An HIV-infected patient reports being a cat lover and says, 'I always get my pets from a known sanitary source.' What should the nurse instruct the patient about cats and the risk of infection?

Correct Answer: D

Rationale: The correct answer is D because HIV-infected individuals are at higher risk for infections, including from Toxoplasma gondii found in cat feces. By ensuring cats have up-to-date immunizations and avoiding their feces, the patient can reduce the risk of infection. A: Keeping cats outdoors most of the time does not address the risk from cat feces inside the house. B: The age of the cat does not necessarily correlate with the risk of infection, so this advice is not relevant. C: Removing all pets and avoiding all contact with cats is an extreme measure and not necessary if proper precautions are taken.

Correct Answer: B

Rationale: Step 1: Lamivudine (Epivir) can cause hepatotoxicity, leading to yellowing of the skin (jaundice). Step 2: Yellowing of the skin is a serious side effect that should be reported immediately to prevent further liver damage. Step 3: Reporting yellowing of the skin promptly allows for timely evaluation and necessary interventions. Summary: Reporting bleeding, change in urine output, or flu-like symptoms are not specific to lamivudine and are not directly related to its side effects. Yellowing of the skin is a critical side effect that requires immediate attention.

Correct Answer: C

Rationale: The correct answer is C: The patient has symptoms of alcohol withdrawal delirium. The presentation of shakiness, irritability, anxiety, diaphoresis, elevated heart rate, and hallucinations ('bugs are crawling on my bed') are classic signs of alcohol withdrawal delirium. Delirium tremens, a severe form of alcohol withdrawal, typically occurs 48-72 hours after the last drink and can be life-threatening. This patient's symptoms are consistent with the timeline and manifestations of alcohol withdrawal, requiring immediate medical intervention. Incorrect answers: A: Manipulating staff for attention is unlikely given the severity of the symptoms and the potential life-threatening nature of alcohol withdrawal delirium. B: Head injury would not typically present with these specific symptoms and timeline. D: Acute psychosis would not typically manifest with these specific symptoms in the context of alcohol intoxication and withdrawal.

Correct Answer: B

Rationale: The correct answer is B: the patient has a high tolerance to alcohol. At a blood alcohol level of 400 mg/dl, most individuals would exhibit severe symptoms such as unconsciousness or coma. However, this patient only shows mild symptoms of ataxia, slurred speech, and confusion, indicating a high tolerance to alcohol. This high tolerance suggests that the patient regularly consumes large amounts of alcohol, leading to an adaptation in the body's response to alcohol. Choice A is incorrect because a blood alcohol level of 400 mg/dl is indicative of significant alcohol consumption, contradicting the statement that the patient rarely drinks alcohol. Choice C is incorrect as disulfiram is used to treat alcohol dependence, not tolerance. Choice D is incorrect since sedative drugs would exacerbate the effects of alcohol, causing more severe symptoms than what is observed in this case.

Correct Answer: D

Rationale: Step-by-step rationale for Answer D (Correct): 1. Safety first: Intoxicated patients can be a safety risk to themselves and others. 2. Ethical responsibility: Providing care to an intoxicated patient may compromise the quality of care. 3. Setting boundaries: Communicating that the appointment cannot proceed due to intoxication sets a clear boundary. 4. Referral assistance: The patient can be directed to appropriate resources for help with substance abuse. Summary of why other choices are incorrect: A (explore reasons): Not appropriate when patient is intoxicated. B (inpatient unit): Premature without assessing the situation. C (detox unit): Immediate detox may not be necessary.