Page 1179 - Saunders Comprehensive Review For NCLEX-RN

remaining infected children become symptomatic sometime before age 3 years. With
their immature immune systems, children have a much shorter incubation period
than adults. Options 1, 2, and 3 are incorrect. Additionally, these options offer false
reassurance.
Test-Taking Strategy: Note the strategic words, most appropriate. Eliminate options
1, 2, and 3 because they are comparable or alike in content. The correct option is the
only one that provides specific and accurate data regarding HIV infection in an
infant.
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Immune
Health Problem: Pediatric-Specific: Immunodeficiency disease
Priority Concepts: Client Education; Immunity
Reference: Hockenberry, Wilson, Rodgers (2017), pp. 806-807.

408. Answer: 3

Rationale: The multiple complications associated with HIV are accompanied by a
high level of pain. Aggressive pain management is essential for the child to have an
acceptable quality of life. The nurse must acknowledge the child’s pain and let the
child know that everything will be done to decrease the pain. Telling the child that
movement or lack thereof would eliminate the pain is inaccurate. Allowing a child to
think that he or she can control the pain simply by thinking or not thinking about it
oversimplifies the pain cycle associated with HIV. Giving false hope by telling the
child that the pain will be taken “all away” is neither truthful nor realistic.
Test-Taking Strategy: Note the strategic word, best. Recall the general concept of
pain and growth and development concepts of a 6-year-old child. Giving the child
information about the pain in words that he or she can understand, but without
providing false hope or not telling the truth, should guide you to the correct option.
Options 1 and 2 provide inaccurate information about pain management. Option 4
provides false hope that the pain can be alleviated completely.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Immune
Health Problem: Pediatric-Specific: Immunodeficiency disease
Priority Concepts: Immunity; Pain
Reference: Hockenberry, Wilson, Rodgers (2017), pp. 808-809.

409. Answer: 1

Rationale: HIV is transmitted through blood, semen, vaginal secretions, and
breast milk. The mother of an infant with HIV should be instructed to use a bleach
solution for disinfecting contaminated objects or cleaning up spills from the child’s
diaper. Alcohol would not be effective in destroying the virus. Options 2, 3, and 4
are accurate instructions related to basic infection control.

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