HESI RN Case Study: HIV/TB
Raymond Malone, age 45 years admitted from his healthcare provider's office (HCP) to the
acute care facility. Jeff was diagnosed HIV positive 2 years ago. His history includes fatigue, a
productive cough, and weight loss. A tuberculosis(TB) test was administered in the healthcare
provider's office. Admission prescriptions include "isolation precautions for suspected pulmonary
tuberculosis." See following questions... - ANS
The nurse admits Raymond to a private room at the end of the hall. According to hospital
protocol, the nurse put on a mask before starting the admission process. Raymond tells the
nurse that his significant other is downstairs and that he would like for him to stay in the room
with him.
1. How should the nurse respond? - ANS"He may stay but only if he wears a mask"
Raymond's significant other may stay in the room, but he should wear a mask to help decrease
the possibility of contracting the TB organism.
Raymond's significant other,Brandon, arrives. Raymond wants to know why a mask is
necessary for people entering his room.
2.What teaching should the nurse implement? - ANSExplain that the Tuberculosis(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. This answer provides Raymond with the scientific rationale for
wearing a mask.
Safety and Infection Control
The unlicensed assistive personnel (UAP) asks why Raymond could not be in an empty
semiprivate room closer to the nurses station so that the staff would not have to walk so far to
provide care.
3. What information should the nurse provide to the UAP on infection control services? -
ANSThe implementation of airborne precautions for possible TB requires a private, negative
pressure room assignment.
According to the Centers for Disease Control (CDC), in addition to isolating Raymond by using a
private room, engineering controls can help to prevent the spread of TB. Controlling the
direction of the airflow can prevent contamination of air in adjacent areas.
, The nurse notices the UAP about to enter Raymond's room to deliver a meal tray without
wearing any protective apparel.
4. What information should the nurse provide the UAP - ANSA mask is required for healthcare
workers entering the room of someone suspected of having active TB.
TB is spread by airborne transmission of droplet nuclei. A specific fit tested, high-efficiency
particulate air (HEPA) mask is necessary to filter the mycobacterium tuberculosis bacillus.
Nursing Process: Intervention
An acid-fast-bacilli (AFB) stain is part of the initial admission prescriptions. Early morning
sputum specimens will be collected for three consecutive days and sent onto the lab.
5. Which tasks may the nurse delegate to the UAP? (SATA) - ANSHave the UAP tell Raymond
that the specimen must be collected in the early morning.
This task may be delegated.
Provide Raymond with three sterile specimen cups at his bedside.
This task may be delegated.
Document the time and date that each sputum specimen was collected.
This task may be safely delegated. However, it is the nurse's responsibility to ensure that the
documentation is completed and sent with the specimen to the lab.
Raymond is scheduled for several activities the following morning.
6. Which activity should Raymond perform first upon awakening? - ANSObtain the first of three
sputum specimens for laboratory testing.
Secretions collecting during the night provide the opportunity for the client to cough and
expectorate upon awakening before performing other morning activities.
Safe and Effective Care Environment: Management of Care
A licensed vocational nurse (LVN) says to the nurse who is making assignments, " I do not want
to be assigned to care for Raymond. I have never cared for a client with HIV and do not want to
start now. I have a family at home that needs me."
7. Which information should the nurse base a response about the LVN's right to refuse care for
a client with HIV? - ANSThe LVN may refuse to care for a client in circumstances in which 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.
Raymond Malone, age 45 years admitted from his healthcare provider's office (HCP) to the
acute care facility. Jeff was diagnosed HIV positive 2 years ago. His history includes fatigue, a
productive cough, and weight loss. A tuberculosis(TB) test was administered in the healthcare
provider's office. Admission prescriptions include "isolation precautions for suspected pulmonary
tuberculosis." See following questions... - ANS
The nurse admits Raymond to a private room at the end of the hall. According to hospital
protocol, the nurse put on a mask before starting the admission process. Raymond tells the
nurse that his significant other is downstairs and that he would like for him to stay in the room
with him.
1. How should the nurse respond? - ANS"He may stay but only if he wears a mask"
Raymond's significant other may stay in the room, but he should wear a mask to help decrease
the possibility of contracting the TB organism.
Raymond's significant other,Brandon, arrives. Raymond wants to know why a mask is
necessary for people entering his room.
2.What teaching should the nurse implement? - ANSExplain that the Tuberculosis(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. This answer provides Raymond with the scientific rationale for
wearing a mask.
Safety and Infection Control
The unlicensed assistive personnel (UAP) asks why Raymond could not be in an empty
semiprivate room closer to the nurses station so that the staff would not have to walk so far to
provide care.
3. What information should the nurse provide to the UAP on infection control services? -
ANSThe implementation of airborne precautions for possible TB requires a private, negative
pressure room assignment.
According to the Centers for Disease Control (CDC), in addition to isolating Raymond by using a
private room, engineering controls can help to prevent the spread of TB. Controlling the
direction of the airflow can prevent contamination of air in adjacent areas.
, The nurse notices the UAP about to enter Raymond's room to deliver a meal tray without
wearing any protective apparel.
4. What information should the nurse provide the UAP - ANSA mask is required for healthcare
workers entering the room of someone suspected of having active TB.
TB is spread by airborne transmission of droplet nuclei. A specific fit tested, high-efficiency
particulate air (HEPA) mask is necessary to filter the mycobacterium tuberculosis bacillus.
Nursing Process: Intervention
An acid-fast-bacilli (AFB) stain is part of the initial admission prescriptions. Early morning
sputum specimens will be collected for three consecutive days and sent onto the lab.
5. Which tasks may the nurse delegate to the UAP? (SATA) - ANSHave the UAP tell Raymond
that the specimen must be collected in the early morning.
This task may be delegated.
Provide Raymond with three sterile specimen cups at his bedside.
This task may be delegated.
Document the time and date that each sputum specimen was collected.
This task may be safely delegated. However, it is the nurse's responsibility to ensure that the
documentation is completed and sent with the specimen to the lab.
Raymond is scheduled for several activities the following morning.
6. Which activity should Raymond perform first upon awakening? - ANSObtain the first of three
sputum specimens for laboratory testing.
Secretions collecting during the night provide the opportunity for the client to cough and
expectorate upon awakening before performing other morning activities.
Safe and Effective Care Environment: Management of Care
A licensed vocational nurse (LVN) says to the nurse who is making assignments, " I do not want
to be assigned to care for Raymond. I have never cared for a client with HIV and do not want to
start now. I have a family at home that needs me."
7. Which information should the nurse base a response about the LVN's right to refuse care for
a client with HIV? - ANSThe LVN may refuse to care for a client in circumstances in which 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.
