug resistance endangers both the patient and community. The other
information is also important to consider, but patients who are unable to manage and follow a
complex drug treatment regimen should not be considered for ART.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
8. Which patient would benefit from education about HIV preexposure prophylaxis (PrEP)?
a. A 23-yr-old woman living with HIV infection.
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b. A 52-yr-old recently single
diagnosed
OM with chlamydia.
c. A 33-yr-old hospice worker who received a needle stick injury 3 hours ago.
d. A 60-yr-old male in a monogamous relationship with an HIV-uninfected partner.
ANS: B
Preexposure prophylaxis (PrEP) is used to prevent HIV infection. Persons who would be good
candidates for PrEP include individuals with a recent diagnosis of an STI and those with more
than one partner. Individuals who are not on PrEP but who have a recent high-risk exposure
(such as a needle stick) would be better candidates for postexposure prophylaxis (PEP). A
person in a monogamous relationship with an HIV-uninfected partner is considered low-risk
for HIV infection.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Multiple Patients
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
9. The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human
immunodeficiency virus (HIV) infection. Which action would be appropriate for the nurse to
take?
a. Instruct the patient to apply ice to the neck.
b. Tell the patient a secondary infection is present.
c. Explain to the patient that this is an expected finding.
d. Request that an antibiotic be prescribed for the patient.
ANS: C
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No
antibiotic is needed because the enlarged nodes are probably not caused by bacteria.
Lymphadenopathy is common with acute HIV infection and is therefore not likely to represent
an additional infection. Ice will not decrease the swelling in persistent generalized
lymphadenopathy
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
10. Which information about a patient population would be most useful to help the nurse plan for
human immunodeficiency virus (HIV) testing needs?
a. Age
b. Lifestyle
c. Symptoms
d. Sexual orientation
ANS: A
The current Centers for Disease Control and Prevention policy is to offer routine testing for
HIV to all individuals age 13 to 64 years. Although lifestyle, symptoms, and sexual
orientation may suggest increased risk for HIV infection, the goal is to test all individuals in
this age range.
DIF: Cognitive Level: Apply (application)
TOP:
MSC: NCLEX: Health Promotion and Maintenance
Nursing Process: Planning
11. A patient who uses injectable illegal drugs asks the nurse how to prevent acquired
immunodeficiency syndrome (AIDS). Which response by the nurse is most accurate?
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a. “Clean drug injection equipment
each use.”
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OM
b. “Ask those who share equipment to be tested for HIV.”
c. “Consider participating in a needle-exchange program.”
d. “Avoid sexual intercourse when using injectable drugs.”
ANS: C
Participation in needle-exchange programs has been shown to decrease and control the rate of
HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be
consistently practiced. HIV antibodies do not appear for several weeks to months after
exposure, so testing drug users would not be very effective in reducing risk for HIV exposure.
HIV can be transmitted through both intercourse and injection.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
12. Which nursing action will be most useful in assisting a young adult to adhere to a newly
prescribed antiretroviral therapy (ART) regimen?
a. Give the patient detailed information about possible medication side effects.
b. Remind the patient of the importance of taking the medications as scheduled.
c. Help the patient develop a schedule to decide when the drugs should be taken.
d. Encourage the patient to join a support group for adults who are HIV positive.
ANS: C
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
The best approach to improve adherence is to learn about important activities in the patient’s
life and adjust the ART around those activities. The other actions are also useful, but they will
not improve adherence as much as individualizing the ART to the patient’s schedule.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
13. A patient with human immunodeficiency virus (HIV) infection has developed
Cryptosporidium parvum infection. Which outcome would be appropriate for the nurse to
include in the plan of care?
a. The patient will be free from injury.
b. The patient will receive immunizations.
c. The patient will have adequate oxygenation.
d. The patient will maintain intact perineal skin.
ANS: D
The major manifestation of C. pravum infection is loose, watery stools, which would increase
the risk for perineal skin breakdown. The other outcomes would be appropriate for other
complications (e.g., pneumonia, dementia, influenza) associated with HIV infection.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
14. A patient treated for human immunodeficiency virus (HIV) infection for 6 years has
developed fat redistribution to the trunk with wasting of the arms, legs, and face. What
recommendation will the nurse give to the patient?
a. Review foods that are higher in protein.
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b. Teach about the benefits N
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c. Discuss a change in antiretroviral therapy.
d. Talk about treatment with antifungal agents.
ANS: C
A frequent first intervention for metabolic disorders is a change in antiretroviral therapy
(ART). Treatment with antifungal agents would not be appropriate because there is no
indication of fungal infection. Changes in diet or exercise have not proven helpful for this
problem.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
15. The nurse prepares to administer the following medications to a hospitalized patient with
human immunodeficiency (HIV). Which medication is most important to administer at the
scheduled time?
a. Nystatin tablet
b. Oral acyclovir (Zovirax)
c. Aerosolized pentamidine (NebuPent)
d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
ANS: D
It is important that antiretrovirals be taken at the prescribed time every day to avoid
developing drug-resistant HIV. The other medications should also be given as close as
possible to the correct time, but they are not as essential to receive at the same time every day.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
16. To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will
the nurse review?
a. Viral load testing
b. Enzyme immunoassay
c. Rapid HIV antibody testing
d. Immunofluorescence assay
ANS: A
The effectiveness of ART is measured by the decrease in the amount of virus detectable in the
blood. The other tests are used to detect HIV antibodies, which remain positive even with
effective ART.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
17. The nurse is caring for a patient who is living with human immunodeficiency virus (HIV) and
taking antiretroviral therapy (ART). Which information is most important for the nurse to
address when planning care?
a. The patient reports feeling “constantly tired.”
b. The patient reports having no side effects from the medications.
c. The patient is unable to explain the effects of atorvastatin (Lipitor).
d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
ANS: D
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N toTdrug resistance,
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Because missing doses of ARTUcanSlead
this patient statement indicates the
need for interventions such as teaching or changes in the drug scheduling. Fatigue is a
common side effect of ART. The nurse should discuss medication actions and side effects
with the patient, but this is not as important as addressing the skipped doses of Descovy.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
18. Eight years after seroconversion, a patient with human immunodeficiency virus infection has
a CD4+ cell count of 800/µL and an undetectable viral load. What should be included in the
plan of care at this time?
a. Encourage adequate nutrition, exercise, and sleep.
b. Teach about the side effects of antiretroviral agents.
c. Explain opportunistic infections and antibiotic prophylaxis.
d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
ANS: A
The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of
asymptomatic chronic infection when the body is able to produce enough CD4+ cells to
maintain a normal CD4+ count. Maintaining healthy lifestyle behaviors is an important goal in
this stage. AIDS and increased incidence of opportunistic infections typically develop when
the CD4+ count is much lower than normal. Although the initiation of ART is highly
individual, it would not be likely that a patient with a normal CD4+ level would receive ART.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
19. Which patient who has arrived at the human immunodeficiency virus (HIV) clinic should the
nurse assess first?
a. Patient whose rapid HIV-antibody test is positive.
b. Patient whose latest CD4+ count has dropped to 250/µL.
c. Patient who has had 10 liquid stools in the last 24 hours.
d. Patient who has nausea from prescribed antiretroviral drugs.
ANS: C
The nurse should assess the patient for dehydration and hypovolemia. The other patients also
will require assessment and possible interventions, but do not require immediate action to
prevent complications such as hypovolemia and shock.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
20. An older adult who takes medications for coronary artery disease and hypertension is newly
diagnosed with HIV infection and is starting antiretroviral therapy. Which information will
the nurse include in patient teaching?
a. Many drugs interact with antiretroviral medications.
b. HIV infections progress more rapidly in older adults.
c. Less frequent CD4+ level monitoring is needed in older adults.
d. Hospice care is available for patients with terminal HIV infection.
ANS: A
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The nurse will teach the patient about potential interactions between antiretrovirals and the
medications that the patient is using for chronic health problems. Treatment and monitoring of
HIV infection is not affected by age. A patient beginning early ART is not a candidate for
hospice. Progression of HIV is not affected by age although it may be affected by chronic
disease.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
21. The registered nurse (RN) is caring for a patient who is living with HIV and admitted with
tuberculosis. Which task can the RN delegate to unlicensed assistive personnel (UAP)?
a. Teach the patient how to dispose of tissues with respiratory secretions.
b. Stock the patient’s room with the necessary personal protective equipment.
c. Interview the patient to obtain the names of family members and close contacts.
d. Tell the patient’s family members the reason for the use of airborne precautions.
ANS: B
A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all
health care workers are taught about the various types of infection precautions used in the
hospital, the UAP can safely stock the room with personal protective equipment. Obtaining
contact information and patient teaching are higher-level skills that require RN education and
scope of practice.
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
22. The nurse designs a program to decrease the incidence of human immunodeficiency virus
(HIV) infection in the adolescent and young adult populations. Which information should the
nurse assign as the highest priority?
a. Methods to prevent perinatal HIV transmission.
b. Ways to sterilize needles used by injectable drug users.
c. Prevention of HIV transmission between sexual partners.
d. Means to prevent transmission through blood transfusions.
ANS: C
Sexual transmission is the most common way that HIV is transmitted. The nurse should also
provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but
the rate of HIV infection associated with these situations is lower.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
1. The nurse is caring for a patient living with asymptomatic chronic HIV infection (HIV).
Which prophylactic measures will the nurse include in the plan of care? (Select all that apply.)
a. Hepatitis B vaccine
b. Pneumococcal vaccine
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c. Influenza virus vaccine U S N T
d. Trimethoprim-sulfamethoxazole
e. Varicella zoster immune globulin
ANS: A, B, C
Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis
of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g.,
fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is
an important intervention in patients who are living with HIV, and these vaccines are
recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are
used to prevent and treat infections that occur later in the course of the disease when the CD4+
counts have dropped or when infection has occurred.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
2. According to the Center for Disease Control and Prevention (CDC) guidelines, which
personal protective equipment will the nurse put on before assessing a patient who is on
contact precautions for Clostridium difficile diarrhea? (Select all that apply.)
a. Mask
b. Gown
c. Gloves
d. Shoe covers
e. Eye protection
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Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
ANS: B, C
Because the nurse will have substantial contact with the patient and bedding when doing an
assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in
contact precautions only when spraying or splashing is anticipated. Shoe covers are not
recommended in the CDC guidelines.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
3. The nurse plans a presentation for community members about how to decrease the risk for
antibiotic-resistant infections. Which information will the nurse include in the teaching plan?
(Select all that apply.)
a. Antibiotics may sometimes be prescribed to prevent infection.
b. Continue taking antibiotics until all of the prescription is gone.
c. Unused antibiotics that are more than a year old should be discarded.
d. Antibiotics are effective in treating influenza associated with high fevers.
e. Hand washing is effective in preventing many viral and bacterial infections.
ANS: A, B, E
All prescribed doses of antibiotics should be taken. In some situations, such as before surgery,
antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics
because all prescribed doses should be taken. However, if there are leftover antibiotics, they
should be discarded at once because the number left will not be enough to treat a future
infection. Hand washing is considered the single most effective action in decreasing infection
transmission. Antibiotics are ineffective in treating viral infections such as influenza.
DIF: Cognitive Level: Apply N
(application)
URSINGMSC:
TB.C
OM Health Promotion and Maintenance
TOP: Nursing Process: Implementation
NCLEX:
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