The nurse is preparing a teaching plan for a group of clients who were found to be HIV positive within the last year. Members of the group express an interest in learning about the pathology of AIDS.
The nurse should explain that HIV acts in which way to suppress the immune system?

Proliferation of suppressor T-cells.

Deficiency of cytotoxic T-cells.

Increase in B-lymphocytes and IgM.

Destruction of helper T-cells and CD4 cells.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Incorrect. Suppressor T-cells (also known as regulatory T-cells) play a role in regulating the immune response, but their proliferation is not the primary mechanism by which HIV suppresses the immune system. In fact, HIV can disrupt the function of suppressor T-cells, leading to an impaired ability to control immune responses.

Choice B rationale:

Incorrect. Cytotoxic T-cells (also known as CD8+ T-cells) are important for killing infected cells, but their deficiency is not the direct cause of immune suppression in HIV. However, HIV can indirectly lead to a deficiency of cytotoxic T-cells by disrupting their production and function.

Choice C rationale:

Incorrect. B-lymphocytes produce antibodies, and IgM is an early antibody produced in response to infection. However, an increase in B-lymphocytes and IgM is not characteristic of HIV infection. In fact, HIV can impair B-cell function, leading to decreased antibody production.

Choice D rationale:

Correct. HIV primarily targets and destroys helper T-cells (also known as CD4+ T-cells). These cells play a crucial role in coordinating the immune response by activating other immune cells, such as cytotoxic T-cells and B-cells. The depletion of helper T-cells leads to a progressive weakening of the immune system, rendering the body vulnerable to opportunistic infections and cancers.

Specific mechanisms of CD4+ T-cell destruction by HIV:

Direct infection and lysis: HIV can directly infect CD4+ T-cells and replicate within them, eventually leading to the death of the infected cells.

CD4+ T-cell apoptosis: HIV can induce programmed cell death (apoptosis) in CD4+ T-cells through various mechanisms, including the activation of pro-apoptotic pathways and the disruption of anti-apoptotic signals.

Immune dysregulation: HIV infection can also dysregulate the immune system, leading to chronic inflammation and immune activation. This can further contribute to CD4+ T-cell depletion and dysfunction.

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Correct Answer is B

Explanation

The most likely diagnosis for this client isB. Pulmonary embolism and postpartum hemorrhage.

Here’s why:

Postpartum Hemorrhage:
- The client has a large amount of lochia rubra, indicating significant blood loss.
- Hemoglobin and hematocrit levels are low (7.5 g/dL and 22%, respectively), which is consistent with significant blood loss.
- Symptoms like feeling lightheaded, pale appearance, and cool, clammy skin further support this diagnosis.
Pulmonary Embolism:
- The client is experiencing shortness of breath, using accessory muscles to breathe, and has an oxygen saturation of 88% on room air.
- Elevated D-dimer levels (1.5 µg/mL) suggest the presence of a clot.
- Arterial Blood Gas (ABG) results show a low PaO2 (60 mmHg) and a slightly acidic pH (7.32), which can be seen in pulmonary embolism.
- The client reports a feeling of tightness in her chest and has a rapid heart rate (120 beats per minute), which are also indicative of a pulmonary embolism.

A. Improved mental status. B. Increase in urine output. C. Reduction in number of liquid stools. D. Ability to ambulate independently.

Correct Answer is A

Explanation

Choice A rationale:

Lactulose is a non-absorbable disaccharide that is metabolized by bacteria in the colon to produce lactic acid and acetic acid. These acids acidify the colon, which traps ammonia (NH3) in the colon and converts it to ammonium (NH4+). Ammonium is not absorbed by the colon and is excreted in the stool. This ammonia-lowering effect is the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.

Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with severe liver disease. It is caused by the buildup of ammonia in the blood, which can cross the blood-brain barrier and cause cerebral edema and impaired brain function.

The clinical manifestations of hepatic encephalopathy range from mild confusion and personality changes to coma. Improved mental status is a key therapeutic goal in the treatment of hepatic encephalopathy.

Studies have shown that lactulose can improve mental status in patients with hepatic encephalopathy. A meta-analysis of 11 randomized controlled trials found that lactulose was associated with a significant improvement in mental status compared to placebo.

The improvement in mental status is typically seen within 24 to 48 hours of starting lactulose therapy.

Choice B rationale:

Increased urine output is not a direct therapeutic effect of lactulose. Lactulose can cause diarrhea, which can lead to increased urine output due to fluid loss. However, this is not the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.

Choice C rationale:

Reduction in the number of liquid stools is a common side effect of lactulose. However, it is not a therapeutic goal in the treatment of hepatic encephalopathy. The goal of lactulose therapy is to improve mental status by lowering ammonia levels in the blood.

Choice D rationale:

Ability to ambulate independently is not a direct therapeutic effect of lactulose. Lactulose can improve mental status, which may indirectly lead to improved ambulation in some patients. However, this is not the primary mechanism by which lactulose works.

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The nurse is preparing a teaching plan for a group of clients who were found to be HIV positive within the last year. Members of the group express an interest in learning about the pathology of AIDS.The nurse should explain that HIV acts in which way to suppress the immune system?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits A nurse is reviewing the client’s condition. Based on the exhibits provided, what is the most likely diagnosis for this client?

Correct Answer is B

Explanation

A client has been administered lactulose for several days.Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?

Correct Answer is A

Explanation

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The nurse is preparing a teaching plan for a group of clients who were found to be HIV positive within the last year. Members of the group express an interest in learning about the pathology of AIDS.
The nurse should explain that HIV acts in which way to suppress the immune system?