NUR 211 Comprehensive Final Practice Q's

Hematogenous Spread

Through the blood

Which of the following complications is not associated with a diagnosis of rheumatoid arthritis (RA)? A) Increased risk of cesarean delivery B) Increased risk of pleural effusion C) Increased likelihood of uveitis D) Increased risk of anemia

A

What word best describes the pain a client experiences at the end of life? A) Unmanageable B) Unpredictable C) Inevitable D) Acute

C

When used as part of behavioral therapy for addictions, token economies function as a form of A) punishment. B) negative reinforcement. C) positive reinforcement. D) extinction.

C

Airborne precautions

used for patients who are known to have or suspected of having serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns

Droplet precautions

used for patients who are known to have or suspected of having serious illnesses transmitted by particle droplets larger than 5 microns

Purified protein derivative (PPD)

used in tuberculin testing to screen for tuberculosis infection; causes a cellular or delayed hypersensitivity response

The nurse is teaching a patient about the antibiotic prescribed to treat their infection. Which information should the nurse include?

"Be certain to take all the prescribed amount of the medication."

The preceptor is explaining to a new nurse the differences between a local infection and a systemic infection. Which statement by the new nurse demonstrates understanding?

- "If a patient has otitis media, that is an example of a local infection."

A college student is incoherent; her roommates tell the nurse that she recently "took downers with beer." For which health problem should the nurse observe in this client? A) Hallucinations B) Respiratory depression C) Seizure activity D) Signs of withdrawal

B

The nurse is providing care to a 3-year-old client who is receiving treatment for sickle cell disease. The client is at risk for infection. Which medication does the nurse expect to administer to this client? A) Acetaminophen B) Penicillin C) Morphine sulfate D) Tamoxifen

B

The nurse is meeting with a patient who reports feeling fatigued and is coughing yellow sputum. The patient is confused about what led to the sickness because no one in their home has been ill. Which response from the nurse would provide the patient an adequate explanation?

- "If you were in public and someone coughed, you could breathe in the droplets that cause infection."

Which statement by the nurse explains the difference between medical and surgical asepsis?

- "Medical asepsis confines a microorganism to a specific area, while surgical asepsis attempts to keep an area free of microorganisms."

A patient informs the nurse that their dialysis port looks red and is painful despite keeping it covered. Which patient statement reflects an understanding on how the port may have become infected?

- "My skin is open around the tube."

Insidious Infection Manifestations

"Sneaks up on you" Fatigue Weight loss Diminished appetite Low-grade afternoon fever Night sweats Dry cough -> Hemoptysis Complications: Tuberculosis empyema Bronchopleural fistula Pneumothorax

The nurse is cleaning up vomitus. Which statement by the nurse demonstrates following the practice of medical asepsis?

- "I will cover the vomitus with granules and allow them to absorb."

Which statement by the nurse explains the difference between a pathogen and an opportunistic pathogen?

- "A pathogen causes disease in a healthy individual, whereas an opportunistic pathogen causes disease in susceptible individuals."

A pregnant patient visits the office for a routine monthly checkup and shares that their 4-year-old child is going to daycare and there seems to be an outbreak of chickenpox. The patient asks whether the fetus will be harmed if she contracts chickenpox. Which is the nurse's accurate response?

- "Chickenpox can cause birth defects in an unborn fetus."

The patient has a wound that has been requiring frequent surgical debridement. Which patient statement indicates a correct understanding of the purpose of debridement?

- "Debridement is done to remove dead skin."

The nurse is talking to a young child's grandmother, who can't remember whether she gave aspirin or acetaminophen when the child had a fever. Which is the best advice the nurse should give the grandmother for the future?

- "Do not give aspirin to children with a fever." * Aspirin is not given to children with fevers because of the risk of Reye syndrome. Although recording the medication is important, this action is not as important as avoiding the 30% mortality rate of Reye syndrome. For that reason, aspirin or acetaminophen cannot be said to work equally well for fever. Acetaminophen can be given to children with a fever

The nurse is teaching infection control to a patient with an open wound on their lower leg. Which patient statement would require additional teaching?

- "I can scratch my wound around the edge of my bandage if it itches."

The parents of a newborn tell the nurse they are concerned about bringing the baby home to a household of relatives with various illnesses. Which response by the nurse is accurate?

- "Newborns may not be able to respond to infections due to an underdeveloped immune system." * Although newborns have some naturally acquired immunity that is transferred from the mother across the placenta at birth, they may not be able to respond to infections due to an underdeveloped immune system. As a result, in the first few months of life, newborns may not exhibit the signs/symptoms typically associated with infection (may not present with fever). Infants begin to produce their own immunoglobulins between 1 and 3 months of age

The public health nurse is training a class about first aid methods. The nurse talks about the activity of pathogens in each stage of the infectious process, including one stage that could last for years. Which is a correct statement about the pathogens during this extended stage?

- "Pathogens replicate but do not cause manifestations."

An older adult patient presents with symptoms that appear to be influenza. The patient does not know what led to the sickness. Which statement by the nurse explains the term reservoir as it applies to this patient's condition?

- "Someone you were near at the grocery store had the flu."

Which statement by the nurse demonstrates understanding of standard precautions?

- "Standard precautions are designed for hospital-based care."

Which statement describes the makeup of viruses?

- "They consist of mainly nucleic acid."

The nurse is teaching the parents of young children about the signs and symptoms of infection. Which statement by the nurse should be included?

- "You will find a rapid onset of symptoms in a child."

The nurse is scheduling the lab technician to draw an antibiotic peak and trough level for a patient receiving an intravenous antibiotic. At which time should the nurse schedule the peak level?

- 30 minutes after administration * By measuring blood levels at the predicted peak (1-2 hours after oral administration, 1 hour after intramuscular administration, and 30 minutes after IV administration) and trough (lowest level, usually a few minutes before the next scheduled dose), healthcare personnel can determine whether the patient is maintaining a level within the therapeutic range at all times, thereby ensuring maximal effect from the drug.

The patient asks the nurse, "How did I get this urinary tract infection (UTI)?" Which common causative factor should the nurse include in the response?

- An ascending infection from the urethra

The nurse is teaching the patient about their new prescription for antibiotics. Which should the nurse include as the imminent problem with incomplete use of their prescription?

- Bacteria resistance

A patient is admitted to the hospital for a bacterial infection and has been having episodes of foul-smelling, watery diarrhea. Which precautions should the nurse use?

- Contact precautions

The nurse is caring for a patient with an upper respiratory infection who has been using a complementary therapy. Which supplement should the nurse recognize as appropriate?

- Echinacea

The nurse is concerned that a patient who has been in isolation for several days in the hospital may be experiencing sensory deprivation. Which clinical sign should the nurse assess?

- Hallucinations

The nurse preceptor is demonstrating how to don sterile gloves prior to an open wound dressing change. Which method should be demonstrated to use outside the operating suite?

- Open method

Which diagnostic test is used to detect antibodies to infecting respiratory organisms?

- Serology testing * Serum has antibodies - can determine the type of immunoglobin produced & concentration

The nurse is caring for a patient with an infection who has been prescribed an intravenous antibiotic. Thirty minutes after administering the antibiotic, the nurse has the lab technician draw a blood sample. What is this test measuring?

- The maximum blood level of the antibiotic

Internal Carotid Artery Manifestations of Stroke

-Contralateral paralysis of the arm, leg, and face -Contralateral sensory deficits of the arm, leg, and face -Aphasia (if dominant hemisphere is involved) -Apraxia, agnosia, and/or unilateral neglect (if nondominant hemisphere is involved) -Homonymous hemianopia

Anterior Cerebral Artery Manifestations of Stroke

-Contralateral weakness or paralysis of the foot and leg -Contralateral sensory loss of the toes, foot, and leg -Loss of ability to make decisions or act voluntarily -Urinary incontinence

Middle Cerebral Artery Manifestations of Stroke

-Drowsiness, stupor, coma -Contralateral hemiplegia of the arm and face -Contralateral sensory deficits of the arm and face -Global aphasia (if dominant hemisphere involved) -Homonymous hemianopia

Vertebral Artery Manifestations of Stroke

-Pain in the face, nose, or eye -Numbness and weakness of the face on the involved side -Problems with gait -Dysphagia

Inflammation

.an adaptive response to what the body sees as harmful

The clinic nurse assesses a client with a history of transient ischemic attacks (TIA) who was advised to lose weight, change the diet to lower cholesterol, and maintain treatment of hypertension. The client has chosen not to take this advice, leading the nurse to conclude the client is at increased risk for what complication? 1. Stroke 2. Aneurysm 3. Vasovagal syndrome 4. Myasthenia gravis

1

The nurse is caring for the pregnant client during a healthcare appointment early in the third trimester. The client states she feels dizzy in her current position. The nurse notes the client is clammy and pale. What would be the best position to reposition the client? 1.Place the client in the left lateral position. 2.Place the client in the right lateral position. 3.Place the client in the supine position. 4.Place the client in the prone position.

1

The nurse is conducting a teaching clinic for older adults about risk factors for stroke. Although the nurse includes all of the following as risk factors, which factor presents the greatest risk for stroke? 1.Hypertension 2.Heart disease 3.Diabetes 4.High cholesterol level

1

Narcolepsy

1.a condition in which the individual experiences excessive daytime sleepiness even with adequate nighttime sleep, resulting in sleep attacks and cataplexy

Autoimmune disorder

1.a disease caused by abnormal, overactive functioning of the immune system that produces a response against the body's own cells and tissues, normally resulting in damage to the tissues

Restless leg syndrome (RLS)

1.a neurologic disorder that results in an irresistible urge to move the legs or other body parts, often resulting in impaired sleep habits

Polysomnography (PSG)

1.a sleep study, often used to diagnose sleep disorders

Sleep hygiene

1.a variety of sleep practices that help individuals attain good-quality sleep at night so they can be alert during the day

Parasomnia

1.an unpleasant or undesirable behavior (e.g., sleepwalking, sleep terrors) that occurs at any point during sleep

Insomnia

1.characterized by difficulty falling asleep or maintaining sleep or by a short sleep duration even with adequate time spent attempting to sleep

Swan-neck deformity

1.characterized by hyperextension of the PIP joints with compensatory flexion of the DIP joints

Rheumatoid arthritis (RA)—

1.chronic systemic autoimmune disorder causing inflammation of connective tissue, primarily in the joints

Synovectomy

1.excision of synovial membrane

Boutonnière deformities

1.flexion deformity of the proximal interphalangeal (PIP) joints with extension of the distal interphalangeal (DIP) joints

Imagery (guided imagery)

1.involves focusing on pleasant images, such as a beach or garden, to replace negative images such as pain and darkness

Muscle relaxation

1.involves tightening and then relaxing each muscle group; technique helps patients recognize the difference between tension and relaxation

Orthotic devices

1.orthopedic devices that may include splints or braces applied to reduce strain on a joint

Comfort

1.the immediate state of being strengthened by having the needs for relief, ease, and transcendence addressed in the four contexts of holistic human experience: physical, psychospiritual, sociocultural, and environmental

Total lymphoid irradiation

1.treatment that decreases total lymphocyte levels

Plasmapheresis

1.treatment used to remove circulating antibodies and thereby moderate the autoimmune response

Breathing exercises

1.used to slow the breathing rate by focusing on taking regular and deep breaths from the diaphragm; increases oxygen delivery throughout the body

Tender points

18 points tested when fibromyalgia suspected; located throughout the neck, spine, shoulders, chest, hips, knees, and elbow regions. used in diagnosing fibromyalgia.

Which finding would alert the nurse that the client has experienced a transient ischemic attack (TIA)? 1.Sudden severe pain over the left eye 2.Tingling at the corner of the mouth with aphasia 3.Complete paralysis of the right arm and leg 4.Loss of sensation and reflexes in both legs

2

An older adult client has been brought to the emergency department (ED) with a suspected stroke. An IV fluid bolus was initiated prior to arriving in the ED, and the second liter of fluid is finishing infusing at this time. Initial vital signs are BP 150/100, pulse 90, and respirations 20. The client was alert and orientated on admission. After 30 minutes, vital signs have changed to BP 200/110, pulse 78, and respirations 28. The client is now lethargic and difficult to arouse. What should the nurse initiate next? 1.Turn the client on the left side. 2.Check the client's phenytoin (Dilantin) level. 3.Get an order to decrease IV fluids. 4.Prepare the client for a lumbar puncture.

3

The nurse is administering oxygen to a client experiencing a stroke in order to prevent hypoxia and hypercapnia. This will also lessen the risk for which finding? 1.Fluid accumulation in the lungs 2.Pulmonary emboli 3.Increased intracranial pressure (IICP) 4.Rebleeding

3

The nurse is asked by the healthcare provider to assess the dorsalis pedis pulse on an adult client. The nurse knows that the location of this pulse is found at which location? 1.The medial surface of the ankle where the posterior tibial artery passes behind the medial malleolus 2.The midline area behind the knee 3.Along an imaginary line drawn from the middle of the ankle to the space between the big and second toe 4.Along the left side of the chest between the 4th to 6th intercostal space

3

The nurse is auscultating the client's heart at the location of the tricuspid valve. The nurse knows this point is found at what location on the client's chest? 1.Second intercostal space at the right sternal border 2.Second intercostal space at the left sternal border 3.Fourth or fifth intercostal space at the left sternal border 4.Fifth intercostal space at the midclavicular line

3

A client's stroke volume (SV) is 85mL/beat and the heart rate (HR) is 71 beats per minute (bpm). What is the client's cardiac output (CO) rounded to the nearest liter?

6 Liters (L) Explanation: CO = SV × HR 85mL = 0.085 L CO = 0.085 × 71 = 6.035 = 6 L

A 13-year-old female client is diagnosed with juvenile primary fibromyalgia syndrome. What should the nurse expect regarding this client? A) The nurse will treat the client in much the same way as an adult with fibromyalgia. B) Chronic fatigue can be ruled out as a likely clinical manifestation. C) The client's pain will likely have lasted no more than 3 months. D) The client's WPI score will be no greater than 7.

A

The nurse is discussing goals to relieve pain and fatigue with a client newly diagnosed with fibromyalgia. Which goal statement would be realistic for this client to achieve within 30 days? A) Cook dinner five nights a week. B) Join an exercise group to meet five nights a week. C) Walk her son to school daily. D) Get a job outside the home.

A

A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis

A

A client is admitted to the emergency department in a sickle cell crisis. The nurse assesses the client and documents the following clinical findings: temperature 102°F, O2 saturation of 89%, and complaints of severe abdominal pain. Based on the assessment findings, which intervention is the greatest priority? A) Apply oxygen per nasal cannula at 3 L/minute. B) Assess and document peripheral pulses. C) Administer morphine sulfate 10 mg IM. D) Administer Tylenol 650 mg by mouth.

A

A client is experiencing sudden-onset severe pain in the left lower quadrant of the abdomen that is rated as a 10 on a pain scale of 0-10. The client is also experiencing nausea, vomiting, and restlessness. Based on this data, the nurse concludes that the client is experiencing which phenomenon? A) Acute pain B) Chronic pain C) End-of-life pain D) Fibromyalgia pain

A

A client who is attending a Narcotics Anonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. How should the nurse respond? A) "The most important initial goal is to admit that you have a problem." B) "The most important initial goal is to learn problem-solving skills." C) "The most important initial goal is to take a personal moral inventory." D) "The most important initial goal is to make amends to people you have hurt."

A

A client who presents with complaints of easily bruising, bleeding gums, and petechiae may be suffering from what complication of leukemia? A) Thrombocytopenia B) Anemia C) Hepatomegaly D) Neutropenia

A

A client with a history of alcohol abuse is being discharged to a treatment facility. Which prescription does the nurse anticipate for this client? A) Disulfiram B) Naloxone C) Bupropion hydrochloride D) Varenicline

A

A college student attends a seminar on alcohol abuse. Which statement would alert the nurse that the student needs more education? A) "The children of alcoholics have a lower risk of becoming alcoholic." B) "Native Americans are at higher risk of becoming alcoholic." C) "Married college graduates are less likely to become alcoholics." D) "Childless people are more likely than parents to become alcoholics."

A

A competent older adult client has a living will that expresses the client's desire to avoid resuscitation and heroic life support measures. The family members are not supportive of this directive and plan to contest the living will. Which nursing action is the most appropriate? A) Place the document on the chart. B) Contact the Social Services department. C) Explain to the client that the conflict could invalidate the document. D) Notify the hospital attorney.

A

A disorder in which endocrine gland could result in an increase in growth of the bones, organs, and muscles? A) Pituitary gland B) Thyroid gland C) Parathyroid glands D) Adrenal glands

A

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."

A

A nurse educator is explaining the term hyperplasia to a group of nursing students. Which statement, made by a nursing student, indicates an understanding of why hyperplasia occurs with myocardial infarction? A) "Heart muscle cells experience hyperplasia with the prolonged need for oxygen." B) "Heart muscle cells are hyperplastic in response to muscle damage." C) "Heart muscle cells are hyperplastic when they have lost fluid." D) "Heart muscle cells experience hyperplasia when they respond to decreased metabolic demands."

A

A nurse in a provider's office is measuring a client and notes a loss in height from the previous year. The nurse should identify this finding as a manifestation of which of the following musculoskeletal system disorders? A. Osteoporosis B. Scoliosis C. Kyphosis D. Lordosis

A

A nurse is caring for a client who had a cerebrovascular accident (CVA). The client appears alert & engaged during a visit but does not respond verbally to questions. The nurse should document this as which of the following alterations? A. Expressive aphasia B. Dysarthria C. Receptive aphasia D. Dysphagia

A

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy veggies

A

A nurse is concerned about potential substance abuse by a coworker. Which of the coworker's behaviors would place the clients on the unit at risk for injury? A) The nurse in question frequently volunteers to give medications to clients. B) The nurse in question prefers not to be the "medication nurse" on the shift. C) The nurse in question declines to take scheduled breaks. D) The nurse in question frequently requests the largest client care assignment for the shift.

A

The nurse is planning care for a client admitted with a stroke. Which intervention would support the client's sensorimotor needs? A) Encourage use of nonaffected arm to feed self, bathe, and dress. B) Speak in normal conversational pattern and tones. C) Provide complete care. D) Talk loudly and distinctly.

A

A nurse is providing discharge instructions about calcium supplements to an older adult female client who has osteoporosis and recently underwent a repair of a fracture in her right hip. Which of the following instructions should the nurse include? A. You should take your calcium supplement with a large glass of water B. You should increase your intake of grain cereals while taking calcium supplements C. You should take at least 2600 mg of calcium supplements daily D. You will not need to take vitamin D with your calcium supplement after menopause

A

A nurse is talking with the adult daughter of an 80-year-old client who was recently discovered to be abusing prescription narcotics. The daughter expresses frustration that this substance abuse wasn't discovered sooner, and she asks the nurse how her father's previous healthcare providers could have overlooked this problem. Which of the following statements would not be appropriate for the nurse to include in her reply? A) "Substance abuse and addiction are almost unheard of among older adults, so few providers would consider the possibility of these diagnoses when working with clients like your father." B) "Older adults often choose not to tell their providers about substance use because they either don't recognize they have a problem or don't feel they need treatment." C) "Diagnosis of substance abuse can be difficult in older clients because their symptoms sometimes mimic those of other disorders." D) "There is currently little research data on substance abuse in the older adult population, which means many providers are unaware of the actual extent of this problem."

A

A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. Extended periods of immobility increase your risk of osteoporosis B. Prolonged periods of sun exposure increase your risk of osteoporosis C. Eating a diet high in protein can reduce your risk of osteoporosis D. Corticosteroid therapy will reduce your risk of osteoporosis

A

A nurse who works in the emergency department is providing care for a group of clients. Which client demonstrates a declining immune response that typically occurs with the aging process? A) An 88-year-old client with pneumonia who has a temperature of 99.5°F B) A 70-year-old client who has swelling and redness around an abdominal incision from an open appendectomy C) A 58-year-old client who complains of redness and itching after developing a rash from contact with poison ivy D) A 56-year-old client who has 8 mm induration at the site of a PPD skin test administered 72 hours earlier

A

A pediatric nurse is educating the client with sickle cell disease and the client's family regarding the genetic implications of the disease. Which information is inappropriate for the nurse to share with the client's family? A) If both parents have the trait, then with each pregnancy, the risk of having a child with the disease is 50%. B) The disorder is transmitted as an autosomal recessive genetic defect. C) The sickle cell gene may have originated to protect against lethal forms of malaria. D) In African Americans, sickle cell disease occurs in 1 of every 365 births.

A

An 18-month-old toddler scheduled for routine vaccinations begins to cry when placed on the examination table. The parent attempts to comfort the toddler, but nothing is effective. Which action by the nurse is the most appropriate? A) Allow the toddler to sit on the parent's lap and begin the assessment. B) Allow the toddler to stand on the floor until the crying stops. C) Ask another nurse in the office to hold the toddler because the parent is not able to control the toddler's behavior. D) Instruct the parent to hold the toddler down tightly to complete the examination.

A

An adolescent client is brought to the emergency department (ED) with fatigue, weight loss, a dry cough, and night sweats. The family just recently immigrated to the United States. Based on this data, which potential risk should the nurse include when planning care for this client? A) Pneumothorax B) Atelectasis C) Renal failure D) Reduced peristalsis

A

An older adult client is diagnosed with cardiomyopathy and a cardiac dysrhythmia. What would the nurse expect to be prescribed for this client? A) Beta blocker B) Digoxin C) Nitrate medications D) Fluids

A

An older adult client with renal failure is diagnosed with anemia. Based on this data, which cause of anemia will the nurse plan for when providing care? A) Loss of the kidney hormone erythropoietin B) A loss of appetite related to elevated blood urea nitrogen (BUN) and creatinine levels C) The renal dialysis used to treat the chronic renal failure D) Loss of blood through the urine because the failing kidney does not function properly

A

During a 6-month well-baby check up, the mother mentions to the nurse that her infant seems to be sleeping just as much as she did as a newborn, and she seems to do everything with her left hand. The nurse recognizes that these are warning signs of stroke that occurred early in life. What other question should the nurse ask to assess for signs of stroke? A) "Have you noticed your baby jerking any muscles of the face, arms, or legs?" B) "Have you noticed your baby having trouble forming words?" C) "Does your baby vomit frequently after feeding?" D) "Does your baby frequently seem to lose her balance?"

A

If nutrients and hydration are provided artificially for a client at the end of life because of the client's diminished muscle control, then what is another therapy that is likely to accompany this therapy? A) Provide oral care regularly. B) Provide mechanical ventilation. C) Gently massage extremities. D) Maintain client safety.

A

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior

A

The nurse is planning care for a client recently diagnosed with tuberculosis (TB). The client lives alone in an apartment and will continue treatment at home. When reviewing the client's history, the nurse notes that the client has had trouble complying with medication regimens in the past. Which nursing diagnosis is a priority for this client? A) Ineffective Health Management B) Deficient Knowledge C) Ineffective Breathing Pattern D) Risk for Injury

A

Lab results are back for a client who has limiting joint pain. Synovial fluid analysis shows no uric acid crystals or bacteria. The client asks what the test results mean. How should the nurse respond? A) "These test results mean that your joint pain is likely not caused by gout or septic arthritis." B) "These test results mean that your joint pain is likely not related to any form of arthritis." C) "These test results mean that your joint pain is likely caused by either rheumatoid arthritis or septic arthritis." D) "These test results mean that your joint pain is likely caused by either cancer of the joint or gout."

A

The medication clopidogrel (Plavix) is most commonly given during which stage of treatment for a stroke? A) Stroke prevention B) Acute care immediately after a stroke C) Recovery care after a stroke D) Rehabilitation after a stroke

A

The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? A) The injured leg is shortened and externally rotated. B) Redness and severe swelling are found at the hip joint. C) Pain is relieved by moving the affected extremity. D) The client is repeatedly flexing the injured leg at the hip.

A

The nurse is assessing the vital signs of a client experiencing hypoparathyroidism. While monitoring the blood pressure, the nurse notes the client's hand begins to spasm. Which term is appropriate for the nurse to use when documenting this assessment finding? A) Trousseau sign B) Chvostek sign C) Turner sign D) Cullen sign

A

The nurse is assigned to care for a client with sickle cell disease who is being admitted with splenic sequestration crisis. Which room would be the most appropriate for this client? A) Private room B) Semi-private room C) Contact-isolation room D) Airborne-isolation room

A

The nurse is caring for a 34-year-old woman who is pregnant with her third child. The client was diagnosed with hypothyroidism between her second and third pregnancies. What special considerations should the nurse include when caring for this client? A) The client may need to change her dosage of levothyroxine (Synthroid). B) The client is at higher risk for gestational diabetes. C) The client may need to add a folic acid supplement to her medication regimen. D) The client is at higher risk for diabetes insipidus.

A

The nurse is caring for a client who is diagnosed with a cocaine addiction. For which additional disorder should the nurse assess this client? A) Anxiety B) Diabetes C) Weight gain D) Kidney stones

A

The nurse is caring for a client who is newly diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse whether there are ways to protect the client's life partner from getting the virus. After the nurse provides the client with teaching related to this topic, which statement on the part of the client would indicate a need for further education? A) "I know to use an oil-based lubricant to prevent spread of the virus to my partner." B) "I can still kiss and hug my partner to show affection." C) "I will not share my razor with my partner." D) "I know I have to practice safer sex with my partner by using a latex condom."

A

The nurse is caring for a client with gangrene of the toe. Which collaborative intervention should the nurse anticipate preparing the client for? A) Surgery B) Debridement C) Myringotomy D) Wound irrigation

A

The nurse is caring for a client with osteoarthritis. Which factor in the client's history and physical assessment would the nurse recognize as a risk factor for developing this condition? A) Body mass index of 36.5 B) History of esophageal reflux disease C) Client plays tennis three times each week D) Blood pressure of 136/78 mmHg

A

The nurse is caring for a pediatric client with a surgical wound. The wound is red with purulent drainage and is causing discomfort for the client. Which diagnostic test will determine if the discomfort of the wound is caused by an infection? A) White blood cell count B) Hematocrit measurement C) Urine analysis D) X-rays of the site

A

The nurse is caring for a preadolescent male client who is accompanied by his mother. Which statement by the mother would be consistent with the client experiencing growing pains? A) "My son often complains that his arms and legs feel sore." B) "My son seems to get injured very easily, especially broken bones." C) "My son often doesn't want to walk because his knees hurt." D) "My son occasionally complains of pain in his lower back."

A

The nurse is caring for the family of a terminally ill client. The family members have been tearful and sad since the diagnosis was given. What is the best nursing diagnosis for this family? A) Grieving B) Hopelessness C) Compromised Family Coping D) Caregiver Role Strain

A

The nurse is collecting a health history for a client being seen in an outpatient clinic who complains of joint pain and swelling that have lasted for about 2 months. The client is diagnosed with rheumatoid arthritis (RA). Which of the following statements made by this client supports the nursing diagnosis of Activity Intolerance? A) "I seem to get tired early in the day and require a nap." B) "My joints are stiffest at night before I go to sleep." C) "I find it difficult to move when I first get up in the morning." D) "I take ibuprofen for the pain as needed."

A

The nurse is completing a health screening for a school-age child with rheumatoid arthritis (RA). The parents ask the nurse to recommend activities that will promote exercise for their child. Which recommendation by the nurse is most appropriate? A) Swimming B) Football C) Softball D) Basketball

A

Which is a characteristic of fibromyalgia? A) Difficult to treat B) Definite as to cause C) Easy to prevent D) Brief in its effects

A

The nurse is planning care for a client who is experiencing an alteration in mobility. Which would the nurse include as an independent nursing intervention? A) Instructing on the importance of proper nutrition and an active lifestyle B) Administering a prescribed nonsteroidal anti-inflammatory drug (NSAID) C) Identifying necessary modifications to the home environment D) Prescribing a skeletal muscle relaxant

A

The nurse is planning care for a client with acute back pain who is a single mother of two small children and works part-time as a receptionist. Based on this information, which nursing intervention is the highest priority? A) Instructing the client in appropriate body mechanics for lifting and ways to modify her work environment B) Suggesting that the client take time off from work until her back is healed C) Obtaining an order for nonsteroidal anti-inflammatory drugs (NSAIDs) from the client's healthcare provider D) Suggesting that the client's children be taken care of by an extended family member until the client's back is healed

A

The nurse is planning care for a client with osteoarthritis of the hip. Which intervention would be appropriate for this client? A) Provide moist heat packs to the affected joint 3 times each day. B) Instruct the client on the importance of strict bedrest. C) Provide nonsteroidal anti-inflammatory drugs (NSAIDs) when pain becomes severe. D) Provide opioid pain medication as prescribed.

A

The nurse is planning care for a young child who is admitted with sickle cell crisis. The parents are with the child, and neither has much information about the disease. When planning care for this family, the nurse will set which goal with this family? A) The child will drink adequate amounts of fluid each day. B) The child will play outside in the sun. C) The family will not have the child vaccinated. D) The family will plan vacations in high-altitude areas.

A

The nurse is presenting a program at a senior center on how to survive a fall. Which statement by a program participant indicates that this person needs clarification about what emergency actions to take after a fall? A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." B) "I should try to cover myself with a blanket while I wait for help to arrive." C) "To call for help, I can scoot on my bottom to a low wall-mounted phone." D) "If possible, I can crawl to a stairway and use the stairs to lift up to a standing position."

A

The nurse is providing care for several clients. For which client should the nurse anticipate an order for administering 1000 mg of aspirin? A) A 68-year-old client with rheumatoid arthritis who is experiencing hand pain B) A 5-year-old client who is experiencing ankle pain after a fall from a horse C) A 38-year-old client who is experiencing headache pain after a skiing accident D) A 70-year-old client who is experiencing back pain after laminectomy

A

The nurse is providing care to a client who is experiencing back pain. Which of the following items in the client's history is a known risk factor for disc herniation? A) 49 years of age B) Female gender C) Short stature D) Anorexia

A

The nurse is providing care to a client with a compromised immune system. Which independent nursing intervention is appropriate for the nurse to include in the client's plan of care? A) Educating the client on the importance of a nutritious diet B) Administering corticosteroids per order C) Prescribing prophylactic antibiotic therapy D) Recommending gene transfer therapy

A

The nurse is reviewing the laboratory results of a client who is newly diagnosed with acquired immunodeficiency syndrome (AIDS). Which result would be considered potentially problematic and should be reported to the client's healthcare provider? A) CD4 cell count of 195/mm3 B) Viral load 6500 copies/mL C) Negative tuberculin skin test D) WBC count of 6500/mm3

A

The nurse is taking care of a client with terminal lung cancer who is showing signs of imminent death. What change should the nurse most expect the client to exhibit first? A) Decreased blood pressure B) Blurry vision C) Confusion D) Irregular pulse rate

A

The nurse is teaching a class to prospective parents about the role that deoxyribonucleic acid (DNA) plays in the development of the human fetus. Which statement made by the parents indicates understanding of the teaching? A) "DNA molecules are made up of genes." B) "DNA is used to form ribosomes." C) "DNA is outside the nucleus of the cell." D) "DNA is attached to the endoplasmic reticulum."

A

The nurse provides an in-service to peers regarding situations that can affect the comfort level of the clients on the unit. Which client statement indicates that the client's sense of well-being is negatively impacted? A) "I feel like I have no energy today." B) "I don't feel any physical pain today." C) "I was able to sleep uninterrupted last night." D) "I am so glad that playing cards takes my mind off my worries."

A

The parents of a child with terminal cancer ask the nurse that the child not be told that he will not recover. The nurse anticipates that the child might ask the nurse if he is dying. What would be most appropriate for the nurse to do? A) Suggest a meeting with the healthcare team and the parents. B) If the child asks about death, offer to bring in the child life therapist to help explain the situation. C) Tell the child he is dying if the child asks and offer to stay with him. D) Prepare to ignore the child's question if the child asks it and change the subject.

A

What is the primary cause of loss of height in individuals with osteoporosis? A) Collapse of vertebral bodies B) Decrease in length of long bones C) Flexion of the knees and hips D) Cervical lordosis

A

When assessing a patient with anemia from acute blood loss, the nurse would expect to find which of the following? A) Sudden onset of symptoms, hypotension, tachycardia B) Exertional dyspnea, poor nutrition, hypotension C) Sudden onset of symptoms, glossitis, tachycardia D) Fatigue, neuropathy, tachycardia

A

Which form of anemia can be prevented by a change in diet? A) Iron deficiency anemia B) Aplastic anemia C) Blood loss anemia D) Hemolytic anemia

A

Which form of juvenile idiopathic arthritis (JIA) primarily affects the knees, ankles, and elbows? A) Pauciarticular arthritis B) Polyarticular arthritis C) Systemic arthritis D) Osteoarthritis

A

Which of the following statements is false and should not be included in client teaching about how to reduce the risk of contracting HIV? A) Clients who will require blood transfusions during surgery should encourage their family members to donate the blood they will receive. B) The only totally safe sex practices are abstinence; long-term, mutually monogamous sexual relations between uninfected individuals; and mutual masturbation without direct contact. C) When possible, autologous transfusion is a good risk reduction strategy for clients who are undergoing surgery. D) Clients should use condoms during every sexual encounter involving vaginal, oral, or anal intercourse.

A

Which of the following tools is considered the best scale for assessing the severity of symptoms of acute alcohol withdrawal? A) CIWA-Ar B) MAST C) CAGE D) B-DAST

A

Which race is at highest risk of inheriting sickle cell disease? A) African American B) Caucasian C) Hispanic D) Asian

A

While completing a health history with an older adult client, the nurse learns that the client experienced a transient ischemic attack (TIA) several months ago. The nurse should recognize that: A) the client is at risk for an ischemic thrombotic stroke. B) the client will have minimal symptoms should a stroke occur. C) the client will not experience a stroke in the future. D) the client is at high risk for a hemorrhagic stroke.

A

While practicing at an outpatient addiction clinic, the nurse summarizes a diagram in the orientation handbook for another nurse who is new to the clinic. That diagram is reproduced below. Which of the following statements on the part of the new nurse would reflect an appropriate understanding of this diagram? A) "Most abused substances either imitate or block the action of neurotransmitters." B) "In order to be addictive, a substance must cause the release of excess neurotransmitters." C) "Substances that exert antagonistic effects can be used to counteract the addictive tendencies of substances that exert agonistic effects." D) "People with addictive personalities process neurotransmitters differently than people who are less prone to addiction."

A

While teaching a wellness class on the warning signs of stroke, a participant asks the nurse, "What's the most important thing for me to remember?" What is an appropriate response by the nurse? A) "Be alert for sudden weakness or numbness." B) "Know your family history." C) "Keep a list of your medications." D) "Call 911 if you notice a gradual onset of paralysis or confusion."

A

Why are proton pump inhibitors often included as part of the pharmacologic treatment regimen for clients with rheumatoid arthritis (RA)? A) Proton pump inhibitors help reduce the unpleasant GI-related side effects of NSAIDs, which are the most common class of medications used in the treatment of RA. B) Proton pump inhibitors can dramatically decrease both inflammation and immune reactions and appear to slow the progression of joint destruction in RA. C) Proton pump inhibitors help reduce the body's autoimmune response, thereby limiting the effects of the autoimmune disease process that underlies RA. D) Proton pump inhibitors help reduce the risk of retinitis and vision loss in clients who are taking antimalarial agents as part of their therapeutic regimen for RA.

A

A client is receiving IV antibiotics for the treatment of a Staphylococcus aureus infection. Which nursing interventions are appropriate when providing care to this client? Select all that apply. A) Encourage adequate fluid intake. B) Monitor for allergic reaction. C) Assess renal and liver function. D) Assess pain level. E) Monitor vital signs.

A B C E

A client receives the yellow fever vaccine before traveling to the Amazon Basin and asks the nurse how the vaccine provides protection. Which responses by the nurse are most appropriate? Select all that apply. A) "Human macrophages engulf the weakened vaccine virus as if it is dangerous, and antigens stimulate the immune system to attack it." B) "In the lymph nodes, which are part of the lymphoid system, the macrophages present yellow fever antigens to T cells and B cells." C) "A response from yellow fever-specific T cells is activated. B cells secrete yellow fever antibodies." D) "The vaccine contains large amounts of protective antibodies that were produced in another host organism, so it provides immediate protection against yellow fever." E) "The initial weak infection is eliminated and the client is left with a supply of memory T and B cells for future protection against yellow fever."

A B C E

The nurse is assessing a client. Which findings indicate a potential problem related to adrenal medulla function? Select all that apply. A) Heart rate of 104 B) Weight decreased 10 lb since previous appointment C) Respiratory rate of 22 D) Dry and cracked heels E) Blood pressure of 132/84

A B C E

The nurse is designing a teaching plan for community members on ways to prevent chronic pain. Which information should the nurse include in this teaching plan? Select all that apply. A) Eating a healthy diet B) Obtaining adequate sleep C) Avoiding illicit drug use D) Limiting smoking to only before bedtime E) Avoiding repetitive movements

A B C E

The nurse is caring for a client who is diagnosed with cancer. Which diagnostic tests may be helpful to assist with treatment options? Select all that apply. A) Tumor markers B) Urinalysis C) Physical assessment D) MRI E) Stool analysis

A B D

A client with a history of anemia has started a vegan diet. Which addition to meals should the nurse recommend to help ensure that this client has adequate amounts of iron in the diet? Select all that apply. A) Legumes B) Orange juice C) Yeast D) Okra E) Peas

A B E

The nurse is caring for a client who is diagnosed with fibromyalgia. Based on this diagnosis, which clinical manifestations might the nurse anticipate for this client? Select all that apply. A) Weakness B) Exhaustion C) Pain in the calves of the leg D) Nausea and vomiting E) Anxiety

A B E

A nurse is caring for a client with cancer. The nurse teaches the client about which potentially undesirable cellular alterations that can occur during the cell cycle? Select all that apply. A) Hyperplasia B) Differentiation C) Anaplasia D) Dysphagia E) Adaptation

A C

A nurse is caring for a client with chronic myeloid leukemia (CML) who is neutropenic. Which interventions will the nurse implement to ensure this client's safety? Select all that apply. A) Teach the client to maintain good personal hygiene. B) Encourage the client to eat a diet low in protein. C) Administer granulocyte colony-stimulating factor (G-CSF) as ordered. D) Administer neutrophil colony-stimulating factor (N-CSF) as ordered. E) Administer a prophylactic gram-negative antibiotic.

A C

A nurse is planning care for a client with leukemia. The nurse chooses "Risk for Bleeding" as the nursing diagnosis. Which interventions support this nursing diagnosis? Select all that apply. A) Educate client to not strain during bowel movements. B) Use nonelectric razor when providing grooming for client. C) Limit parenteral injections. D) Apply pressure to arterial puncture sites for 5 minutes. E) Encourage client to deep breathe and huff cough frequently.

A C

The nurse is caring for an adolescent client with a strong family history of breast cancer. What should the nurse instruct the client regarding cancer prevention? Select all that apply. A) Encourage the client to learn more about the disease. B) Talk to family members who have the disease. C) Perform monthly breast self-examination. D) Teach the side effects of cancer treatment. E) Discuss cancer fears with the healthcare provider.

A C

The nurse is counseling an adult client with fibromyalgia. What are some elements of counseling that can help this client develop effective coping skills? Select all that apply. A) Ask the client about specific stressors in the client's life and how the client handles them. B) Inform the client about what to do as the disease worsens. C) Ask the client about sources of support that the client may be able to rely on. D) Advise the client that a dimension of self-efficacy is independently developing a response to the problems of fibromyalgia. E) Suggest to the client that some symptoms may be psychosomatic.

A C

The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD) tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients. She is also concerned that, even if he were eligible for hospice care, they couldn't afford it, they'd have medical personnel constantly underfoot, and her husband would have to switch healthcare providers. Which responses by the nurse are appropriate? Select all that apply. A) Inform her that a diagnosis of cancer is not required for hospice care. B) Inform her that hospice care is very expensive. C) Tell her that hospice care is intended to ease the burden of primary caregivers, not add to it by being in the way. D) Tell her that, even though her husband has end-stage COPD, he is not eligible for hospice care. E) Inform her that all hospice programs are provided 24/7 in long-term care facilities.

A C

A nursing student is preparing an educational program on hemolytic anemia for the residents of an assisted living center. Which extrinsic causes of hemolytic anemia should the student include in the program? Select all that apply. A) Bacterial infection B) Thalassemia C) Blood transfusion reaction D) Prosthetic heart valves E) Acetaminophen use

A C D

The nurse is teaching a class at a local community center about decreasing risk factors for cancer. Which risk factors should the nurse include in the teaching regarding leukemia? Select all that apply. A) Smoking B) Diets low in fat C) Exposure to infectious agents D) Bloom syndrome E) Decreased exercise

A C D

The nurse is conducting a physical assessment for a client with a compromised immune system. Which actions by the nurse are appropriate? Select all that apply. A) Assessing general appearance B) Recommending increased fluid intake C) Inspecting the mucous membranes of the nose and mouth D) Palpating the cervical lymph nodes E) Checking joint range of motion (ROM), including that of the spine

A C D E

The nurse is providing care to a client who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis. When providing care to this client, which actions by the nurse are appropriate? Select all that apply. A) Monitoring for signs of allergic reaction B) Assuring the client that NSAIDs are safe for clients with cardiovascular disease C) Encouraging the client to take NSAIDs with a small snack to help avoid GI distress D) Monitoring for signs of renal problems E) Inquire about the use of herbal supplements such as feverfew, garlic, ginger, or ginkgo

A C D E

A nurse is providing discharge instructions to a client with iron deficiency anemia who is experiencing glossitis. Which statements will the nurse include in the discharge teaching for this client? Select all that apply. A) Monitor the condition of the lips and tongue daily. B) Use an alcohol-based mouthwash every 2 to 4 hours. C) Provide frequent oral hygiene. D) Apply a non-petroleum-based lubricating jelly or ointment to the lips after oral care. E) Use a soft toothbrush or sponge to provide oral care.

A C E

A nurse is caring for a client who is newly diagnosed with rheumatoid arthritis (RA). The client asks the nurse to explain the difference is between RA and osteoarthritis (OA). Which responses by the nurse are most appropriate? Select all that apply. A) "The onset of OA is gradual, whereas the onset of RA may be rapid." B) "With OA, multiple joints are symmetrically affected; RA affects one joint at a time." C) "The affected joints in RA feel cold to the touch, whereas the affected joints in OA are warm or hot to the touch." D) "OA is slowly progressive, whereas RA is characterized by exacerbations and remissions." E) "With RA, pain and stiffness occur with activity; with OA, pain and stiffness are predominant upon arising."

A D

The nurse caring for a client at risk for tuberculosis (TB) should include which symptoms of the disease when educating the client? Select all that apply. A) Fatigue B) Low-grade morning fever C) Productive cough that later turns to a dry, hacking cough D) Weight loss E) Night sweats

A D E

The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is on antiretroviral therapy. The client complains of nausea, fever, severe diarrhea, and anorexia. Which of the following prescribed medications does the nurse anticipate in order to relieve the anorexia and stimulate the client's appetite? Select all that apply. A) Dronabinol (Marinol) B) Zidovudine (Retrovir, AZT) C) Abacavir (Ziagen) D) Ciprofloxacin (Cipro) E) Megestrol (Megace)

A E

The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this medication? Select all that apply. A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." B) "Oral calcium supplements are best taken on an empty stomach." C) "Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental calcium." D) "If you have a condition called ventricular fibrillation, this medication might help." E) "Report symptoms of weakness, increased urination, and thirst."

A E

The nurse is planning care for a client with acute myeloid leukemia (AML). Which diagnoses are priorities for this client to minimize the risk of complications associated with AML? Select all that apply. A) Risk for Infection B) Ineffective Thermoregulation C) Imbalanced Nutrition, Less than Body Requirements D) Fluid Volume Excess E) Risk for Bleeding

A E

Once inside the body, human immunodeficiency virus (HIV) infects and destroys several types of cells, including helper T cells. List each of the events in this process in the order in which they occur. A) Virus recognizes and invades helper T cell B) Viral RNA is acted upon by reverse transcriptase C) Viral DNA integrates with helper T cell DNA D) Virus disrupts cell membrane of helper T cell, leading to its destruction E) Virus sheds its protein coat

A E B C D

Tuberculosis

A chronic, recurrent, infectious disease caused by Mycobacterium Tuberculosis

Pathogen

A microorganism that causes disease; Opportunistic pathogen causes disease only in susceptible host

Pneumothorax

A partial lung collapse caused by air or gas collecting in the lung or pleural space that surrounds the lungs

Mycobacterium Tuberculosis

A relatively slow-growing, slender, rod-shaped, acid-fast organism with a waxy outer capsule that increases its resistance to destruction

Negative Airflow Room

A room where airflow is controlled to prevent the air from circulating into the hallway or other rooms

Tubercle

A sealed-off colony of bacilli

The nurse is providing discharge instructions to an older adult client who is recovering from a fractured hip. The client is planning to stay with an adult child, who is included in the discharge teaching. Which statements on the part of the client indicate appropriate understanding of the information presented by the nurse? Select all that apply. A) "I have signed a contract with Lifeline." B) "We are removing the area rugs in the hallway." C) "I've borrowed a toilet seat riser from the equipment closet." D) "I will be sure to take oxycodone before I go downstairs in the morning." E) "I can help with housework while I'm staying at my child's house."

A, B, C

A client with alcoholism is receiving court-ordered care in a residential treatment facility. After alcohol is discovered in her room, the client states, "It is not mine." Which responses by the nurse are appropriate in this situation? Select all that apply. A) "You will lose your day pass privileges for this Sunday." B) "We have a video of you accepting the alcohol from your brother." C) "What do you think about sharing this at AA tonight?" D) "You won't be allowed to go to dinner tonight." E) "You have violated our behavior contract."

A, B, C, E

A client with osteoarthritis (OA) of the knees and hips returns for a 3-month follow-up visit with the provider. The nurse calculates that the client's body mass index (BMI) is now 22. The client reports starting a water aerobics and running program three times per week. The client is also using hot packs for edema for 20 minutes and cold packs for pain for 40 minutes daily. After evaluating the client's actions, which follow-up interventions should the nurse plan? Select all that apply. A) Reinforce the correct use of hot packs. B) Suggest the client replace running with a lower impact exercise. C) Explain the risk of injury associated with use of cold packs. D) Advise the client to continue weight loss. E) Congratulate the client on starting water aerobics.

A, B, C, E

The mother of a preadolescent client meets with the school nurse to discuss the client's recent diagnosis of scoliosis. Which interventions would be appropriate for the nursing diagnosis of Disturbed Body Image related to deformity and brace? Select all that apply. A) Including the student and family in a meeting to elicit her feelings about scoliosis and wearing a brace B) Offering to arrange a meeting for the student with an 8th grader who has scoliosis C) Encouraging the student and family to register for home schooling to minimize the risk of ridicule D) Teaching the student and family about clothing that will hide the brace E) Suggesting that the pediatrician prescribe an anti-anxiety agent for the student

A, B, D

The nurse is collecting data on clients at a clinic. One client has risk factors for substance abuse. What physical sign or signs did the nurse assess that suggest substance abuse in this client? Select all that apply. A) Dilated pupils B) Odor of alcohol on the breath C) Frequent accidents or falls D) Extremely low body weight E) Dressed in jeans and a t-shirt

A, B, D

The nurse is completing a health history for an adolescent client and determines that the client would benefit from teaching about substance abuse. Which client statements caused the nurse to come to this conclusion? Select all that apply. A) "I drink alcohol with my friends on the weekends." B) "I smoke cigarettes on a daily basis." C) "I use my seat belt every time I ride in a car." D) "I started having sex when I was 13." E) "I get all A's and B's in school."

A, B, D

The nurse gives discharge instructions to an adult client who sustained a bicycle fall and underwent open reduction and internal fixation of a fractured hip. After the teaching is complete, which statements by the client indicate appropriate understanding of the information presented? Select all that apply. A) "I will use my abduction pillow while sleeping to maintain proper hip alignment." B) "I will use a high toilet seat to prevent excess flexion of my hip." C) "I only need to use my walker during physical therapy appointments." D) "I will take my prescribed ibuprofen to decrease the risk for deep vein thrombosis." E) "I might experience bruising because of the warfarin I've been prescribed."

A, B, E

A nurse is caring for a client with congestive heart failure (CHF) who currently smokes cigarettes and has a 50 pack-year smoking history. When providing smoking cessation education to this client, which statements regarding the pathophysiology of nicotine use are appropriate? Select all that apply. A) "In low doses, nicotine stimulates nicotinic receptors in the brain to release dopamine." B) "In high doses, nicotine stimulates the parasympathetic system to release epinephrine, causing vasoconstriction." C) "Initially, nicotine increases mental alertness and cognitive ability." D) "Nicotine is a nonpsychoactive substance found in tobacco." E) "Gradual reduction of nicotine intake appears to be the best method of cessation."

A, C

A preadolescent client is recovering from spinal fusion surgery for scoliosis. Which nursing interventions should the nurse carry out to address comfort and mobility? Select all that apply. A) Reposition every 2 hours. B) Monitor intake and output. C) Encourage and assist with range of motion (ROM) exercises every 4 hours while awake. D) Administer pain medication around the clock. E) Encourage incentive spirometer use every 4 hours while awake.

A, C, D

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training

A, C, D, E

tPA - Alteplase Thrombolytics

AVOID giving to: -Active bleeding (peptic ulcer) -Uncontrolled HTN 180/110+ -Recent surgery within 2 weeks Clarify Prescription with Provider! -A-Acidents "Recent Trauma" -A-Aneurysm - Hx of hemorrhagic CVA -A-AV malformation Clot Busters - MOST powerful 1 time push drugs These are the ONLY ones that dissolve clots Aspirin & Clopidogrel NOT clot busters - they are Anti-Platelets Heparin & Warfarin - NOT clot busters - They prevent new clots & existing clots from getting bigger THE BIG CAUTION HERE IS THE MASSIVE BLEEDING RISK AND ITS THE MOST DEADLY NO injections at all! NO NEW: -IVs -Sub Q -IMs -ABGs GIVE WITHIN 3 HOURS FROM ONSET OF SYMPTOMS Can ONLY be given in a compressible site like a peripheral IV - NOT A CENTRAL LINE

Steroids

Action: Anti-inflammatory effect Uses: -COPD -RA -Lupus Side Effects: -Hyperglycemia -Causes osteoporosis -Decreased immunity/sepsis -Depression -Water & salt retention (hypertension) -Decreased libido -Water gain/weight gain -Risk for cataracts Education: -Report signs of an infection -Increase calcium in the diet -Yearly eye appointment -Stress/surgery causes a decrease in cortisol -Never Stop Steroids Suddenly (must be tapered) -Inhalers: rinse mouth to decrease risk of fungal infection

Adherence & Follow-Up

Adherence: Evaluated at follow-up visits Urine examined, tested Color changes characteristic of rifampin Follow-Up: Repeat sputum specimens, CXRs

Infection

An invasion of the body tissue by microorganisms with the potential to cause illness or disease

Aspirin - Salicylates

Analgesic & Antipyretic Anti-inflammatory Anticoagulant Uses: -Mild to moderate pain -Decrease body temp -Inflammatory conditions -Decrease the risk of an MI & CVA Side Effects: -GI upset -N/V -Heartburn -GI bleeding Contraindications: -Known sensitivity to NSAIDS -Any BLEEDING TENDENCIES -Children with recent viral infection - REYE's SYNDROME Nursing Considerations: -Stop taking salicylates 1 week prior to major surgery -Monitor for GI bleeding Antidote: Activated Charcoal Toxicity: -Gastric lavage -Activated charcoal within 2 hrs of ingestion

Specific Defenses

Anatomic & Physiologic Barriers: Intact skin, Mucous membranes Nasal Passages Lungs Each body orifice has protective mechanisms

A client with anemia is prescribed synthetic erythropoietin. When teaching the client about the therapeutic effect of this treatment, which is appropriate for the nurse to include? A) Increase in platelets B) Increase in red blood cells C) Decrease in white blood cells D) Decrease in lymph fluid

B

Modern medicine contributes to development of infection

Antibiotic-Resistant Strains of Microorganisms: MRSA ORSA VRE PRSP VISA/VRSA EBSL Carbapenem-Resistant Enterobacteriacea Multidrug-Resistant Pseudomonas Aeruginosa MDR-TB (Multi Drug Resistant TB) Immunosuppressive Therapy: More susceptible to infection (RA)

A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20- to 40-pound boxes. Based on the client's history, the nurse should anticipate which initial recommendation from the multidisciplinary healthcare team? A) Joint replacement surgery B) Pharmacologic therapy C) Referral for a disability application D) Intermittent use of a cane

B

A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety

B

Observation & Patient Interview

Assess degree of patient risk for infection Observations of patient's current condition Interview Existing disease process History of recurrent infections Current medications, therapeutic measures Current emotional stressors Nutritional status History of immunizations

Assessment

Assessing patients for infection is vital to Treating patients Preventing spread of infection Specially important for patients at risk of infection such as those with IV lines Indwelling catheters Surgical wounds

Treatment of Active TB

At least 2 antibacterial drugs Bacillus mutates readily with only one anti-infective 4 Oral Meds for first 2 months: Isoniazid Rifampin Pyrazinamide Ethambutol Followed by 4 months of: (9 mos w/HIV infection) Isoniazid Rifampin

A client with a BMI of 35 is recovering from total hip replacement surgery and experiencing pain that is exacerbated with movement. The client says to the nurse, "I live alone. How will I ever be able to return to my home?" Based on this information, which is the priority nursing diagnosis for this client? A) Overweight B) Acute Pain C) Impaired Physical Mobility D) Ineffective Coping

B

Transporting patients with infection

Avoid transporting outside room Cover wound Surgical mask Notify personnel at receiving area of any infection risk

A client complaining of mouth soreness had gastric bypass surgery 1 year ago. During the assessment, the nurse notes the client's tongue is beefy, red, and smooth and the client's skin appears yellowish. Which additional information is most likely needed before diagnosing this client? A) Vitamin B6 levels B) Vitamin B12 levels C) Potassium levels D) Iron levels

B

A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity

B

A client is admitted for the fourth time in 4 years for opioid detoxification. When planning care for this client, the nurse should consider which pathophysiologic aspect of substance abuse because of its impact on care? A) Aging can impact the body's ability to handle detoxification from alcohol and drugs. B) The client's withdrawal may be greater this time than during past detoxifications. C) The client's dependency might have been greater this time than during past periods of abuse. D) Increased difficulty with opioid detoxification is likely the result of an addiction to another substance at the same time.

B

A home health nurse is conducting home visits for several clients who are diagnosed with acquired immunodeficiency syndrome (AIDS). Which client would the nurse see first? A) A client who is receiving lamivudine (Triumeq) because of a low CD4 cell count B) A client with Pneumocystis jiroveci pneumonia who called the office this morning to report a new onset of fever, cough, and shortness of breath C) A client with wasting syndrome who needs dietary modifications and education regarding these changes D) A client who is receiving IV antibiotics daily for toxoplasmosis

B

A nurse educator is teaching student nurses about methods of cellular transport. When instructing on passive transportation, which process will the nurse include in the teaching plan? A) Endocytosis B) Facilitated diffusion C) Exocytosis D) Phagocytosis

B

A nurse in a provider's office is providing teaching to a client with osteoporosis who has a new prescription for alendronate sodium. Which of the following pieces of information should the nurse include? A. Alendronate sodium can be administered by IV once yearly B. Take alendronate sodium with a full glass of water on an empty stomach C. Side effects of alendronate sodium include leukopenia D. Alendronate sodium should be taken with calcium-containing foods to increase absorption

B

A nurse is administering medications to a client who is recovering from a stroke and has right-sided paralysis. The nurse places the client's medications on the left side of the mouth and administers pills one at a time. Which of the following ethical principles is the nurse displaying? A. Autonomy B. Nonmaleficence C. Fidelity D. Justice

B

A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for osteoporosis? A) Having a body mass index (BMI) that indicates obesity B) Using glucocorticoids for 10 years because of a chronic lung disorder C) Eating three to five servings of shrimp and liver per week D) Drinking three glasses of skim milk daily

B

A nurse who runs an addiction treatment group at an inner-city clinic has noticed that many of the group's participants struggle with the stigma attached to their condition. Which of the following statements on the part of the nurse would best help participants overcome this stigma? A) "Relapse is a common feature of substance abuse." B) "Heredity and complex environmental influences predispose some people to substance dependence." C) "People who have an addiction problem cannot be held accountable for their actions." D) "Alcoholics Anonymous and Narcotics Anonymous are both accepted treatment approaches."

B

A nurse working in the pediatric intensive care unit (PICU) is caring for a child with leukemia. What is the most common type of leukemia in children? A) Chronic lymphocytic leukemia B) Acute lymphocytic (lymphoblastic) leukemia C) Acute myeloid (myeloblastic) leukemia D) Chronic myeloid (myelogenous) leukemia.

B

A nurse working in the pediatric intensive care unit (PICU) is caring for a client with human immunodeficiency virus (HIV). The client is severely symptomatic with the additional diagnoses of lymphoma and wasting syndrome. Based on this data, which clinical stage of HIV does the nurse anticipate for this client? A) Category N B) Category C C) Category A D) Category B

B

A patient with anemia from acute blood loss has been admitted to the med-surg unit. What assessment finding would the nurse expect to find? A) Night sweats, weight loss, diarrhea B) Dyspnea, tachycardia, pallor C) Nausea, vomiting, anorexia D) Itching, rash, jaundice

B

A postmenopausal client asks the nurse what she can do to prevent fracturing her hips, as her mother and grandmother both experienced this health problem. Which response by the nurse is most appropriate? A) "You should avoid all types of exercise." B) "You should consider a smoking cessation program." C) "You should limit your exposure to the sun." D) "You should use throw rugs throughout your home."

B

A preadolescent client who fell from a balance beam in physical education class injured her ankle. Given this information, which action by the nurse is appropriate? A) Referring the client to physical therapy B) Placing an ice pack on the client's ankle C) Planning for a corticosteroid injection D) Ordering an x-ray of the ankle

B

After a stroke, sensory-perceptual changes increase the client's risk for what? A) Aspiration B) Injury C) Bleeding D) Infection

B

An 80-year-old client with heart disease tells the nurse, "I am sick because I sinned by smoking cigarettes." Which response by the nurse is appropriate? A) "Smoking cigarettes isn't a sin. There are many worse habits you could have." B) "Cigarette smoking was socially acceptable when you began smoking. People didn't fully understand the problems it could cause." C) "Why don't we call the hospital chaplain and you can pray about your sins?" D) "You are correct, but it is too late to do anything about it now."

B

An adult client is diagnosed with a degenerative bone disease that is impairing mobility. Based on this information alone, which of the following actions should be the nurse's first priority? A) Implementing a low-level exercise program for the client B) Assessing the client's pain management C) Teaching the client relaxation techniques D) Referring the client to a dietitian

B

An adult client is diagnosed with fibromyalgia. The client asks the nurse whether a recent of infection with the Coxsackie B virus could have caused fibromyalgia. Which response by the nurse is the most appropriate? A) The Coxsackie B virus has nothing to do with fibromyalgia. B) The Coxsackie B virus may have triggered the fibromyalgia. C) The Coxsackie B virus definitely caused the fibromyalgia. D) The Coxsackie B virus probably caused the fibromyalgia.

B

An adult client who resides in a long-term care facility is diagnosed with osteoporosis. The client has a history of falls and dementia. Which nursing intervention will best aid in meeting an outcome goal of injury prevention for this client? A) Using furniture as obstacles to keep the client in the bed B) Keeping the bed in the lowest position C) Keeping a nightlight on in the hallway D) The use of wrist restraints

B

The nurse is caring for a client who has recently been diagnosed with fibromyalgia. The client has complained of pain, fatigue, and sleep disruptions. Which medication should the nurse anticipate will most likely be prescribed as part of the client's treatment plan? A) Duloxetine B) Milnacipran C) Pregabalin D) Acetaminophen

B

An older adult client with bilateral osteoarthritis of the knees tells the nurse, "I know I need to lose weight, but exercising makes my knees ache." What instruction should the nurse provide to this client? A) "You should discuss knee replacement surgery with your physician." B) "Exercising the muscles in your legs might be hard now, but over time, it will help protect your knees." C) "Try eating a reduced-calorie diet for several months before attempting exercise." D) "You need to stretch your muscles, because stretching is the only form of exercise that improves osteoarthritis."

B

Based on gender and age alone, which of the following clients is most likely to experience the new onset of rheumatoid arthritis (RA)? A) A 31-year-old man B) A 42-year-old woman C) A 65-year-old woman D) An 18-year-old man

B

During visitation on the unit, a nurse is observing the family dynamics of an adolescent client who has an addiction problem. In doing so, the nurse concludes that the family is exhibiting codependence. Which of the following behaviors on the part of the family supports the nurse's conclusion? A) The family is intolerant of any frustration on the part of the client. B) The family engages in actions that enable the client's self-destructive behavior. C) The family is argumentative about seemingly insignificant issues. D) The family exhibits high levels of impatience.

B

On the first postoperative day after spinal fusion, the nurse assesses a client and notes the following vital signs: T 39.2°C, BP 100/50 mmHg, HR 118, and RR 23. Drainage at the client's incision site is clear and tests positive for glucose. Which assessment parameter indicates the highest risk for surgical wound infection? A) Temperature B) Incisional drainage positive for glucose C) Heart rate 118 bpm D) Presence of incisional drainage

B

The community nurse is teaching a class at the community center regarding the cultural and ethnic risk factors for stroke. Which statement should nurse include in this presentation? A) Caucasians have an increased incidence of intracerebral hemorrhage. B) African Americans have almost twice the number of first-ever strokes compared with Whites. C) Asian Americans are more likely to die following a stroke than Whites. D) The prevalence of hypertension among Hispanics is the highest in the world.

B

The home healthcare nurse is preparing a care plan for a client with severe anemia. The client currently lives alone and states, "I can't even walk to the kitchen without getting winded." What would be the priority nursing diagnosis for this client? A) Hopelessness B) Activity Intolerance C) Imbalanced Nutrition, Less than Body Requirements D) Anxiety

B

The mother of three teenagers is diagnosed with fibromyalgia and asks the nurse to how to keep up with all of the children's activities. Which suggestion by the nurse is the most appropriate? A) Attempt to attend all the functions of the children. B) Negotiate with the children to alternate attendance of their functions. C) Avoid attending any afterschool functions for the children. D) Ask the children to limit their activities.

B

The nurse assesses a client with a history of alcoholism who is hospitalized with anorexia, dysphagia, odynophagia, and chest pressure after eating. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Imbalanced Nutrition: Less than Body Requirements C) Disturbed Sensory Perception D) Disturbed Thought Processes

B

The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."

B

The nurse educator is teaching a group of student nurses regarding human growth and development. Which statement by the student nurse indicates that teaching has been effective? A) "The zygote undergoes differentiation to form a multicellular embryo, which becomes a fetus and then an infant." B) "Meiosis occurs only in the sex cells of the testes and ovaries." C) "Mitosis reduces the amount of genetic material by half." D) "When the two sex cells combine during fertilization, a total of 50 chromosomes are present in the offspring's cells."

B

The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."

B

The nurse is assessing a client who is recovering following surgery. Which factor would increase this client's susceptibility to infection? A) Intact mucous membranes B) Presence of an incision C) Dry skin D) Active bowel sounds

B

The nurse is assessing a postmenopausal client. Which question should the nurse ask to assess for signs of osteoporosis? A) "Have you experienced any palpitations?" B) "Are you having any low back pain?" C) "Are you having problems with swelling in your feet?" D) "Is constipation a problem for you?"

B

The nurse is caring for a client who is 28 weeks pregnant. The client says she has recently begun to experience frequent lower back pain and asks the nurse what can be done to control this pain. What is the nurse's best response? A) "Back pain is common during pregnancy and can usually be managed by taking nonsteroidal anti-inflammatory drugs (NSAIDs)." B) "Let's talk about some postural adjustments that might help alleviate your pain." C) "Back pain during pregnancy is often related to kidney infection. Have you experienced any recent urinary problems, including pain when voiding?" D) "The physician will likely order an x-ray to investigate potential causes of your pain."

B

The nurse is caring for a client who is admitted to the unit with tuberculosis (TB). Which type of isolation room is most appropriate? A) Single-door room with positive airflow (air flows out of the room) B) Isolation room with an anteroom and negative airflow (air flows into the room) C) Isolation room with an anteroom and normal airflow D) Single-door room with normal airflow

B

The nurse is caring for a client who is experiencing acute chest pain that is rated as a 9 on a 0 to 10 pain scale. Based on this data, which medication does the nurse expect to administer? A) Acetaminophen B) Morphine C) Ibuprofen D) Naproxen

B

The nurse is caring for a client who is prescribed calcitonin-human (Cibacalcin) nasal spray. Which teaching point should the nurse include in this client's plan of care? A) Always administer the nasal spray in the left nostril. B) Administer the nasal spray in alternate nostrils each day. C) Administer the nasal spray in both nostrils at each dose. D) Always administer the nasal spray in the right nostril.

B

The nurse is caring for a client who is scheduled to receive metoprolol (Lopressor). What should the nurse teach the client about this medication? A) Expect a rapid heart rate. B) Change positions slowly. C) Reduce protein intake. D) Increase fluids.

B

The nurse is caring for a client who was diagnosed with rheumatoid arthritis (RA) last year. The client has just been prescribed methotrexate as part of his RA treatment regimen. The nurse is teaching the client about use of this medication. Which client statement indicates that this teaching was successful? A) "It's not safe for me to take nonsteroidal anti-inflammatory drugs (NSAIDs) while on methotrexate therapy." B) "I can help control the side effects of methotrexate by taking folic acid." C) "I should expect to see beneficial results within 3 to 5 days of starting methotrexate therapy." D) "It's important that I take my methotrexate at the same time every day."

B

The nurse is caring for a client with leukemia who is experiencing neutropenia as a result of chemotherapy. Which action should the nurse include in the plan of care for this client? A) Replace hand hygiene with gloves. B) Restrict visitors with communicable illnesses. C) Restrict fluid intake. D) Insert an indwelling urinary catheter to prevent skin breakdown.

B

The nurse is caring for a client with leukemia. Which treatment should the nurse expect to be prescribed for this client? A) Diuretic therapy B) Chemotherapy C) Electrolyte replacement therapy D) IV fluid therapy

B

The nurse is caring for a client with sickle cell anemia. The nurse teaches the client that the inherited alteration of which type of hemoglobin causes the abnormal shape to the red blood cell? A) Hgb A B) Hgb S C) Hgb B D) Hgb E

B

The nurse is caring for an 8-year-old client with cerebral palsy and limited walking ability. The parents are very protective and perform most activities for the child. Which intervention is essential in promoting bone growth and reducing the risk of osteoporosis? A) Provide client teaching related to using restraints to prevent falls. B) Provide client teaching related to assistive devices to encourage walking. C) Refer the client to a dietitian to increase calcium and vitamin D intake. D) Refer the client to an occupational therapist to increase limb movement.

B

The nurse is caring for an adult client who sustained a right distal radial fracture and a left tibia fracture. Which mobility aid does the nurse anticipate being used for this client? A) Lofstrand crutches B) Platform crutches C) Walker D) Axillary crutches

B

The nurse is concerned that a client with an alteration in perfusion is at risk for inadequate oxygenation. What should the nurse consider when planning for this client's potential health problem? A) Encouraging ambulation every 30 minutes B) Instructing on deep breathing C) Administering medications appropriate to increase heart rate D) Positioning to increase blood return

B

The nurse is conducting a health history and wants to determine the client's level of alcohol use. What question from the nurse will provide the greatest amount of information? A) "Are you a heavy drinker?" B) "How many alcoholic beverages do you drink each day?" C) "Is alcohol use a concern for you?" D) "Drinking doesn't cause any problems for you, does it?"

B

The nurse is evaluating care provided to a client with osteoarthritis (OA). Which client statement indicates to the nurse that interventions for OA have been successful? A) "I had to take early retirement and now stay at home all day and rest my legs." B) "I am sleeping throughout the night and have not missed any work because of knee pain." C) "I am moving from my two-story house into the first floor of my daughter's home so I won't have to walk steps anymore." D) "I changed my work hours so now I work part time and have a nursing assistant who helps me bathe twice a week at home."

B

The nurse is planning care for a client with osteoarthritis. Which nursing diagnosis would have the highest priority? A) Fatigue B) Chronic Pain C) Ineffective Coping D) Disturbed Body Image

B

The nurse is preparing to assess a 1-year-old client for signs of discomfort. When conducting the assessment, which action by the nurse is the most appropriate? A) Asking the client to rate the pain on a scale of 0-10 during the assessment process B) Asking the parent to hold the client in the lap during the assessment process C) Reading a book to the client during the assessment process D) Recommending that the parent leave the room during the assessment process

B

The nurse is preparing to conduct a cardiac assessment for a pediatric client. Which location will the nurse use when auscultating the apical pulse? A) At the fifth intercostal space B) At the left nipple C) At the right nipple D) At the eighth intercostal space

B

The nurse is providing care to a client who returns to the medical-surgical unit after herniated disc surgery. The client's vitals are as follows: HR 100, RR 22, BP 130/86 mmHg, T 98.8°F, and pain rating of 7 on a scale of 0 to 10. Which nursing diagnosis is the highest priority for this client based on these assessment data? A) Impaired Physical Mobility B) Acute Pain C) Activity Intolerance D) Chronic Pain

B

The nurse is teaching a class of adolescents about smoking. Which of the following points is most important to convey to this audience? A) Teenagers and young adults are not strongly influenced by tobacco advertising. B) Smoking is a major cause of lung cancer. C) Increasing the cost of cigarettes is not an effective deterrent to smoking. D) Few young people who smoke regularly during their teenage years continue to use tobacco as adults.

B

The nurse is teaching a class on infection control. Which nursing measure is most appropriate in breaking a link in the chain of infection? A) Place contaminated linens in a paper bag. B) Use personal protective equipment (PPE). C) Cover one's cough by placing the mouth in the hand. D) Wear sterile gloves for client care.

B

Transfusion reactions and Rh incompatibility are both examples of which type of hypersensitivity reaction? A) Type I B) Type II C) Type III D) Type IV

B

What best explains the reason that a nurse should be responsible for communicating any changes in the condition of a client at the end of life that would warrant a change in the care plan? A) Nurses typically are responsible for definitively diagnosing patient conditions. B) Nurses are the healthcare providers who tend to have the greatest amount of contact with clients at the end of life. C) Clients typically do not prefer to talk to physicians about problems. D) It is legally mandated that nurses are solely responsible for communicating this information.

B

What independent nursing intervention is important for the nurse to implement for clients who have alterations in cellular regulation? A) Administer pain and other medications B) Help the client identify support systems C) Design a diet that provides proper nutrition D) Suggest contacting the nurse's spiritual leader

B

What is the most commonly observed opportunistic infection in clients with AIDS? A) Tuberculosis B) Pneumocystis jiroveci pneumonia C) Candida albicans infection D) Mycobacterium avium complex

B

When teaching safety precautions to a patient with thrombocytopenia, the nurse should include which of the following directives? A) Eat foods high in iron B) Avoid products that contain aspirin C) Avoid people with respiratory tract infections D) Eat only cooked vegetables

B

Which agent can be used to destroy pathogens other than spores? A) Antiseptic B) Disinfectant C) Sterilizing agent D) Isolating agent

B

Which condition or symptom is most common in clients with a herniated cervical disc? A) Sciatica B) Stiff neck and shoulder pain C) Changes in knee and ankle reflexes D) Cauda equina syndrome

B

Which intervention can the nurse implement independently to provide support to clients with an alteration in metabolism? A) Administer hormone therapies. B) Refer the client to a nutritionist. C) Order blood tests. D) Refer the client to an acupuncturist.

B

Which of the following signs and symptoms would least likely be observed in a client who is experiencing alcohol withdrawal syndrome? A) Anorexia B) Hypotension C) Visual hallucinations D) Hyperthermia

B

Which of the following statements best describes the therapeutic approach to acute and chronic pain, fatigue, fibromyalgia, and sleep disorders? A) Therapy is primarily psychosocial in nature. B) Therapy involves both pharmacologic and nonpharmacologic approaches. C) Therapy is essentially physiologically focused. D) Therapy mostly involves the client avoiding risk behaviors.

B

Which of the following terms is used to describe osteoarthritis (OA) that is caused by an underlying condition, such as injury, congenital malformation, or metabolic disease? A) Idiopathic B) Secondary C) Localized D) Generalized

B

Which of the following terms refers to a physiologic need for a substance that the client cannot control and that results in withdrawal symptoms if the substance is withheld? A) Tolerance B) Dependence C) Addiction D) Codependence

B

Which of the following treatment options would least likely be considered for a 71-year-old client with osteoarthritis (OA)? A) Physical therapy B) Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) C) Weekly tai chi sessions D) Administration of narcotics

B

Which score would a nurse select from the muscle function grading scale if the client has full strength and range of motion in a given joint? A) 0 B) 5 C) 8 D) 10

B

Which statement best exemplifies the etiology of fibromyalgia? A) Stress and poor sleep hygiene are the main precipitating factors for fibromyalgia. B) No exact cause is known, but some clients with fibromyalgia may have precipitating factors. C) The primary cause for fibromyalgia in nearly all clients who have it is infection. D) Precipitating factors for fibromyalgia are primarily physiological.

B

Why is smoking particularly dangerous for clients with atherosclerosis? A) Smoking causes a direct increase in HDL cholesterol, which further contributes to plaque buildup. B) Smoking causes vasoconstriction, which further impairs tissue oxygenation. C) Smoking causes a direct increase in total cholesterol, which further contributes to plaque buildup. D) Smoking causes a decrease in blood pressure, which further impairs tissue oxygenation.

B

Within the human body, which type of connective tissue connects bones to other bones to form a joint? A) Tendon B) Ligament C) Cartilage D) Myelin

B

A pediatric nurse is caring for a child with acute lymphoblastic leukemia (ALL). When providing education to the child's parents regarding this disease, which topics should the nurse include? Select all that apply. A) ALL is characterized by abnormal proliferation of all bone marrow elements. B) This form of leukemia is the most common type among children and adolescents. C) Most cases of ALL result from the malignant transformation of B cells. D) Malignant lymphocytes are able to effectively maintain immunity. E) The onset of ALL is usually gradual.

B C

The charge nurse for a medical-surgical unit is notified that a client with tuberculosis (TB) is being transported to the unit. Which actions for infection prevention are the most appropriate in this circumstance? Select all that apply. A) Stock the client's supply cart at the beginning of each shift. B) Wear a respirator and gown when caring for the client. C) Have the client wear a mask when coming from admissions. D) Perform hand hygiene only after leaving the room. E) Test all staff members for TB immediately.

B C

The nurse is caring for a client who is hospitalized on a medical unit for a systemic infection. The client asks the nurse which defenses the body has against infection. Which physiologic barriers that protect the body against microorganisms should the nurse include in the response to the client? Select all that apply. A) The spleen B) Adequate urinary output C) Intact skin D) Generalized inflammation E) The thymus gland

B C

The nurse is instructing a client on lifestyle changes to promote a healthy cardiovascular system. Which of the following should be included in this teaching session? Select all that apply. A) Limit exercise to 15 minutes a day B) Reduce saturated fats in the diet C) Avoid cigarette smoking D) Wear elastic hose E) Limit fluid intake

B C

A nurse educator is teaching a group of parents how to prevent a sickle cell crisis in the child with sickle cell disease. What precipitating factors that could contribute to a sickle cell crisis should the nurse teach the parents? Select all that apply. A) Increased fluid intake B) High altitudes C) Fever and infection D) Emotional or physical stress E) Warm temperatures

B C D

Which actions should the nurse take to help the client with bowel and bladder dysfunction reduce the risk of infection? Select all that apply. A) Isolate the client using transmission-based precautions. B) Monitor intake and output. C) Provide hygienic care after episodes of incontinence. D) Use standard precautions when handling linen after episodes of incontinence. E) Limit fluid intake.

B C D

While performing an endocrine assessment on a client suspected of having an endocrine disorder, the nurse asks if the client has experienced recent weight changes. The nurse asks this question because he understands that alterations in which endocrine glands are most directly related to weight changes? Select all that apply. A) Gonads B) Pituitary gland C) Thyroid gland D) Adrenal gland E) Parathyroid gland

B C D

A client who was recently diagnosed with rheumatoid arthritis (RA) asks the nurse if RA always causes crippling deformities. What information should the nurse include when teaching this client about ways to decrease the likelihood of crippling deformities? Select all that apply. A) Ignore pain as a warning signal. B) Type instead of hand-writing items if possible. C) Use the strongest joints possible to complete most tasks. D) Avoid stress to any current area of deformity. E) Stop an activity immediately if it is beyond your ability to perform.

B C D E

The nurse is caring for a client who is exhibiting signs of a systemic infection following surgery. Which diagnostic tests would the nurse anticipate being ordered? Select all that apply. A) Serum electrolyte levels B) Urinalysis C) White blood cell differential D) White blood cell count E) Wound culture

B C D E

An adult client reports to the nurse an inability to tolerate usual exercise and the feeling of fatigue. The client states that these symptoms have been gradual over time. Which physical assessment findings, along with the client's verbal complaints, would indicate chronic lymphocytic leukemia (CLL)? Select all that apply. A) Joint pain B) Pallor C) Splenomegaly D) Abnormal bleeding E) Edema

B C E

A client is receiving chemotherapy for acute lymphocytic leukemia. While providing care for this client, which clinical manifestations would indicate tumor lysis syndrome? Select all that apply. A) Thrombocytopenia B) Cardiac arrhythmia C) Respiratory distress D) Changes in urine output E) Upper-extremity edema

B D

An emergency department nurse is caring for a child in sickle cell crisis. The nurse suspects the etiology of the crisis as being thrombotic in nature because of which clinical manifestations? Select all that apply. A) The client has profound pallor and fatigue. B) The client is in extreme pain. C) The client has profound hypotension and shock. D) The client has a fever.

B D

The healthcare provider prescribes a client to have peak and trough blood levels drawn to evaluate the therapeutic effect of an IV antibiotic. When should the nurse schedule the blood samples to be drawn? Select all that apply. A) Prior to the discontinuing the antibiotic B) A few minutes before the next scheduled dose of medication C) During the infusion of the antibiotic D) 30 minutes after the IV administration E) 1 to 2 hours after the oral administration of the medication

B D

The nurse is providing care to an adolescent client who presents at the clinic for a routine health assessment. Which immunizations should the nurse anticipate administering to the client during this visit? Select all that apply. A) Herpes zoster vaccine B) Papillomavirus vaccine C) Rotavirus vaccine D) Meningococcal vaccine E) Hepatitis B vaccine

B D

A client with a suspected transient ischemic attack (TIA) presents to the emergency department with aphasia. Based on this data, the nurse plans care based on ischemia to which portion of the brain? A) Anterior cerebral artery B) Vertebral artery C) Left hemisphere of the brain D) Right hemisphere of the brain

C

A nurse is caring for a client who was admitted to the hospital with an exacerbation of rheumatoid arthritis (RA). The client reports that her pain is a 3 on a scale from 0 (none) to 10 (high) today. Which nonpharmacologic interventions can the nurse provide to enhance the client's comfort? Select all that apply. A) Discourage any position changes. B) Encourage relaxation techniques. C) Immobilize the extremity. D) Offer heat and/or cold packs. E) Provide distraction activities.

B D E

The nurse instructs a group of community members about ways to reduce the development of cancer. Which participant statements indicate that teaching has been effective? Select all that apply. A) "I should eat at least two servings of fruits or vegetables each day." B) "Sunscreen should be applied before spending time outdoors." C) "I need to cut down on my smoking." D) "I need to get my home tested for radon." E) "I need to minimize my child's exposure to secondhand smoke."

B D E

The nurse is planning care for a pediatric client who is infected with the human immunodeficiency virus (HIV). The nurse selects Risk for Infection as a priority nursing diagnosis for this client. Based on this nursing diagnosis, which actions by the nurse are appropriate? Select all that apply. A) Administering tuberculosis skin tests every 6 months B) Teaching proper food-handling techniques to the family C) Instructing on the importance of delaying vaccinations until adulthood D) Assessing the health status of all visitors E) Monitoring hand-washing techniques used by the family

B D E

The nurse is reviewing the laboratory test results for a client with an endocrine disorder. Which diagnostic tests would the nurse anticipate reviewing for this client? Select all that apply. A) Prothrombin time B) Serum albumin C) Ammonia level D) Liver enzymes E) T3 and T4 levels

B D E

The son of a client with fibromyalgia asks the nurse if he will also experience the health problem. Which responses by the nurse are appropriate for this situation? Select all that apply. A) If your diet is high in fatty foods, you have a greater chance of developing fibromyalgia. B) Having a family member with fibromyalgia increases the risk for developing it. C) If you exercise often enough you'll be fine. D) Only people aged 20-50 develop fibromyalgia. E) Fibromyalgia is more prominent in women.

B E

A client is recovering from surgery to repair a fractured hip. Which actions by the nurse may reduce this client's risk for osteomyelitis in the postoperative period? Select all that apply. A) Assess for pain every 1-2 hours. B) Use sterile technique for dressing changes. C) Assess wound for size, color, and drainage. D) Administer antibiotics as prescribed. E) Administer anticoagulants as prescribed.

B, C, D

The nurse is caring for a client who is experiencing limited mobility related to a musculoskeletal alteration. Which laboratory tests would be useful to diagnose the client appropriately? Select all that apply. A) Magnetic resonance imaging (MRI) B) Alkaline phosphatase (ALP) C) Human leukocyte antigen-B27 (HLA-B27) D) Rheumatoid factor (RF) E) Electromyography (EMG)

B, C, D

The nurse is providing care to a client who admits to smoking two packs of cigarettes per day for 34 years. The client also has a history of intermittent claudication, chronic bronchitis, and emphysema. After 6 weeks of smoking cessation, the client reports that he is frequently "yelling" at his spouse and "flying off the handle." Which effects of cigarette smoking are associated with the data the nurse has collected from the client? Select all that apply. A) Nicotine causes destruction of the alveoli. B) Smoking triggers the release of epinephrine, which causes vasoconstriction. C) Dopaminergic processes are implicated in nicotine withdrawal. D) The tar in cigarettes can cause the mucus production seen in chronic bronchitis. E) Tobacco use leads to atherosclerosis.

B, C, D, E

A client is admitted to the emergency department after overdosing on phencyclidine (PCP). Based on this information, which nursing actions are appropriate? Select all that apply. A) Obtain materials to assist with lavage. B) Initiate an IV. C) Initiate seizure precautions. D) Induce vomiting. E) Administer ammonium chloride.

B, C, E

A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B, C, E

A nurse educator is teaching a group of students about the comprehensive theory of addiction proposed by George Engel. Which of the following student statements indicate proper understanding of this theory? Select all that apply. A) "Addiction occurs because of a lack of emotional attachment." B) "There is a biological factor involved in the development of addiction." C) "There are social factors that contribute to the development of addiction." D) "There is a moral factor involved in the development of addiction." E) "There are psychologic elements involved in the development of addiction."

B, C, E

The nurse is conducting a crisis assessment for a client who admits to cocaine use. Which questions are appropriate for the nurse to ask the client during this process? Select all that apply. A) "Do you have access to any recreational centers?" B) "What is the most significant problem affecting your life right now?" C) "How long has this been a problem?" D) "What are the living conditions in your neighborhood?" E) "What other stresses are you dealing with?"

B, C, E

The nurse is providing education to a client who wants to quit smoking. Which statements are appropriate for the nurse to include in the teaching session? Select all that apply. A) "There is no adverse risk if you choose to smoke while wearing a nicotine patch." B) "Bupropion (Zyban) is used to suppress the craving for tobacco." C) "A piece of nicotine gum should be chewed for 5 minutes of every waking hour, then held in the cheek." D) "Most people quit smoking several times before they are successful." E) "Alternative therapies can help reduce the stress that accompanies smoking cessation."

B, D, E

A client is undergoing surgery for a fractured hip. The surgeon has stated that careful attention will be paid to preserving the epiphyseal plate. Which client will require this precaution during surgery? A) A postmenopausal woman with paraplegia B) A 32-year-old man who is a competitive body builder C) A prepubescent girl who is a vegetarian D) An 85-year-old woman with osteoporosis

C

Blood pressure is influenced by all except which factor? A) Pumping action of the heart B) Peripheral vascular resistance C) Heart rate D) Blood volume

C

A client who is at risk for developing osteoporosis asks what can be done to decrease the risk of actually developing the disease. Which intervention would be the most beneficial for this client? A) Decreasing the amount of calcium in the client's diet B) Providing the client with assisted range of motion exercising twice daily C) Increasing regular weight-bearing activities D) Protecting the client's bones with strict bedrest

C

A client with a previously healed tuberculosis lesion experiences lesion rupture that leads to active disease. Which type of tuberculosis does this client have? A) Miliary tuberculosis B) Extrapulmonary tuberculosis C) Reactivation tuberculosis D) Cavitation tuberculosis

C

Microorganism Categories

Bacteria Viruses Fungi Parasites

Chronic Disease

Balance between organism and host, neither predominating

Hemoptysis

Blood-tinged sputum

Alendronate Bisphosphonates

Bone resorption inhibitors Uses: -Treats & prevents osteoporosis -Treats paget's disease -Treats hypercalcemia Side Effects: -GI upset Education: -Take with full glass of water on empty stomach -Stay upright for 30 minutes (can cause esophagitis) -Separate iron, antacids, multiple vitamins at least 30 minutes apart from taking bisphosphonates -Encourage increased intake of calcium & vitamin D -Encourage weight-bearing exercises to preserve bone mass Nursing Considerations: -Monitor serum calcium levels before, during, & after therapy

A 15-year-old female client diagnosed with juvenile primary fibromyalgia syndrome asks the nurse whether the fibromyalgia can be cured so that she won't have to deal with it as an adult. Which of the following is the best response the nurse could make to this question? A) The fibromyalgia likely can be cured with proper sleep hygiene, exercise, and pharmacologic management. B) Fibromyalgia can be difficult to treat effectively, but the symptoms are unlikely to persist into adulthood. C) It is likely that the fibromyalgia will persist into adulthood, and there is no cure, but the symptoms can be treated and the condition is not life-threatening. D) The client will suffer from persistent fibromyalgia for the remainder of her life unless a cure can be found.

C

A 50-year-old male with a diagnosis of leukemia is responding poorly to treatment. He is tearful and trying to express his feelings, but he is having difficulty. The nurse should first: A) tell him that she will leave for now but she will be back B) offer to call pastoral care C) ask if he would like her to sit with him while he collects his thoughts D) tell him that she can understand how he is feeling

C

A client with osteoarthritis tells the nurse she has difficulty walking to the bathroom first thing in the morning. Which nursing action would assist this client? A) Suggesting a family member provide the client with a bedpan B) Discussing the option of residing in an assisted-living facility C) Consulting with physical therapy for an assistive walking device such as a walker or cane D) Suggesting the client use a bedside commode at home

C

A client with rheumatoid arthritis (RA) is being seen in the outpatient clinic for a progress checkup. Which of the following statements on the part of the client suggests that she has met a goal of treatment? A) "I sleep for 10 hours at night." B) "I have increased pain in my joints all the time now." C) "I have delegated many household chores to my children and spouse." D) "I do not perform household chores at all anymore."

C

A community health nurse is providing teaching to the faculty of a local high school about preventing, recognizing, and treating substance use and addiction in teenagers. Which of the following statements on the part of the faculty members suggests that further teaching is necessary? A) "The earlier a teenager begins using substances, the more likely it is that the teenager will develop an addiction problem." B) "Teenagers whose parents suffer from addiction are at greater risk of addiction themselves." C) "The brain stops developing during the teenage years, so any substance-related brain changes that occur during this period will likely affect a person for the rest of his or her life." D) "Group therapy can be beneficial for teenagers with addiction, but it comes with a risk of unintended adverse effects."

C

A hip fracture that occurs in the trochanter region would be classified as a(n) A) intracapsular fracture. B) intercapsular fracture. C) extracapsular fracture. D) subcapsular fracture.

C

A man brings his wife to the clinic and states, "I want you to fix my wife and tell her that there is nothing wrong with her." The client has symptoms of pain, sleep disorders, and stiffness. Which would be most appropriate for the nurse to include in a plan of care for this family? A) Medications used to treat fibromyalgia B) An exercise program to increase energy C) Information and literature on fibromyalgia D) Suggested dietary changes to help with the pain

C

A nurse is caring for a client who had a stroke and is at risk of falling. Which of the following actions should the nurse take? A. Assign the client to a private room B. Keep 4 side rails up while the client is in bed C. Monitor the client at least once every hour D. Request PRN prescriptions for restraints

C

A nurse is caring for a client who smokes cigarettes and wants information about nicotine replacement therapy (NRT). Which statement is appropriate for the nurse to include in the teaching session? A) "Over-the-counter NRT products include transdermal patches, gums, nicotine inhalers, and nasal sprays." B) "NRT helps relieve the psychologic and physiologic effects of nicotine withdrawal." C) "NRT does not address addictive behavior." D) "Using NRT in conjunction with a smoking cessation program is no more effective than using NRT alone."

C

A nurse is caring for a client with HIV who just learned she is several weeks pregnant. The client states that she is concerned about how her HIV diagnosis might affect the health of her child. Which of the following statements should the nurse include in her teaching for this client? A) "One way to reduce the risk of transmitting the virus to your child is to opt for vaginal birth rather than cesarean delivery." B) "Although infants can acquire HIV from their mothers at birth, the virus cannot cross the placenta during pregnancy." C) "Most HIV medications are safe during pregnancy, and taking them can reduce the risk of transmitting the virus to the fetus." D) "Women with HIV are no more likely than uninfected women to experience miscarriage or fetal loss."

C

A nurse is caring for a client with who is experiencing leukocytosis. When providing care to this client, which action by the nurse is most appropriate? A) Instructing the client on the use of an electric razor and soft toothbrush B) Evaluating the client for bleeding and bruising C) Assessing the client for the source of infection D) Placing the client in reverse isolation

C

A nurse is caring for a newborn who is being treated in the newborn intensive care unit (NICU) due to complications from exposure to illicit drugs in utero. The newborn has microcephaly and multiple cerebral infarcts and is inconsolable with a high-pitched cry. Which illicit drug is likely to blame for the newborn's symptoms? A) Marijuana B) PCP C) Cocaine D) LSD

C

A nurse is developing a plan of care for a client who was recently diagnosed with human immunodeficiency virus (HIV). The client states, "I don't plan on giving up sex just because I am HIV positive." Based on this data, which nursing diagnosis is the priority for this client? A) Risk for Infection B) Death Anxiety C) Deficient Knowledge D) Social Isolation

C

A nurse is educating a client with anemia about the pathophysiological mechanisms of anemia. Which should be excluded in the nurse's teaching plan for this client? A) Altered hemoglobin synthesis B) Altered DNA synthesis C) Decreased hemolysis D) Bone marrow failure

C

A nurse is planning care for a client with sickle cell disease and chooses "Acute Pain" as the nursing diagnosis. Which intervention is inappropriate for the nurse to include in this plan of care? A) Administer prescribed analgesic medications around the clock. B) Place client in position of comfort. C) Use heat or cold packs as tolerated. D) Support the client's joints and extremities with pillows.

C

A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure B. Take a calcium supplement once each day if at risk for osteoporosis C. Walking is the preferred mode of exercise to maintain strong bones D. Caffeine intake minimizes the risk of developing osteoporosis

C

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following client statements indicates that the teaching was effective? A. I should take the medication with a glass of orange juice B. I will allow the medication to dissolve in my mouth C. I will sit upright for 30 minutes after taking the medication D. I should take the medication right after eating breakfast

C

A nurse is teaching a client who is experiencing age-related vaginal atrophy and has a prescription for estradiol cream. Which of the following statements should the nurse include in the teaching? A. This medication should be used daily B. This medication should be applied externally C. This medication has fewer systemic effects than oral estrogen D. This medication can increase your risk of bone loss

C

A nurse is teaching the parents of a client who was recently diagnosed with osteoarthritis (OA) about their child's condition. Which statement by the parents indicates the need for further instruction? A) "Our daughter's OA is likely related to a joint injury she sustained last year." B) "Most kids with OA usually have only one or two affected joints." C) "Because our daughter developed OA as a child, she is more likely to become disabled as a result of this condition." D) "Our daughter may outgrow her OA as she ages."

C

A nurse works at a clinic that provides care to a community with a high population of smokers. The nurse is planning an educational session entitled "Tips for Quitting." Which action by the nurse is appropriate for inclusion in this session? A) Telling participants that smoking is an unacceptable behavior B) Making sure participants are aware of the increased risk of liver disease and esophageal cancer associated with smoking C) Reviewing available pharmacologic adjuncts to cessation with participants D) Recommending that participants seek hypnosis at a local dinner theater to aid in their attempts at smoking cessation

C

A postmenopausal adult client is concerned about the development of osteoporosis and wants to begin preventative activities. Which statement by the nurse is appropriate? A) "You should first determine if you are at risk for the development of osteoporosis." B) "After menopause, the decline is too rapid to begin preventative interventions." C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." D) "Hormone replacement therapy should be initiated as soon as possible."

C

A pregnant client experiences abruptio placentae. The father of the baby asks the nurse why this has happened. Which risk factor in the client's history is the most likely cause for this condition? A) Maternal use of marijuana during pregnancy B) Genetic history C) Maternal use of methadone during pregnancy D) Low maternal folic acid levels

C

A pregnant client tells the nurse that she and her husband are going to a 50th wedding anniversary party for her grandparents this weekend. The client asks the nurse if it will be okay for her to have a few glasses of wine at the party. Which response by the nurse is appropriate? A) "Drinking a few glasses of wine will not be a problem." B) "Consuming alcohol during pregnancy can cause the baby to be born without limbs." C) "Drinking any alcoholic beverages of any type during pregnancy puts your baby at risk for injury." D) "Wine is acceptable but not hard liquor."

C

A type of infection that is associated with the delivery of healthcare services in a facility such as a hospital or nursing home is called a(n) A) etiologic infection. B) latent infection. C) healthcare-associated infection. D) hospital-associated infection.

C

A young school-age boy is admitted with newly diagnosed acute lymphocytic leukemia. The multidisciplinary team is meeting to plan care for this child and family. Which statement by the parents should receive priority in the nursing planning process? A) "His brother is upset about the amount of time we are away from home." B) "Can we plan a trip out of town sometime this summer?" C) "We are afraid that he will dislodge his central line at school." D) "How are we going to pay for his treatment?"

C

After assessing a new client who admits to opioid addiction, a nursing student expresses the belief that drug addiction is not a real illness because "people who use drugs do it to themselves." Which response by the staff nurse is appropriate? A) "Sometimes a client doesn't show much effort to change his or her behavior." B) "We are legally obligated to provide care, regardless of the cause of a client's illness." C) "It is important to remain nonjudgmental when caring for any client, even a drug addict." D) "You are right. I don't know why we bother."

C

An adolescent client with scoliosis has a Cobb angle of 32 degrees. Given this information, what treatment will the nurse likely need to prepare the client for? A) This client will not need specific treatment. B) The nurse will prepare the client for physical therapy. C) The nurse will prepare the client for wearing a brace. D) The nurse will prepare the client for undergoing spinal fusion surgery.

C

An adolescent client with terminal cancer tells the nurse that she does not want any more treatment, even though her parents are planning for her to participate in a study trial that involves aggressive chemotherapy. Which action by the nurse is the most appropriate? A) Tell the client that the decision is her parents' and she has to participate in the study. B) Tell her that, at 16, she can make her own decisions no matter what her parents want. C) Request that the parents and daughter meet together with the healthcare team to discuss options and the implications of various choices. D) Tell her not to worry because her parents want the best for her.

C

An employee health nurse is providing care to a worker who was injured on the job. The client has a history of drug addiction and is currently enrolled in a 12-step recovery program. In order to determine whether the employee was impaired at the time of the accident, which diagnostic tool should the nurse use? A) Liver enzymes B) Stool guaiac C) Urine toxicology testing D) Hair testing

C

An older client is diagnosed with disorders of fat metabolism, reduced absorption of fat-soluble vitamins, and a slightly elevated blood glucose level. When developing interventions for this client, the nurse considers that normal age-related changes in which endocrine organ are likely to contribute to reduced absorption of fat-soluble vitamins? A) Pituitary B) Thyroid C) Pancreas D) Adrenal medulla

C

An older school-age child is brought to the emergency department after a car accident. The parents witness and stare at the resuscitation scene unfolding before them. The child is not responding to the resuscitative efforts after 30 minutes. Which is the best communication strategy for the nurse to use in this situation? A) Ask the parents whether they would like resuscitative efforts to be continued at this point. B) Ask the parents to stand at the foot of the cart to watch. C) Inform the parents that resuscitative efforts have not been effective and are not beneficial to the child. D) Ask the parents to leave until the child has stabilized.

C

Clients who have high scores on the OOWS and SOWS A) are at elevated risk for substance abuse and addiction. B) are at low risk for substance abuse and addiction. C) experience particularly intense symptoms of substance withdrawal. D) experience relatively mild symptoms of substance withdrawal.

C

Development of leukopenia suggests that an individual A) is immunocompetent. B) is experiencing an infection somewhere in the body. C) may have suppressed bone marrow activity. D) has an abnormally high number of circulating leukocytes.

C

During a home visit, the family of a client with fibromyalgia asks the nurse what they can do to help the client with painful episodes. What should the nurse suggest to the client and family? A) Protect the client from injury. B) Plan a family reunion or vacation. C) Divide household chores among each member of the family. D) Keep the client in bed.

C

For clients with a deficiency in any hormone, what client teaching is important for the nurse to provide? A) Teaching related to increasing fluid intake B) Teaching related to decreasing body weight C) Teaching related to taking hormone supplements as directed D) Teaching related to regulating sugar intake

C

Parents of a newborn infant are concerned that their baby may have sickle cell disease. The nurse reviews the medical record and finds that both parents have the sickle cell trait. Which is the best response for the nurse to give the parents? A) "Since neither of you actually has sickle cell disease, your baby is not at risk." B) "Your baby has the disease, as you both carry the trait." C) "We are required to test all babies for sickle cell disease." D) "Have you talked to a genetic counselor about your concerns?"

C

The cells that produce the matrix for bone formation are known as A) osteoclasts. B) sarcomeres. C) osteoblasts. D) epiphyseal plates.

C

The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? A) Coordinate personnel to assist with ambulation B) Document the client's refusal C) Assess why the client is refusing to ambulate D) Notify the healthcare provider

C

The nurse is assisting the healthcare provider with a bone marrow aspiration and biopsy on a client who has leukemia. The client also has thrombocytopenia. Upon completing the test, which intervention is a priority for the nurse? A) Dispose of the equipment used, and clean the area properly. B) Label and refrigerate the specimen obtained by the physician. C) Hold pressure on the wound for approximately 5 minutes. D) Make certain the client understands the purpose of the test.

C

The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. The client wants to know why her doctor told her she had an extra heart sound at the last visit. Which response by the nurse is appropriate? A) "You will need to have an echocardiogram to determine the reason for the extra sound." B) "You are likely experiencing heart failure due to the extra fluid that accumulates during this time in pregnancy." C) "You have what is known as a ventricular gallop, and it can be a normal finding during this trimester of pregnancy." D) "You have what is known as atrial gallop, and this is cause for concern."

C

The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."

C

The nurse is caring for a client admitted to the hospital with lower extremity edema and shortness of breath. Which electrocardiogram finding indicates the client is at risk for an alteration in perfusion? A) P wave smooth and round B) Absent U wave C) PR interval 0.30 seconds D) ST segment isoelectric

C

The nurse is caring for a client who has come to an urgent care clinic due to an arm infection. The client reports being bitten by a raccoon on a recent camping trip. Based on this data, which treatment option does the nurse anticipate for this client? A) Injection of rabies immunoglobulin only B) Administration of rabies vaccine only C) Both injection of rabies immunoglobulin and administration of rabies vaccine D) Neither injection of rabies immunoglobulin nor administration of rabies vaccine

C

The nurse is caring for a dying child. Which nursing action supports the primary goal for a dying child? A) Keep the child entertained so she does not think about dying. B) Ensure that a good relationship is maintained with the family. C) Administer pain medication as ordered. D) Maintain a busy schedule for child and family members.

C

The nurse is caring for a toddler who is undergoing treatment for sickle cell crisis. The parents ask the nurse, "Our child has been potty trained for 2 years, but suddenly he's wetting the bed again. What do we do?" How should the nurse respond? A) "He is likely rebelling because he doesn't like the treatments. You may need to discipline him." B) "Bedwetting is often a sign of urinary tract infection. I will have the provider check for that." C) "Toddlers often regress in behaviors when they are sick. Just be patient with him." D) "Nocturnal enuresis is a side effect of his medications. Once he's done with his treatment, he will stop wetting the bed."

C

The nurse is caring for a woman who is at 14 weeks' gestation with her first child. The woman asks the nurse, "Am I at risk for osteoporosis since my baby takes calcium from my body?" What response by the nurse is correct? A) "You may lose small amounts of bone mass with each pregnancy, but if you only have one child, the bone loss should not be significant enough to cause osteoporosis." B) "When bone mass is lost during pregnancy, it is very difficult to restore, and you may be at increased risk for osteoporosis later in life. You should take a calcium supplement to prevent this." C) "If you eat a diet that is rich in calcium, any bone mass that is lost during pregnancy and breastfeeding will be restored within several months of weaning the child." D) "The baby won't require enough calcium during development to affect your bone mass or cause osteoporosis."

C

The nurse is conducting a gait and posture assessment for a client who is experiencing mobility issues. Which action by the nurse is appropriate during this assessment? A) Assessing the client's muscle mass and strength B) Measuring the length and circumference of the client's extremities C) Inspecting the client's spine for curvature D) Palpating the client for tenderness and pain

C

The nurse is evaluating a client's understanding of dietary needs to treat dietary deficiency anemia. Which client statement indicates a need for additional teaching? A) "I will eat more fruits and vegetables, especially green leafy ones, to get more iron in my diet." B) "I will need to include more protein foods in my diet such as meats, dried beans, and whole-grain breads." C) "I will decrease foods high in vitamin C, as they decrease my absorption of iron." D) "I will take vitamins with extra iron in addition to eating a balanced diet with meat to correct my anemia."

C

The nurse is evaluating care provided to a client recovering from hip replacement surgery. Which piece of documentation in the medical record indicates that the client has achieved the expected outcome for pain management? A) The client states pain is a 6 on a numeric pain scale of 0 to 10 prior to evening care. B) The client is crying and requesting pain medication prior to morning care. C) The client is using a PCA pump around the clock and rates pain as a 2 on a numeric pain scale of 0 to 10. D) The client refuses pain medication prior to physical therapy. Pain is rated as a 7 on a numeric pain scale of 0 to 10.

C

The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.

C

The nurse is planning care for a client who is 1 day postoperative after spinal fusion surgery. Which of the following is an appropriate outcome for this client? A) The client will remain in prone position. B) The client will maintain urine output at 20 mL per hour. C) The client will use the incentive spirometer every 2 hours. D) The client will void 12 hours after surgery.

C

The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques

C

The nurse is planning care for the client with chronic pain from herniated intervertebral discs who is also experiencing constipation. Which intervention should the nurse carry out to address constipation? A) Restrict foods high in fiber. B) Avoid the use of stool softeners. C) Encourage fluid intake of 2500-3000 mL each day. D) Medicate for pain around the clock.

C

The nurse is preparing to assess an older adult client admitted with tuberculosis. Which assessment finding does the nurse anticipate? A) Night sweats B) Swollen lymph nodes C) Cough D) Hemoptysis

C

The nurse is providing care for a client who is experiencing subjective symptoms of carpal tunnel syndrome. Which test should the nurse anticipate being performed by a provider during the physical assessment of this client? A) Bulge test B) Ballottement test C) Phalen test D) McMurray test

C

The nurse is providing care to a client with a history of chronic obstructive pulmonary disease (COPD) who wants help and information regarding nicotine addiction and ways to quit smoking. After the nurse has provided education regarding smoking cessation, which client statement would indicate appropriate understanding of the information presented? A) "I will keep a pack of cigarettes in my closet in case I need it." B) "I will taper off smoking gradually." C) "I will chew sugar-free gum when I want a cigarette." D) "I will eat a snack when I am feeling nervous."

C

The nurse is providing care to a client with alcohol and opioid dependency. The client's mother states, "I don't understand why my daughter has been prescribed naltrexone, because it causes a high, too, right?" Which response by the nurse is appropriate? A) "Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs." B) "Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer." C) "Naltrexone helps diminish your daughter's cravings for alcohol and opioids." D) "Naltrexone will prevent your daughter from getting drunk when she drinks."

C

The nurse is providing teaching to a young adult who is at risk for early-onset osteoporosis. Which intervention should the nurse suggest? A) The client should stop all physical activity. B) The client should reduce the intake of dairy in the diet. C) The client should increase intake of calcium and vitamin D. D) The client should start estrogen replacement therapy.

C

The nurse is providing teaching to the client recently diagnosed with osteoarthritis. Which statement by the nurse is correct? A) "Osteoarthritis is most commonly seen in thin, small-built female clients." B) "Osteoarthritis is a result of joint inflammation." C) "Osteoarthritis occurs due to erosion of cartilage in the joints." D) "Osteoarthritis is a metabolic bone disease."

C

The nurse is reviewing objective data obtained during the assessment of a pregnant woman in her 34th week of gestation. Which finding would be cause for concern? A) Pulse 103 bpm B) Blood pressure 108/70 C) Hematocrit 24% D) WBC count 10,340/mm3

C

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.

C

Three weeks after receiving a donor liver, a client begins to experience fever, tachycardia, right upper quadrant pain, and increased accumulation of fluid in the abdomen. The transplanted liver also becomes dangerously enlarged. In this scenario, the client is likely experiencing which of the following conditions? A) Hyperacute rejection B) Chronic rejection C) Acute rejection D) Delayed rejection

C

Which client is most likely to reject attempts at comfort? A) An infant crying B) A school-age child with abdominal pain who is anxious about a procedure C) An adolescent with a sleep disorder who doesn't want his parents to be near him D) An older adult with end-stage renal disease

C

Which nursing intervention related to perfusion can be performed independently? A) Administration of drug regimens B) Insertion of device to measure central venous pressure (CVP) C) Teaching relaxation techniques D) Thoracentesis

C

Which of the following best characterizes the sociocultural context of holistic human experience? A) Balance of physical processes B) Connection to a higher power C) Connection to others D) Equilibrium with external circumstances

C

Which of the following characteristics would increase a client's risk of unpleasant side effects from nicotine replacement therapy (NRT)? A) Male gender B) Heavy smoking prior to beginning NRT C) Low body weight D) History of failed attempts at smoking cessation

C

Which of the following is a pharmacologic therapy for acute pain? A) Antidepressants B) Muscle relaxants C) Opioid analgesics D) Stimulants

C

Which of the following is not a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling

C

Which of the following nursing interventions would be most appropriate when caring for clients who are experiencing acute alcohol withdrawal? A) Avoiding administration of benzodiazepines B) Reassuring clients who are experiencing delusions that you share their beliefs C) Reducing environmental stimuli to the greatest extent possible D) Arguing with clients who are experiencing visual hallucinations in an attempt to prove that what they are seeing is not real

C

Which of the following procedures would be most appropriate to repair a finger joint that is affected by severe osteoarthritis (OA)? A) Osteotomy B) Joint resurfacing C) Joint fusion D) Internal fixation

C

Which of the following statements best explains why young children develop infections more often than older children and adolescents? A) Cell-mediated immunity doesn't achieve full function until a child is roughly 5 years old. B) The thymus doesn't begin to function until adolescence, so prior to this time, children don't produce enough T cells to adequately protect them from infectious agents. C) Children don't develop all of the immunoglobulins they need to protect against infection until they are about 6 or 7 years of age. D) Young children have comparatively small lymphoid tissues, which means they are less able to fight infection than are older children.

C

Which of the following statements is true with regard to vaping? A) Vaping is a safe alternative to cigarette smoking. B) E-cigarettes are less popular among teenagers than cigarettes and other traditional tobacco products. C) Vaping has been linked to a devastating respiratory disease known as "popcorn lung." D) Throughout the United States, vaping is subject to the same regulations as cigarette smoking.

C

Which region of the spine is the most common location of herniated discs? A) Cervical region B) Thoracic region C) Lumbar region D) Sacral region

C

Which type of anemia results from deficiency of all the blood's formed elements, caused by failure of the bone marrow to generate enough new cells? A) Sickle cell anemia B) Folic acid deficiency anemia C) Aplastic anemia D) Iron deficience anemia

C

Which type of precaution should the nurse implement when providing direct care in the intensive care unit (ICU) to a client diagnosed with acquired immunodeficiency syndrome (AIDS)? A) Droplet B) Reverse C) Standard D) Contact

C

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.

C

Why does breastfeeding confer some degree of passive immunity to an infant? A) The infant receives maternal antibodies via breastmilk, and these antibodies stimulate the infant's immune system to begin producing antibodies of its own. B) Consumption of breastmilk introduces certain antigens into the infant's body, thereby stimulating the infant's immune system to begin producing antibodies to these antigens. C) The infant receives maternal antibodies via breastmilk, and these antibodies provide the infant with immediate protection against specific antigens. D) Consumption of breastmilk introduces certain antigens into the infant's body, thereby stimulating the infant's immune system to begin producing antigens of its own.

C

Which statements are correct regarding the various layers of the heart? Select all that apply. A) The endocardium covers the entire heart and great vessels. B) The endocardium is the muscular layer of the heart that contracts during each heartbeat. C) The outermost layer of the heart is the epicardium. D) The myocardium consists of myofibril cells. E) The myocardium has four layers.

C D

The nurse is preparing to perform a health assessment on an adult client who has a family history of cancer. Which questions should the nurse ask the client to assess for the early warning signs of cancer? Select all that apply. A) "Do you have a cough that is associated with seasonal allergies?" B) "Have you noticed a change in your appetite?" C) "Have you noticed any cuts that have not healed?" D) "Have you had any changes in bowel or bladder habits?" E) "Have you experienced any problems swallowing?"

C D E

A nurse is caring for a client with tuberculosis (TB) who is taking rifampin for treatment of the disease. Which nursing interventions are appropriate for this client? Select all that apply. A) Administer the medication with meals to reduce gastrointestinal side effects. B) Record a baseline visual examination before initiating therapy. C) Administer the medication on an empty stomach. D) Administer the medication by deep intramuscular injection into a large muscle mass. E) Monitor complete blood count (CBC), liver function studies, and renal function studies for evidence of toxicity.

C E

A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and cigarettes? Select all that apply. A) "Smoking decreases nerve supply to the bones." B) "Nicotine increases calcium absorption, leading to decreased bone density." C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content." D) "Alcohol has a direct toxic effect on osteoclast activity, suppressing bone formation." E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."

C E

The nurse is planning care for a female adult client who is high-risk for developing osteoporosis. Which interventions will decrease the client's risk of developing this health problem? Select all that apply. A) Increasing the intake of alcoholic beverages B) Isometric exercise for at least 30 minutes three times per week C) Weight-bearing exercises such as walking D) Having a yearly dual-energy x-ray absorptiometry (DEXA) test E) A diet with adequate amounts of calcium and vitamin D

C E

The nurse suspects that a client with severe shortness of breath in the absence of cyanosis is experiencing anemia. Which laboratory tests should the nurse review to confirm anemia? Select all that apply. A) Serum electrolytes B) Cardiac enzymes C) Hemoglobin D) Blood sugar E) Hematocrit

C E

A nurse who works in the emergency department is caring for a client who has overdosed on cocaine. The nurse receives an order from the healthcare provider to administer a prescription antipsychotic. Which symptoms of cocaine overdose would this medication help manage? Select all that apply. A) Alkaline urine B) Decreased deep tendon reflexes C) Hyperpyrexia D) Respiratory distress E) Central nervous system (CNS) depression

C, D

The nurse is providing care to a client during a prenatal visit. The nurse suspects that the client has used cocaine. Which clinical manifestations support the nurse's suspicion? Select all that apply. A) Increased appetite B) Pinpoint pupils C) Muscle jerks D) Hypertension E) Bradycardia

C, D

The nurse is documenting the interdisciplinary team report on an adolescent client who has a 35-degree Cobb angle confirmed by x-ray. What interventions should the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Obtaining a physical therapy consult prior to surgical intervention B) Maintaining the existing curvature with no increase C) Bracing for 12-23 hours per day and providing a support group referral D) Administering nonopioid analgesics and a TLSO or Milwaukee brace E) Instructing the client on exercises and appropriate support groups

C, D, E

Which of the clients described below are at increased risk for back problems? Select all that apply. A) A 45-year-old man who has played golf three times a week for the past 20 years B) An 18-year-old woman who has been a distance runner since middle school C) A 62-year-old man who is a heavy truck mechanic and has a body mass index (BMI) of 30 D) A 12-year-old boy who has a history of cerebral palsy and a current BMI of 21 E) A 78-year-old man with a 40 pack-year smoking history who was recently widowed

C, D, E

The nurse is evaluating a list of outcome goals for a client with alcoholism who is being discharged from a detoxification program. The list was written by a nursing student who is being mentored by the nurse. Which of the following outcomes are appropriate for this client? Select all that apply. A) Follow a 2000-calorie high-carbohydrate diet. B) Sponsor a participant in Alcoholics Anonymous (AA) meetings. C) Obtain at least 6-8 hours of sleep per night. D) Acknowledge the blame that family members must take for codependent behavior. E) Enroll in the Employee Assistance Program (EAP) through the client's employer.

C, E

A NICU nurse is caring for several newborns with anemia. Which infant with anemia would the nurse be least concerned about? A) A baby born at 32 weeks' gestation after the mother suffered from abruptio placentae B) A baby born at 38 weeks' gestation who has a blood group incompatibility with the mother C) A baby born at 35 weeks' gestation who suffered birth trauma to the head D) A baby born at 39 weeks' gestation via a scheduled cesarean section

D

Prevention 2/3

CDC recommends screenings for Medically underserved, low-income populations Individuals with alcoholism Residents and staff of long-term care facilities False-negative responses are common in people who are immunosuppressed. A two-step procedure may be necessary to elicit a positive response. If the first test elicits a negative response, a second PPD test is given 1 week later. If the second test also is negative, the patient either is free of infection or is anergic (unable to react to common antigens). This two-step procedure is recommended for long-term care residents and employees.

STANDARD ISOLATION PRECAUTIONS

CMV HIV Hepatitis B & C Aspergillosis

Healthcare-Associated Infections (HAIs)

Can develop during patient's stay in the facility Manifest after discharge Respiratory complication have become common type of HAI Top 3 Types: Urinary Tract infection - MOST COMMON HAI Surgical Site Infection Pneumonia

AIRBORNE ISOLATION PRECAUTIONS

Chicken Pox Disseminated Herpes Zoster Measles N-95 MASK: Tuberculosis SARS Avian Influenza COVID-19

Tuberculosis (TB) Overview

Chronic, recurrent infectious disease Caused by Mycobacterium tuberculosis Continuing public health threat in United States Drug-resistant strains Susceptibility of people with HIV/AIDS Influxes of refugee populations Inadequate access to healthcare for high-risk populations

Infection Types

Colonization: Microorganisms grow, multiply, but do not cause disease (ex: MRSA in nares) Infection: Microorganisms invade part of body with ineffective defenses Types: Local vs. Systemic - Wound vs. Sepsis Acute vs. Chronic - Paper cut infected vs. TB

Teach Patient How to Limit Transmission

Cough and expectorate into tissues, dispose of tissues properly Wear mask if sneezing or unable to control secretions No special precautions for eating utensils, clothing, books, other objects How to collect sputum samples Importance of complying with prescribed treatment for entire course of therapy

A client diagnosed with a stroke is going to receive treatment with fibrinolytic therapy using the recombinant tissue plasminogen activator alteplase (rt-PA). Which information should the nurse include when performing medication teaching for the client's family? A) Used to treat thrombotic and hemorrhagic strokes B) Not associated with serious complications C) Indicated if the stroke symptoms have occurred within the last 6 hours D) Administered to break up existing clots and increase cerebral blood flow

D

A client experiencing fatigue, pallor, and dyspnea on exertion has a complete blood count drawn. Which red blood cell disorder should the nurse anticipate the client is experiencing? A) Polycythemia B) Erythropoiesis C) Herpes simplex D) Anemia

D

A client has been admitted to a healthcare facility for treatment for substance addiction. Shortly after entering the facility, the client received a prescription for phenytoin. Based on this data, which of the following statements is most likely true? A) The client is addicted to opioids. B) The client is experiencing cravings for nicotine. C) The client has high levels of anxiety. D) The client is experiencing withdrawal-related seizure activity.

D

A client in sickle cell crisis reports taking a recent skiing trip that caused a respiratory infection from the cold weather. The client reports a pain level of 8 on a pain scale from 1 to 10. Which nursing diagnosis is a priority for this client? A) Fluid Volume Excess B) Risk for Self-Mutilation C) Knowledge Deficit D) Acute Pain

D

A client is admitted to the emergency department with signs of drug use. The client reports ingesting Percocet and is currently experiencing respiratory depression. Based on this information, which prescription should the nurse anticipate for this client? A) Diazepam B) Haldol C) Vitamin B12 D) Naloxone

D

A client presents with an alteration in mobility. Which finding would suggest damage to the muscle? A) Increased PTH levels B) Decreased PTH levels C) Decreased CK levels D) Increased CK levels

D

A client with chronic hip pain is diagnosed with osteoarthritis. Which instruction regarding home safety is most appropriate for the nurse to provide to this client? A) Walk up and down the steps at home as much as possible. B) Rest in a recliner. C) Place scatter rugs in high-traffic areas. D) Install grab bars in the bathroom near the commode and in the shower.

D

A nurse is caring for a client following a stroke. Which of the following actions should the nurse take first? A. Obtain coagulation lab studies from the client B. Apply pneumatic compression boots to the client C. Request a referral for a speech-language pathologist D. Keep client NPO

D

A nurse is caring for a client who has a left intracranial hemorrhage from a stroke. Which of the following findings should the nurse expect? A. Spasticity of the left foot B. Negative Babinski reflex C. Ocular hypertension D. Right-sided hemiplegia

D

A nurse is caring for a client who is recovering from a recent stroke. Which of the following assessments is the nurse's priority? A. The client's ability to communicate verbally B. The client's ability to move all extremities C. The client's ability to remain continent of urine D. The client's ability to clear oral secretions

D

A nurse is caring for a pregnant client who has rheumatoid arthritis (RA). Based on this data, what should the nurse anticipate when providing care to this client? A) A higher risk for preterm delivery B) An increased need for medication C) An acute exacerbation of symptoms D) A continued risk for anemia

D

A nurse is planning an in-service on preventing infection for the staff nurses on a hospital's medical-surgical unit. Which of the following should be the priority teaching point for this in-service? A) Raising the temperature in each client's room B) Assessing vital signs once daily C) Wearing a mask for client care D) Performing hand hygiene

D

A nurse is planning care for a client who had a stroke. Which of the following goals should the nurse identify as the priority for this client? A. The client's skin will remain intact during hospitalization B. The client will verbalize one new word each week C. The client will begin to help turn himself in bed, indicating improved mobility D. The client's airway will remain clear, as evidenced by clear breath sounds

D

A nurse is providing preconception counseling and education to an adult client with no prior pregnancies. Which client statement indicates that the nurse's teaching has been effective? A) "I can continue to drink alcohol throughout my pregnancy." B) "One beer once per week will not harm the fetus." C) "I don't need to stop drinking alcohol until my pregnancy is confirmed." D) "I can't drink alcohol while breastfeeding, because it will pass into my breast milk."

D

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen D. History of anorexia nervosa

D

A nurse is reviewing the progress notes for a client who has heart failure. The provider noted some improvement in the client's cardiac output. The nurse should understand that cardiac output reflects which of the following physiologic parameters? A. The % of blood the ventricles pump during each beat B. The amount of blood the left ventricle pumps during each beat C. The amount of blood in the left ventricle at the end of diastole D. The heart rate times the stroke volume

D

A nurse is teaching a client about the effects of smoking during pregnancy. Upon conclusion of the teaching session, which of the following client statements would suggest that further education is necessary? A) "When a pregnant woman smokes, the concentration of nicotine in the fetus can be even higher than that in the woman's own body." B) "Smoking during pregnancy is associated with an increased risk of placental problems." C) "Prenatal nicotine exposure is linked to attention deficits and learning difficulties during childhood." D) "Although women who smoke during pregnancy are at higher risk for respiratory disease later in life, their children are not."

D

A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weigh-bearing exercises

D

A nurse who works in an outpatient primary care clinic is caring for a client with asthma who has an 80 pack-year smoking history. When assessing the client's current use of nicotine, which question is most appropriate? A) "Have you tried a nicotine patch for quitting smoking?" B) "Do you smoke cigarettes with filters or without?" C) "Do you smoke immediately after waking up?" D) "What prior attempts have you made to quit using nicotine?"

D

A pregnant client tested positive for group B streptococcus during her 36-week checkup. For which intervention should the nurse prepare the client in order to prevent transmission of infection to the neonate? A) Not breastfeeding the neonate during the first week after birth B) Administration of antibiotics to the neonate after birth C) Delivery by cesarean section D) Administration of antibiotics to the client during labor

D

A public health nurse is presenting a teaching session about alcohol use to a group of college seniors. During the session, one of the students admits to frequent alcohol use. What is the nurse's priority action? A) Initiate a community assessment of the campus B) Contact the campus nurse and refer the student for services C) Notify campus security that the student may be driving while intoxicated D) Complete a crisis assessment with the student

D

A young adult client is at 28 weeks' gestation. The client's prenatal history reveals past drug abuse, and her urine screening indicates that she has recently used heroin. Which potential health problem should the nurse recognize as the greatest risk to the fetus? A) Congenital anomalies B) Abruptio placentae C) Diabetes mellitus D) Intrauterine growth restriction (IUGR)

D

An alteration in parathyroid hormone levels is likely to directly affect what other nursing concept related to metabolism? A) Acid-base balance B) Reproduction C) Perfusion D) Mobility

D

An occupational health nurse is screening a new employee in a long-term care facility for tuberculosis (TB). The employee questions why purified protein derivative (PPD) testing is done twice. Which is the most appropriate response by the nurse? A) "Different medication is used in the second PPD." B) "The treatment for TB is 6 months of medication, and we want to make sure the first results of the first PPD were accurate." C) "The first PPD was not interpreted in the correct time frame of 48-72 hours." D) "There is an increased risk for a false-negative response for people who work in long-term care facilities. The two-step process is recommended to accurately screen for TB."

D

An older adult client experiences a hip fracture. Prior to the injury, the client had an active lifestyle. Based on this information, which surgical procedure should the nurse anticipate? A) Total hip replacement B) Open reduction and external fixation C) Arthroplasty D) Open reduction and internal fixation

D

An older adult client with terminal lung cancer is not breathing well and has cold and mottled skin. The client has a living will and requests comfort measures only. What should the nurse do to help this client? A) Ask the family what they want to be done for the client. B) Withhold all care until the client dies. C) Contact the provider for orders to control the client's breathing. D) Provide the client with pain medication as ordered.

D

As compared to men, women are A) less likely to begin regularly using alcohol at an early age. B) likely to wait a greater number of years before entering treatment for alcohol abuse. C) less susceptible to alcohol-related organ damage. D) likely to experience greater cognitive impairment from alcohol consumption.

D

Clients with osteoarthritis (OA) can reduce their risk of further joint damage by doing which of the following? A) Applying topical analgesic creams as prescribed B) Avoiding movement of affected joints C) Taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) before joint pain becomes severe D) Receiving cortisone injections in affected joints no more than three times per year

D

During a home care visit, an older adult client begins to cry softly when asked about coping with back pain. The client states, "My back hurts bad all the time. I am so confused about all these tests and scared that the doctor wants me to have surgery." In this scenario, which of the following nursing interventions is the highest priority? A) Asking the client to rate the pain on a scale of 0 to 10 B) Explaining potential procedures in a way the client will understand C) Administering all pain medication as ordered D) Attentively listening to the client's thoughts and fears

D

Fibromyalgia is a disorder that involves which of the following? A) Muscle strength B) Respiratory control C) Heat regulation D) Pain Processing

D

For non-elderly adult clients who fracture a hip, why is internal fixation or casting of the fracture generally preferred over hip replacement? A) Internal fixation or casting is preferred because it does not disturb the client's epiphyseal plate. B) Internal fixation or casting is preferred because of the lower risk of deep vein thrombosis. C) Internal fixation or casting is preferred because of the shorter recovery time. D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses.

D

The infecting organism that causes tuberculosis is A) Micrococcus tuberculosis. B) Microbacterium tuberculosis. C) Mycoplasma tuberculosis. D) Mycobacterium tuberculosis.

D

The nurse has provided teaching on multidrug treatment to a client with tuberculosis. Which statement by the client indicates that the teaching was effective? A) "Multiple drugs are necessary to develop immunity to tuberculosis." B) "Multiple drugs are necessary because I became infected from an immigrant." C) "Multiple drugs will be required as long as I am contagious." D) "Multiple drugs are necessary because of the risk of resistance."

D

The nurse identifies the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements as appropriate for a client with osteoporosis. Which client statement indicated to the nurse that this nursing diagnosis was appropriate? A) "I like to remove all of the fat from the meat I eat." B) "I am trying to eat a low-carb diet." C) "I plan to start eating out less." D) "I am allergic to dairy products."

D

The nurse identifies the nursing diagnosis of Chronic Pain as being appropriate for a client with fibromyalgia. Which manifestation did the client most likely report that caused the nurse to select this diagnosis? A) Pain from eyestrain B) Pain from a severe skin rash C) Acute chest pain D) Tender points in the knees

D

The nurse in an inner city clinic is providing a health screening for a homeless client with a history of drug abuse. The client has a chronic nonproductive cough. For which should the nurse expect to screen this client? A) Herpes zoster B) Sickle cell disease C) Sick sinus syndrome D) Tuberculosis

D

The nurse is caring for a client who has suffered a massive cerebral hemorrhage and is not expected to survive. The client's mother indicates the client is Catholic. Which intervention is most appropriate? A) If the nurse is not Catholic, then finding a Catholic nurse to continue care for the client is necessary. B) The nurse should contact a priest and ask him what must be done for the client. C) The nurse should assume the client's desires based on the nurse's existing understanding of the Catholic faith. D) The nurse should ask the client or the client's family what they want in terms of religious rituals.

D

The nurse is caring for a client who is being discharged following abdominal surgery with an incision. Which instruction is most important for the nurse to teach this client regarding wound healing? A) "Thoroughly irrigate the wound with hydrogen peroxide once a day." B) "Apply a lubricating lotion to the edges of the wound twice a day." C) "Add more fruits and vegetables to your diet." D) "Notify the healthcare provider if you notice swelling, warmth, or tenderness at the wound site."

D

The nurse is caring for a client who was admitted to a medical-surgical unit in sickle cell crisis. Which medication should the nurse expect to administer to this client? A) Acetaminophen (Tylenol) B) Ibuprofen (Advil) C) Meperidine (Demerol) D) Hydroxyurea

D

The nurse is caring for a pregnant woman with a cellular regulation disorder. The nurse understands that the woman is at higher risk for certain serious complications of pregnancy, so the nurse is planning a client teaching session related to signs and symptoms of these complications. Which condition should the nurse include in her teaching? A) Gestational diabetes B) Placenta previa C) Urinary tract infection D) Preeclampsia

D

The nurse is caring for an older adult client with hemolytic anemia. When planning care for this client, which should the nurse take into consideration regarding this diagnosis? A) It causes the red blood cells to be microcytic. B) It is associated with a decrease in the reticulocyte count. C) It is the result of blood loss. D) It is a result of the premature destruction of red blood cells.

D

The nurse is instructing a client with iron deficiency anemia about appropriate menu choices. Which diet choice indicates that teaching has been effective? A) Tofu with mixed vegetables in curry, milk, whole-wheat bun B) Broiled fish, lettuce salad, grapefruit half, carrot sticks C) Pork chop, mashed potatoes and gravy, cauliflower, tea D) Roast beef, steamed spinach, tomato soup, orange juice

D

The nurse is instructing the spouse of a client with a stroke on how to do passive range-of-motion exercises to the affected limbs. Which rationale for this intervention will the nurse include in the teaching session? A) Improve muscle strength B) Maintain cardiopulmonary function C) Improve endurance D) Maintain joint flexibility

D

The nurse is planning care for a client with esophageal cancer caused by years of nicotine abuse. Which of the following would be the priority nursing diagnosis for this client? A) Decisional Conflict B) Social Isolation C) Disturbed Body Image D) Ineffective Airway Clearance

D

The nurse is preparing to assess comfort for several clients. If the nurse, in addition to assessing the client's physical experience of pain, assesses whether the client has a present and reliable personal support network, then the nurse is assessing which context of holistic human experience during this process? A) Transcendence B) Environmental C) Psychospiritual D) Sociocultural

D

The nurse is providing care for a client who admits to alcohol addiction. The client states she is able to hide the addiction from family and friends. Based on this information, which independent nursing intervention is appropriate for this client? A) Assertiveness training B) Milieu therapy C) Family therapy D) Communication training

D

The nurse is providing care to a client diagnosed with alcoholism. The client's physical examination reveals a BMI of 18. Which prescription does the nurse anticipate to manage the client's nutritional status? A) Sertraline B) Methadone C) Naloxone D) Multivitamin with folic acid

D

The nurse is providing community health teaching on stroke in children and adolescents. Which risk factors for this population should the nurse identify? A) Hypertension B) Dysrhythmias C) Arteriosclerosis D) Head trauma

D

The nurse is teaching a child care class for mothers of young children. What should the nurse teach as being the most common mode of transmission of infectious disease? A) Children who are playing board games B) Children who are sitting together eating meals C) Children who are playing with the same toy D) Children who don't wash their hands after using the bathroom

D

What is the largest lymphoid organ in the human body? A) Thymus gland B) Bone marrow C) Tonsils D) Spleen

D

What type of stroke occurs when the blood supply to a part of the brain is cut off by a thrombus, embolus, or stenosis? A) Intracerebral stroke B) Subarachnoid stroke C) Hemorrhagic stroke D) Ischemic stroke

D

Which change in bone structure contributes to osteoporosis? A) The diaphysis of the bone becomes longer. B) Trabeculae are increased in cancellous bone. C) The outer cortex of the bone becomes thicker. D) The diameter of the bone increases.

D

Which client should the nurse anticipate will have the greatest psychosocial needs? A) A client under standard precautions B) A client taking antibiotics C) A client under droplet precautions D) A client in isolation

D

Which disorder results from a deficiency of circulating platelets? A) Hemophilia B) Sickle cell anemia C) Von Willebrand's disease D) Thrombocytopenia

D

Which of the following cells would be classified as granulocytes? A) Helper T cells B) Macrophages C) Natural killer (NK) cells D) Eosinophils

D

Which of the following is not an effect of chronic long-term marijuana use? A) Airway constriction and inflammation B) Decreased spermatogenesis in males C) Chronic bronchitis D) Increased prolactin levels in females

D

Which of the following procedures used in the treatment of osteoarthritis (OA) involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the bone? A) Osteotomy B) Arthroplasty C) Arthroscopy D) Joint resurfacing

D

Encapsulated

Enclosed

Sterilizing

Destroys all microorganisms Four types of sterilization: Moist Heat Gas Boiling Water Radiation

Communicable Disease

Directly: body fluids Indirectly: contact with contaminated objects, airborne particles, or vectors

Preventing Healthcare-Associated Infections

Effective hand hygiene: single most important measure in infection control Invasive procedures and equipment should be used only when absolutely necessary Medical and surgical asepsis is necessary Use critical thinking, agency policy in implementing infection control procedures

HAIs Sources

Endogenous: from within patient Exogenous: from outside patient Main Contributors: Invasive Procedures: iatrogenic Warm Altered Immune Defenses HANDS ARE COMMON VEHICLE FOR SPREAD

Disposal of soiled equipment/supplies

Essential to prevent inadvertent exposure Bagging Linens Laboratory specimens Dishes Blood pressure equipment Disposable needles, syringes, sharps Disposable, non-disposable equipment, supplies

Disinfecting

Etiologic agent & reservoir interrupted: Disinfectant: Used on inanimate objects Antiseptic: Used on skin, tissue Bactericidal Agent: Destroys bacteria Bacteriostatic Agent: Prevents growth Must consider: Type, # of infectious organisms Recommended concentration & duration Presence of soap Presence of organic materials Surface areas to be treated

Exotoxins

Ex: Cholera Pertusis Diphtheria Toxins

Poor hygiene behaviors facilitate transmission

Fecal-oral, respiratory routes most common modes of transmission in children

Initial Infection Manifestations

Few symptoms May be found via positive tuberculin test or lesion seen on chest x-ray (CXR)

Cavitation

Formation of a cavity or bubble

Folic Acid

Function: -Coenzyme during metabolism - required for synthesis of amino acids, DNA, RNA -Forms heme portion of hemoglobin -Proper formation of fetal neural tubules Sources: -Leafy greens -Lejumes -Cereals -Foods that contain vitamin c Deficiency: -Vit V protects folate from oxidation -Spina bifida, anencephaly -Megaloblastic anemia -Glossitis, diarrhea, irritability, absentmindedness Toxicity: -High levels may mask the presence of pernicious anemia

Observation & Patient Interview

General appearance, skin color Difficulty breathing Presence, nature of cough Fatigue, weight loss, night sweats Blood in sputum, chest pain Known exposure to TB Most recent TB test, results Living circumstances Use of alcohol, recreational drugs

Personal Protective Equipment (PPE)

Gloves: Protect hands Reduce transmission of microorganisms Change between patient contacts Clean hands with glove removal Latex allergy issues Gowns: Sterile when patient has extensive wounds Single-use gown technique Face Masks: Reduce risk of droplet/airborne transmission Worn by those with close patient contact Respirators: Preventing inhalation of tuberculin organisms N-95 = 95% efficiency Eyewear: Goggles/Glasses/Face Shields When body substances may splatter face

Prevention

Good hand hygiene Getting immunization Preventing airborne droplets from spreading Taking precautions when handling potentially contaminated materials

REMEMBER

Good hand hygiene very important Wear gloves Soap & Water to clean hands CDC recommends alcohol-based antiseptic hand rubs before/after each patient contact

Calcitonin (Salmon) - Miacalcin

Hormone Hypocalcemic agent Inhibits osteoclasts & decreases rate of bone breakdown Uses: -Treats & prevents postmenopausal osteoporosis -Treats hypercalcemia Side Effects: -GI upset Education: -Encourage increased intake of calcium & vitamin D -Encourage weight-bearing exercises to preserve bone mass

Health Promotion

Hygiene Nutrition Fluid Immunizations Sleep Stress Reduction

Prevention 3/3

If screening tests indicate TB Patients with latent infection should take precautions to prevent transmission Prophylactic pharmacologic therapy Infection prevention techniques For clinicians, infection control Promptly identifying patients with active TB Using airborne precautions Effectively treating suspected/confirmed TB

Risk Factors

In US: Immigrants HIV/AIDS Racial, Ethnic minorities Poor urban areas hardest hit Overcrowded institutions Hospitals Homeless shelters Drug treatment centers Prisons Residential facilities Prolonged contact with infectious individual

Levothyroxine - Synthroid

Increases metabolic rate of tissues Synthetic hormone Uses: -Hypothyroidism -Thyroid-stimulating hormone suppression -Thyroid diagnostic testing -Hormone supplement after thyroidectomy Side Effects: -Anxiety -GI upset -Sweating -Weight loss -Heat intolerance -Hyperthyroidism Therapeutic Response: -No longer showing signs of hypothyroidism Patient Education: -Safe during pregnancy -May take 8 weeks to see full effects -Report signs of hyperthyroidism -Monitor T3, T4 levels -Take once a day in the AM before breakfast -Take at same time everyday -Take on empty stomach with full glass of water -Don't stop if symptoms resolve LIFE LONG THERAPY

Epidemiology

Increasing since 1990s HIV/AIDS Multidrug-Resistant (MDR) strains Social Factors

Stages of Infectious Process

Incubation Period: replication, no symptoms Prodromal Stage: early symptoms, generalized Illness Stage: cell destruction, inflammation Convalescent Stage: either healing or becomes chronic

Lifespan Considerations

Infants, Children, Adolescents: Good hand hygiene in child care centers and schools to prevent infection spread Older Adults: Normal aging may increase risk of infection, delay healing Recognizing changes important for early detection, treatment Special considerations for older adults: Poor nutrition Diabetes mellitus Immune system reacts slowly Normal inflammatory response delayed Physiologic changes of aging: Cardiovascular Respiratory Genitourinary Gastrointestinal Skin, subcutaneous tissue Immune Factors -> Increased risk for infection: Decreased activity level Poor nutrition, increased risk dehydration Chronic diseases Chronic medication use Lack of recent immunizations Altered mental status, dementias Hospitalization, resident in LTC Presence of invasive devices

Lifespan Considerations w/Active Disease

Infants:: Persistent cough Weight loss or failure to gain weight Low-grade fever Children: Fatigue Cough Diminished appetite Weight loss or growth delay Night sweats Chills Low-grade fever Enlarged lymph nodes Treatment: Several meds for 6 - 9 months If stopped before completion: Can become sick again, bacteria can become resistant, making TB harder to treat Older Adults: Presenting symptoms often vague Coughing Weight loss Diminished appetite Periodic fevers

Caseation Necrosis

Infected tissue dies, forming a cheese-like center within the tubercle

Chain of Infection

Infectious Agent Reservoir Portal of Exit from Reservoir Method of Transmission (direct/indirect/airborne) Portal of Entry (inhaled/open sore/mouth, etc) Susceptible Host

Isolation Practices

Initiation of isolation nursing responsibility Based on comprehensive assessment Aseptic Precautions: Strict aseptic technique Change IV tubing, solution containers Prevent urinary tract infections (UTIs) Measures to prevent impaired skin integrity

E. coli

Is a type of bacteria that normally lives inside our intestines, where it helps the body break down and digest the food we eat. The most common UTIs occur mainly in women and affect the bladder and urethra and are usually caused by Escherichia coli (E. coli)

Endotoxins

Less specific effects than exotoxins

Compare Communicability/Infectivity

MERS < Influenza < Ebola < COVID-19 < SARS < COVID-19 Delta < Chickenpox < Measles

CONTACT ISOLATION PRECAUTIONS

MRSA, Salmonella VRE, Shingelia Adenovirus, Hepatitis A Diarrhea, Herpes Zoster C.Diff, Herpes Simplex Rotavirus, Parainfluenza E. Coli 0157, RSV Enterovirus, Lice Scabies, Chicken Pox

Infectious Disease

Major cause of disease, death

ISOLATION PRECAUTIONS

Measures to prevent spread of infection: Category-specific Disease-specific Universal precautions Body substance isolation

Aseptic Technique

Medical Asepsis: CLEAN TECHNIQUE Surgical Asepsis: STERILE TECHNIQUE

Bacteria

Most commonly cause infection

TB of Bones, Joints

Most likely to occur during childhood Often becomes evident many years later Large, weight-bearing joints most affected

Asymptomatic or Subclinical Infection

No clinical evidence of disease

Eosinophil

Normal Value: 1 - 3% Elevated Levels May Indicate: Allergic Reactions Autoimmune Diseases Parasitic Worms

Lymphocyte

Normal Value: 25 - 33% Elevated Levels May Indicate: Mononucleosis Whooping Cough Viral Infections

Monocyte

Normal Value: 3 - 9% Elevated Levels May Indicate: Malaria Tuberculosis Fungal Infections

Neutrophil

Normal Value: 54 - 62% Elevated Levels May Indicate: Bacterial Infections Stress

Basophil

Normal Value: < 1% Elevated Levels May Indicate: Cancers Chicken Pox Hypothyroidism

Viruses

Nucleic acid, must enter living cells to reproduce

Reduce Risk for Infection

Patient in private room with airflow control Negative airflow room recommended Standard precautions, TB isolation Discuss reasons for, importance of isolation Place mask on patient when transporting Inform all personnel having contact with patient Help visitors to mask before entering room

DROPLET ISOLATION PRECAUTIONS

Pertussis, Bacterial Meningitis Influenza A & B, RSV MRSA, Mumps Neissera Meningitides, Rubella Coxsackie

Diagnostic Tests

Positive tuberculin test By itself, does not indicate active disease Sputum smear for acid-fast bacilli Sputum culture Definitive diagnosis Sensitivity testing Polymerase chain reaction CXR Baseline studies prior to drug therapy Additional tests before initiation of drug therapy to establish baseline data for monitoring potential adverse effects Liver function tests Before isoniazid, which is hepatotoxic Thorough visual exam Before ethambutol: may cause optic neuritis

Independent Interventions

Prevent transmission of infection Hand hygiene Basic medical asepsis Standard precautions, isolation techniques, sterile field PPE, decontamination Promote psychosocial needs of patients in isolation Sensory deprivation Decreased self-esteem

Reactivation Tuberculosis (TB)

Previously healed lesion reactivated when immune system suppressed Without treatment, chronic tubercle formation (cavitation) Spread through blood, lymph system to other organs -> extrapulmonary TB Active lesion or become dormant

Medical therapies may predispose patient

Radiation Treatments Diagnostic Procedures Medications Disease that lower body's defenses

Drug-Resistant Strains of M. Tuberculosis

Resistant to: Isoniazid Rifampin

Miliary Tuberculosis

Results from hematogenous spread of the bacilli throughout the body

Bacilli

Rod-shaped bacteria

Sleep Apnea

Sleep-disordered breathing, occurs when an individual experiences breathing pauses during sleep

CDC Hospital Infection-Control Practices Advisory Committee (HICPAC) Isolation Precautions

Standard Precautions Transmission-Based Precautions: Used in addition to standard precautions Airborne precautions Droplet precautions Contact precautions

Sterile Technique

Sterile Object: Free of all microorganisms Sterile Technique: Practiced in operating rooms, special diagnostic areas Principles and practice of surgical asepsis Not all sterile techniques always required Sterile Field: Microorganism-free area Established by using sterile drape or innermost side of a sterile wrapper Sterile Gloves: Wear latex/nitrile gloves when tasks Demand flexibility Place stress on the material Involve high-risk of exposure to pathogens Sterile Gowns: Where surgical asepsis is necessary

Dormant

Temporarily inactive but not dead

Extrapulmonary Tuberculosis

The spread of disease through the blood & lymph system to other organs

Prevention 1/3

Tuberculin test used to screen for infection: Intradermal purified protein derivative (PPD) test (Mantoux) Interferon-gamma release Centers for Disease Control and Prevention (CDC) recommends screenings for: People with or at high risk of HIV infection Close contacts of people who have or are suspected of having infectious TB People with medical risk factors People born in countries with high prevalence of TB

Anergic

Unable to react to common antigens

Antibody

a blood protein produced in response to and counteracting a specific antigen

Purified Protein Derivative (PPD)

Used in tuberculin testing to screen for tuberculosis infection; causes a cellular or delayed hypersensitivity response

Beta Blockers - Metoprolol

Uses: -HTN -Stable angina -Chronic/compensated heart failure -Dysrhythmias Action: -Blocks norepinephrine & epinephrine (flight/fight) -Decreases resistance, workload, cardiac output Side Effects: -Bradycardia & heart blocks -Breathing problems -Bad for heart failure patients (acute) -Blood sugar masking -Blood pressure lowered - hypotension Nursing Considerations: -Monitor for hypotension -Educate on changing positions slowly -Don't give to asthma/COPD patients -Educate to not suddenly stop the medication -Monitor for S/S of heart failure

Atorvastatin - Lipitor - HMG-COA REDUCTASE INHIBITORS "STATINS"

Uses: -Lowers Cholesterol (prevents in at risk patients & stabilizes fatty plaques in patients with current CAD) Side Effects: -Headache -Nausea -Dizziness -Constipation/Cramping -Abdominal pain -Hyperglycemia -Rhabdomyolysis (rare condition where the muscles are damaged; myoglobin leaks into the blood which can cause kidney damage; S/S include muscle pain, tenderness, weakness, malaise/fever, increased creatine kinase levels, dark urine color) Nursing Considerations: -Monitor liver enzymes (ALT/AST) -Monitor therapeutic response -Avoid grapefruit consumption -Pregnancy category X & don't take while breastfeeding -Monitor for signs of Rhabdomyolysis

Physical Examination

Vital signs Ear assessment Oral cavity assessment Eye assessment Lymph node assessment Respiratory assessment Skin assessment Urinary assessment

Physical Exam

Vital signs Respiratory rate Lung sounds Weight Signs of malnutrition Screening questions

Diagnostic Tests

WBC WBC w/Differential Procalcitonin (CTpr) Cultures of wound, blood or other body fluids Serologic tessting Direct antigen detection methods Antibiotic peak & trough levels Radiologic exam of chest, abdomen, urinary system Lumbar puncture Ultrasonic examination Echocardiogram Renal ultrasonography Urinalysis Stool culture

Efforts to control spread of microorganisms, protect against infections

WHO CDC NCDHHS Local Health Departments

Sickle Cell Anemia

a chronic hemolytic anemia; most common type of SCD

Juvenile idiopathic arthritis (JIA)

a chronic inflammatory autoimmune juvenile disorder characterized by joint inflammation resulting in decreased mobility, swelling, and pain

Tuberculosis

a chronic, recurrent, infectious disease caused by Mycobacterium tuberculosis

Sepsis

Whole-body inflammatory process

Fungi

Yeasts, molds

Candidiasis

a common, opportunistic fungal infection in patients with AIDS

Leukopenia

a decrease in the number of circulating leukocytes that occurs when bone marrow activity is suppressed or when leukocyte destruction increases

Fibromyalgia

a disease that is often associated with other rheumatoid conditions and is characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and psychologic distress and difficulty concentrating

Sleep loss

a duration of sleep shorter than the recommended 7-8 hours per night for adults

Carrier

a human or animal reservoir of a specific infectious agent that usually does not manifest any clinical signs of disease

Virulence

a measure of the severity of disease caused by a microorganism

Pathogen

a microorganism that causes disease

Opportunistic pathogen

a microorganism that causes disease only in susceptible individuals

Sterile field

a microorganism-free area

Chronic fatigue

a more intense fatigue that lasts longer than acute fatigue and may be exacerbated by physical and mental activity

Pneumothorax

a partial lung collapse caused by air or gas collecting in the lung or pleural space that surrounds the lungs

Sterilization

a process that destroys all microorganisms, including spores and viruses

Mycobacterium tuberculosis

a relatively slow-growing, slender, rod-shaped, acid-fast organism with a waxy outer capsule that increases its resistance to destruction

human immunodeficiency virus (HIV)

a retrovirus that is transmitted by direct contact with infected blood and body fluids

Negative airflow room

a room where airflow is controlled to prevent the air from circulating into the hallway or other rooms.

Tubercle

a sealed-off colony of bacilli

Graft-versus-host disease

a series of immunologic reactions in response to transplanted cells

Body substance isolation (BSI)

a system that employs generic infection control precautions for all patients, except those with the few diseases transmitted through the air

Pauciarticular arthritis

a type of JIA that primarily affects the knees, ankles, and elbows

Cell-mediated (cellular) immune response

acts at the cellular level by attacking antigens directly

Pathogenicity

ability to produce disease

Eosinophils

account for 1-4% of the total number of circulating leukocytes

Disinfectants

agents that destroy pathogens other than spores

Antiseptics

agents that inhibit the growth of some microorganisms

Pannus

an abnormal tissue layer that includes newly formed blood vessels, may develop within the synovial membrane, leading to greater loss of bone and cartilage

Vaccine

an antigen is given in a weakened or dead form, which stimulates antibody production without causing clinical disease

Communicable disease

an illness that is directly transmitted from one individual or animal to another by contact with body fluids or indirectly transmitted by contact with contaminated objects, airborne particles, or vectors

Acquired immunodeficiency syndrome (AIDS)

an immune system deficit that is induced by infection with HIV -term used to describe immune system deficits associated with specific opportunistic disorders

Compromised host

an individual at increased risk, who, for one or more reasons, is more likely than others to acquire an infection

Do-Not-intubate (DNI) order

an order that prohibits endotracheal intubation in the event of severe respiratory failure or respiratory arrest; the individual is not in cardiopulmonary arrest.

Pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Infectious disease

any communicable disease that is caused by microorganisms that are commonly transmitted from one individual or animal to another or from an animal to an individual

Acute infections

appear suddenly and last a short time

Septicemia

bacteremia resulting in a systemic infection

Bacteremia

bacteria in an individual's blood revealed by a blood culture

Sickle Cell trait

being a carrier of one abnormal hemoglobin (HbS) gene

Hemoptysis

blood-tinged sputum

Chronic myeloid leukemia (CML)

characterized by abnormal proliferation of all bone marrow elements

Hemolytic anemia

characterized by premature destruction (lysis) of RBCs.

Acute myeloid leukemia (AML)

characterized by uncontrolled proliferation of myeloblasts (the precursors of granulocytes) and hyperplasia of the bone marrow and spleen

Healthcare-associated infection (HAI)—(or HCAI)

classified as infection that is associated with the delivery of healthcare services in a facility such as a hospital or nursing home

Antiretroviral therapy (ART)

combines the administration of at least three medications that inhibit HIV replication

B lymphocytes (B cells)

complete their maturation in the bone marrow and, like T cells, are integral to the specific immune response

Viruses

consist primarily of nucleic acid and must enter living cells to reproduce

Antibody-mediated (humoral) immune response

consists of the proteins IgM, IgG, IgA, IgD, and IgE

Lymphocytes

derive from the stem cells in the bone marrow

Durable power of attorney

designates an individual to make medical, legal, and financial decisions for the patient in the event the patient is unable to do so

Bactericidal agent

destroys bacteria

Chronic infection

develops slowly, over a very long period, and often persists for months and sometimes years

Iron deficiency anemia

develops when the body's supply of iron is inadequate for optimal RBC formation. chronic iron deficiency may lead to brittle, spoon shaped nails, cheilosis (cracks at the corners of the mouth) a smooth, sore tongue and pica.

Hospice Care

•provides comfort and dignity for patients' last days by offering care provided by a team-oriented group of trained professionals with a specialized knowledge of pain management

Encapsulated

enclosed

Phagocytosis

engulfing and then digesting the antigen

Range of motion (ROM) exercises

exercises designed to take each joint through all possible movements to maintain flexibility and movement in the joint

Pernicious anemia

failure to absorb dietary vitamin B12

Primary immune response

first exposure to an antigen causes the B lymphocyte system to begin to produce antibodies that react specifically to that antigen

Immunoglobulins

five classes of antibodies

Antigens

foreign substances that trigger the immune response

Cavitation

formation of a cavity or bubble

Endotoxins

found in the cell wall of gram-negative bacteria and are released only when the cell is disrupted

Exogenous

from the hospital environment and hospital personnel

Dysplasia

•represents a loss of DNA control over differentiation in response to adverse conditions

End of Life

•the final weeks of life just before death

Sickle cell disease (SCD)

hereditary disorder characterized by replacement of normal hemoglobin with HbS in RBCs

Exotoxins

highly poisonous soluble proteins that the microorganisms secrete into surrounding tissue

Bacilli

rod-shaped bacteria

Mitosis

•the process of making new cells

Immunocompetent

immune systems that identify antigens and effectively destroy or remove them

Medical Asepsis

includes all practices intended to confine a specific microorganism to a specific area, thus limiting the number, growth, and transmission of microorganisms

Leukocytosis

increase in production of additional leukocytes leads to a count of greater than 10,000/mm3

Caseation necrosis

infected tissue dies, forming a cheese-like center within the tubercle

Opportunistic infections

infections that would normally not affect people with intact immune systems

Immunization

introduces an antigen into the body, allowing immunity against a disease to develop naturally

Specific defenses

involve the immune system when an antigen induces a state of sensitivity and antibodies respond to contain or destroy the antigen

Arthrodesis

joint fusion

Fatigue

lack of energy and motivation

Natural Killer Cells (NK cells, null cells)

large, granular cells found in the spleen, lymph nodes, bone marrow, and blood

Chronic pain

lasts longer than 6 months and persists beyond the expected period of healing

Chronic fatigue syndrome

lasts more than 6 months and is accompanied by muscle and joint pain, headaches, and sleep and memory problems

Local Infection

limited to the specific part of the body where the microorganisms remain

Parasites

live on other organisms

Bone marrow transplant (BMT)

•the treatment of choice for some types of leukemia

Acute fatigue

manifests as normal tiredness associated with a single event, such as a poor night's sleep, a stressful experience, or an acute infection

T lymphocytes (T cells)

mature in the thymus gland and are integral to the specific immune response

Macrophages

mature monocytes which are differentiated by the tissues in which they reside

neonatal anemia

may be caused by blood loss, hemolysis/erythrocyte destruction, and impaired RBC production. Blood loss (hypovolemia) occurs in utero from placental bleeding (placenta previa or abruptio placentae). Intrapartum blood loss may be feto-maternal, feto-fetal, or the result of umbilical cord bleeding. Birth trauma to abdominal organs (adrenal hemorrhage) or the cranium (sublegal bleed) may produce significant blood loss, and cerebral bleeding may occur because of hypoxia.

Clean

means that almost all microorganisms are absent

Isolation

measures designed to prevent the spread of infection or potentially infectious microorganisms to health personnel, patients, and visitors

Bloodborne pathogens

microorganisms carried in blood and body fluids that are capable of infecting other individuals with serious and difficult-to-treat viral infections

Antibodies

molecules that bind with the antigen and inactivate it

Disease surveillance

monitoring patterns of disease occurrence from the cases of infectious and communicable diseases reported by healthcare workers to state health officials

AIDS dementia complex

most common cause of changes in mental status for patients with HIV infection

Osteoarthritis

most common form of arthritis in older adults; caused by chronic degenerative changes in the cartilage and synovial membranes of the joints

Opportunistic Infections

most common manifestations of AIDS and often occur simultaneously

Pneumocystis jiroveci pneumonia (PCP)

most common opportunistic infection affecting patients with AIDS

End-of-life care

nursing care given to a patient who is near death as well as care provided to the patient's family

Physiologic anemia of the newborn

occurs as a result of the normal gradual drop in hemoglobin for the first 6-12 weeks of life. When the amount of hemoglobin decreases in term infants the bone marrow begins production of RBCs again and the anemia disappears.

Active Immunity

occurs through exposure to disease or through vaccination

Passive Immunity

occurs when individuals receive antibodies from another person rather than by producing them through their own immune system

Anemia

occurs when oxygen delivery is inadequate as a result of a deficient hematocrit (volume percentage of healthy RBCs) or a decreased amount of normal hemoglobin.

Alloimmunization

occurs when the immune system reacts against antigens on donated tissues

Chromosomes

•threadlike strands of DNA in the cell that carry the genes

Endogenous

originate from the patients themselves

Hypersensitivity

overreaction of the immune system to an antigen or antigens

Acute pain

pain that lasts only through the expected recovery period, which is usually 30 days to 6 months

Priapism

painful, prolonged penile erection

Transplacental immunity

passive immunity transferred from mother to infant

Movement techniques

postures such as yoga and tai chi stretch specific muscle groups and have been shown to improve strength and balance and reduce pain

Bacteriostatic agent

prevents the growth and reproduction of some bacteria

Disease

process that occurs when the microorganisms produce a detectable alteration in normal tissue function

Cytokines

proteins secreted by immune cells

Parasites

protozoa, helminths, arthropods

Helper T cells

recognize foreign antigens and infected cells activate antibody producing B cells

Sterile technique

refers to practices that keep an area or object free of all microorganisms

Thalassemia

refers to the inherited disorders of hemoglobin synthesis in which either the alpha or beta chains of the hemoglobin molecule are missing or defective.

Hemoglobinopathy

replacement of normal hemoglobin with abnormal hemoglobin S (HbS) in RBCs

Droplet Nuclei

residue of evaporated droplets emitted by an infected host; can remain in the air for long periods of time

Acquired Immunity

resistance to an antigen resulting from previous exposure to that antigen

Miliary tuberculosis

results from hematogenous spread of the bacilli throughout the body

Occupational exposure

skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties

Dirty

soiled, contaminated, microorganisms are likely to be present

Reservoirs

sources of microorganisms

Hemosiderosis

storage of iron in tissues and organs

Colonization

the process by which strains of microorganisms become resident flora

Anaplasia

the regression of a cell to an immature or undifferentiated cell type

Systemic infection

the result of microorganisms spreading and damaging different parts of the body

Immunosuppression

suppression of the immune response

Extrapulmonary tuberculosis

the spread of disease through the blood and lymph system to other organs

Vaso-occlusive crisis

the term used to describe painful periods resulting from ischemia due to vascular occlusion; also called sickle cell crisis

Sickle cell crisis

the term used to describe painful periods resulting from ischemia due to vascular occlusion; also called vaso-occlusive crisis

Sepsis

the whole body inflammatory process, resulting in acute illness; often used generally to refer to the state of infection

Universal precautions (UP)

techniques to be used with all patients to decrease the risk of transmitting unidentified pathogens

Dormant

temporarily inactive but not dead

Asepsis

the absence of disease-causing microorganisms

Immunity

the body's natural or induced response to infection and its associated conditions

Aplastic anemia

the bone marrow fails to produce all three types of blood cells, leading to pancytopenia a deficiency in both red and white blood cells.

Sickling

the characteristic shape of malformed RBCs associated with SCD

Immunodeficiency

the immune system is incompetent or unable to respond effectively

Autoimmune disorders

the immune system loses the ability to recognize its own tissues and begins to attack them

Infection

the invasion of body tissue by microorganisms with the potential to cause illness or disease

Kaposi sarcoma (KS)

the most common cancer associated with AIDS

Bacteria

the most common infection-causing microorganisms

Acute lymphocytic leukemia (ALL)

the most common type of leukemia in children and adolescents

Hematogenous spread

through the blood

Arthroplasty

total joint replacement

Secondary immune response

triggered by memory cells upon subsequent encounters with the same antigen

Systemic arthritis

type of JIA that affects male and female patients equally with characteristic manifestations of high fever, polyarthritis, and rheumatoid rash

Polyarticular arthritis

type of JIA that involves many joints (five or more), particularly the small joints of the hands and fingers; may also affect the hips, knees, feet, ankles, and neck

Meiosis

type of cell division that takes place in the sex cells of the testes and ovaries and results in formation of the sperm and oocytes

Anergic

unable to react to common antigens

Surgical asepsis

used for all procedures involving sterile areas of the body to prevent introduction of microorganisms

Contact precautions

used for patients who are known to have or suspected of having serious illnesses that are easily transmitted by direct patient contact or by contact with items in the patient's environment

Leukocytes

white blood cells (WBCs), that are the primary cells involved in both nonspecific and specific immune system responses

Epidemics

widespread outbreaks of infectious disease with many infected people

Fungi

yeasts and molds

Allogeneic bone marrow transplant

•uses bone marrow cells from a donor

Autologous bone marrow transplant

•uses the patient's own bone marrow to restore bone marrow function after chemotherapy or radiation; often called bone marrow rescue

Sex chromosomes

•23rd pair, determines gender

Philadelphia chromosome

•a balanced translocation of chromosome 22 to chromosome 9

Metaplasia

•a change in the normal pattern of differentiation such that dividing cells differentiate into cell types not normally found at that location in the body

Remission

•a disease-free period with no signs or symptoms

Leukemia

•a group of chronic malignant disorders of WBCs and WBC precursors

Do-not-resuscitate (DNR) order

•a medical order written by a physician that states the patient's wishes to withhold cardiopulmonary resuscitation (CPR) in the event of respiratory or cardiac arrest. It covers only CPR; it does not pertain to other treatments such as medications or nutrition

Differentiation

•a normal process occurring over many cell cycles that allows cells to specialize in certain tasks

Genome

•all of the DNA in a human cell

Stem cell transplant (SCT)

•an alternative to BMT that results in complete and sustained replacement of the recipient's blood cell lines

Palliative Care

•an approach to patient care that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

Hyperplasia

•an increase in the number or density of normal cells

Death anxiety

•anxiety associated with impending death, may stem from the patient's concerns for self or for others

Advance healthcare directive

•are legal documents that allow individuals to choose their preferred treatment plan while they are mentally able to ensure that their wishes will be carried out even when they are unable to make decisions themselves

Chronic lymphocytic leukemia (CLL)

•characterized by proliferation and accumulation of small, abnormal, mature lymphocytes in the bone marrow, peripheral blood, and body tissues

Cell cycle

•comprises the four phases of cell growth and development

Living Will

•describes the patient's treatment preferences for life-prolonging procedures such as the use of feeding tubes, mechanical ventilation, and resuscitation

Healthcare Proxy

•designates an individual to make healthcare decisions for the patient in the event the patient is unable to do so

Autosomes

•first 22 pairs of chromosomes

Ribonucleic acid (RNA)

•forms ribosomes

Deoxyribonucleic acid (DNA)

•found in the nucleus; contains instructions that determine the individual's inherited characteristics

Somatic cells

•found in tissues of the body

Assisted suicide

•intentionally ending a life in order to relieve pain and suffering; occurs when physician or other healthcare team member provides the lethal dose of medication, but the patient self-administers the medication

euthanasia

•intentionally ending a life in order to relieve pain and suffering; occurs when the physician or other healthcare provider performs the last act, usually in the form of an intentional drug overdose

Homologous chromosomes

•pairs of inherited chromosomes