The nurse is caring for a client with acquired immunodeficiency syndrome. Which finding noted in the client indicates the presence of an opportunistic respiratory infection?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Fever and dyspnea on exertion are the classic, hallmark symptoms of Pneumocystis jirovecii pneumonia (PCP).
PCP is the most common opportunistic respiratory infection affecting individuals with AIDS.
The infection causes inflammation and fluid buildup in the lungs, leading to impaired gas exchange, which manifests as shortness of breath, especially during activity.
These symptoms often have an insidious or gradual onset over several days to weeks.

Option A: Loss of sight is not a symptom of a respiratory infection. It is a classic sign of Cytomegalovirus (CMV) retinitis, an opportunistic infection that affects the eyes.
Option C: An arterial blood gas (ABG) pH of 7.40 is a perfectly normal finding. The normal range is 7.35-7.45. This value does not indicate any pathology.
Option D: A respiratory rate of 20 breaths per minute is at the upper limit of the normal range for an adult (12-20 breaths/min). It is not considered an abnormal finding indicative of infection.

Clinical Relevance

Nursing practice connection: Use the key finding related to Recognition of opportunistic respiratory infections in AIDS to guide bedside assessment, documentation, and the next nursing action.
Early recognition of PCP symptoms like exertional dyspnea and fever is critical for prompt diagnosis and treatment, which significantly improves patient outcomes and prevents progression to respiratory failure.
Nurses play a key role in monitoring CD4+ counts in HIV-positive patients. Prophylactic medication for PCP is initiated when the count drops below 200 cells/mm³, a crucial preventive measure.
What if the patient's CD4+ count was 450 cells/mm³? In this case, an opportunistic infection like PCP would be less likely, and the nurse would consider other common causes of pneumonia, such as bacterial pathogens like Streptococcus pneumoniae.

How to Approach the Question

First, identify the key elements of the question: the patient has AIDS, and you are looking for a sign of an opportunistic RESPIRATORY infection.
Analyze the patient's underlying condition: AIDS causes severe immunosuppression, making the patient vulnerable to specific infections.
Evaluate each option to determine if it is an abnormal finding and if it relates to the respiratory system.
Eliminate options that represent normal physiological values. A pH of 7.40 and a respiratory rate of 20 breaths/minute are normal findings.
Differentiate the location of the remaining symptoms. Loss of sight points to an eye infection (CMV retinitis), not a respiratory one.
This leaves fever and exertional dyspnea, which are classic signs of lung pathology and are strongly associated with Pneumocystis jirovecii pneumonia (PCP) in the context of AIDS.

Concept Tested & Keywords

Concept Tested: Recognition of opportunistic respiratory infections in AIDS
Stem keywords: acquired immunodeficiency syndrome, AIDS, opportunistic respiratory infection
Lead-in keywords: indicates
Clinical cues: Patient has AIDS, which points to a compromised immune system.
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 1 p. 1636-1638

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) p. 13-15

E6 Pathology-Textbook of PATHOLOGYHarsh Mohan Part 1 (1-214) p. 157-159

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.