A client with HIV is being discharged home and will begin receiving care in the home setting. During discharge education, which aspect of self-care should the nurse emphasize as the priority to help prevent complications?

Avoiding crowded places such as public transportation during peak hours

Appropriate use of prophylactic antibiotics

Taking prescribed medications with food to reduce gastrointestinal upset

Maintaining strict personal hygiene practices

Answer and Explanation

The Correct Answer is D

A. Avoiding crowded places such as public transportation during peak hours: Avoiding crowded areas can help reduce exposure to infections, but it is not the most critical aspect of self-care. Clients cannot always fully avoid public spaces, and prevention strategies must be more comprehensive.

B. Appropriate use of prophylactic antibiotics: Some clients with HIV may be prescribed prophylactic antibiotics to prevent opportunistic infections. However, this is provider-directed and not a universal measure for all clients. Teaching should emphasize broader, daily self-care practices.

C. Taking prescribed medications with food to reduce gastrointestinal upset: Taking medications with food can help manage side effects and improve adherence, but this is secondary to infection prevention. GI upset is manageable, whereas infections can quickly become life-threatening.

D. Maintaining strict personal hygiene practices: Clients with HIV are immunocompromised and highly susceptible to infections. Proper handwashing, safe food handling, and skin/mouth care are essential in reducing exposure to pathogens and preventing serious complications.

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Correct Answer is B

Explanation

A. Symmetrical chest expansion: In a tension pneumothorax, chest expansion is usually asymmetrical because air trapped in the pleural space prevents full lung expansion on the affected side. Symmetrical movement would not be expected in this condition.

B. Tracheal deviation away from the affected side: This is a hallmark sign of tension pneumothorax. As intrapleural pressure increases, the mediastinum shifts, pushing the trachea and other structures toward the unaffected side, which is a medical emergency requiring immediate intervention.

C. Increased breath sounds on the affected side: Breath sounds are typically absent or markedly diminished over the affected lung due to lung collapse. Increased breath sounds would not occur in the presence of trapped air compressing the lung.

D. Hyperresonance to percussion on the affected side: Hyperresonance can occur with a simple pneumothorax due to excess air in the pleural cavity. However, while present, it is not as specific or critical as tracheal deviation, which directly indicates a tension pneumothorax.

A. "Are the voices telling you to harm yourself or someone else?" B. "The voices are not real or we would both hear them." C. "Why are the voices talking to only you?" D. "Why didn't you ask the voices to go away?"

Correct Answer is A

Explanation

A. "Are the voices telling you to harm yourself or someone else?": This response directly assesses for command hallucinations, which may increase the risk of self-harm or violence. Safety is the priority, and clarifying the content of the hallucinations helps guide immediate interventions.

B. "The voices are not real or we would both hear them.": This approach challenges the client’s perception and can increase defensiveness or mistrust. Denying the hallucination does not promote therapeutic communication or ensure safety.

C. "Why are the voices talking to only you?": This response is non-therapeutic and may make the client feel ridiculed or invalidated. It does not provide support or assess the potential danger of the hallucinations.

D. "Why didn't you ask the voices to go away?": This places responsibility on the client to control the hallucination, which they cannot do. It is dismissive of the distress they are experiencing and fails to address safety concerns associated with auditory hallucinations.

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A client with HIV is being discharged home and will begin receiving care in the home setting. During discharge education, which aspect of self-care should the nurse emphasize as the priority to help prevent complications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which assessment finding indicates a tension pneumothorax, a complication of untreated pneumothorax?

Correct Answer is B

Explanation

A client diagnosed with Schizophrenia states, "The voices won't leave me alone!" Which of the following statements should the nurse make?

Correct Answer is A

Explanation

Which of the following best describes the pathophysiology of HIV/AIDS and its impact on the immune system?

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