NURS 172 Exam 4
Epinephrine (EpiPen) A. Can be administered through clothing B. Is expired if liquid is amber in color C. Should be administered in the outer thigh while holding for count of 3 D. Is available in two dosages: Epi Pen (0.3mg) and Epi Pen Junior (0.15 mg) E. All of the above
E. All of the above
Which of these is a symptom of rabies in animals? A. Choking sounds B. Loss of appetite C. Agitation D. Trembling E. All of the above
E. All of the above
Which of these is an early symptom of rabies? A. A short period of depression B. Restlessness C. Itching and numbness around the site of the bite D. Nausea E. All of the above
E. All of the above
In which animal is rabies more likely to be found? A. Dog B. Cat C. Bat D. Raccoon E. C and D
E. C and D
In which state is rabies not found? A. Alaska B. Hawaii C. Florida D. Maine E. None of the above
E. None of the above
The greatest problems associated with animal bites are ________________ and mechanical destruction of skin, muscle, tendons, blood vessels, and bone.
Infections
why would plasmapheresis be beneficial for a patient who has Systemic Lupus Erythmatosus or Rheumatoid Arthritis
It filters blood to remove auto-antibodies and immune complexes and replace them with saline or albumin
What is the normal range for CD4 T-cell counts?
Normal range is 800 to 1200 cells/μL
The most common infectious organisms from dog and cat bites are the _________________ species. Most healthy cats and dogs carry this organism in the mouth.
Pasteurella
5. The registered nurse is performing discharge teaching with the parents of a child who underwent placement of tympanostomy tubes. List what the nurse should include in this discharge teaching:
S/S of infection Diet Activity Medications/Dosage Follow-up appointment What the T-tube looks like and when it should fall out swimming=don't put head under water, don't swim in lake, wear ear plugs keep bath water and shampoo out of ears
what mnemonic is used to diagnose Systemic Lupus Erythematosus (SLE)
SOAP BRAIN MD Serositis - Pleurisy, pericarditis Oral ulcers Arthritis Photosensitivity Blood disorders Renal involvement Antinuclear antibodies Immunologic phenomena Neurologic disorder Malar rash Discoid rash
___________ arthritis, osteomyelitis, and tenosynovitis can occur animal bites.
Septic
what manifestations may indicate the onset of septic shock?(SATA) a. hypertension b. decreased urinary output c. altered mental status d. nausea and vomiting e. cool, clammy skin
b. decreased urinary output c. altered mental status
In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional manifestation(s) of RA might Terry exhibit?(SATA) a. weight gain b. joints tender, painful and warm to touch c. joint stiffness on arising that usually subsides after 30 mins d. fever e. swan neck deformities of fingers f. bilateral symmetrical joint involvement
b. joints tender, painful and warm to touch d. fever e. swan neck deformities of fingers f. bilateral symmetrical joint involvement
Why is it important for the patient to have two EpiPen Auto Injectors available at all times?
because the effect lasts only 15-20 and they might need a second epi shot before they arrive at the emergency department
Rabies is usually transmitted through the saliva via a _________ by the infected animal.
bite/scratch
The child's mother asks the nurse how her son could have gotten such a serious disease. What is the appropriate response by the nurse? (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
by an infected tic bite(spirochete organism = borrefia burgdorfere)
What are the indicators of an Intermediate Chronic Infection of HIV?
*CD4 T-cell count of below 200-500 cells/uL *Increased viral load *Increased infections, earlier symptoms more severe
What are the goals of treating HIV?
*Decrease viral load *Maintain of increase CD4 T-cell count *Delay onset of HIV related symptoms *Prevent of delay opportunistic infections
What are the indicators of an Late Chronic Infection of HIV?
*Diagnosis of AIDS
What opportunistic infections may occur with AIDS?
*Fungal-candidiasis, pneumocystis jiroveci pneumonia. *Viral-cytomegalovirus. *Bacterial-mycobacterium tuberculosis, pneumonia. *Protozoal- toxoplasmosis of brain and intestines)
What are the indicators of an Early Chronic Infection of HIV?
*HIV Infection to development of AIDS - average 11yrs *Symptoms- fatigue, lymphadenopathy, headache, low grade fever *Normal CD4 T-cell count *Increased Infections
What types of cancer may occur with AIDS?
*Invasive cervical *Kaposi's Sarcoma *Lymphoma
What are complications of Rheumatoid Arthritis?
*Musculoskeletal-hand deformities, flexion contractures *Cardiac-pericarditis, myocarditis, valve involvement *Pulmonary-fibrosis, pneumonitis, pleural disease *Cataracts-loss of vision *Rheumatoid nodules
What interprofessional referrals may benefit C.Z.? (Rheumatoid Arthritis Case Study)
*PT *OT *Social work *Dietitian *Rheumatologist
How is Rheumatoid Arthritis diagnosed?
*Positive Serum Rheumatoid Factor *Elevated Erythrocyte Sedimentation Rate(ESR) *Elevated C-Reactive Protein *Positive Antinuclear Antibody
What teaching would you provide on physical activity to a patient with Rheumatoid Arthritis? (Rheumatoid Arthritis Case Study)
*Weight bearing exercises without overdoing it *Walk but not strenuously(2-3 days/week) *rest frequently *Warm shower in the morning to decrease joint stiffness *Swimming *If joints are red or swollen use ice packs(10-15 mins) *low impact exercise(yoga, tai chi)
How would you educate your patient with Rheumatoid Arthritis to manage fatigue? (Rheumatoid Arthritis Case Study)
*avoid flexion *take meds(wait, then start activity) *pace yourself- frequent rest periods *sit rather than stand
You are concerned with C.Z.'s psychological status, identify independent nursing actions you would implement(Rheumatoid Arthritis Case Study)
*evaluate family support *referral to support group *therapy *exercise *assist patient to identify coping mechanisms *referral to social worker
How would you review with your patient with Rheumatoid Arthritis to meet expected outcomes of protecting joints from stress? (Rheumatoid Arthritis Case Study)
*frequent rest periods *when rising from chair, push with palms rather than fingers on armrests *sit rather than stand for long periods of time *use palms to push door handles open *avoid twisting *avoid heavy lifting *distribute weight out over several joints *no pillow under knees to avoid flexion *mattress - firm over soft *slide rather than life objects *avoid grasping for extended periods of time *avoid repetitive movements
Write a nursing outcome addressing the issue of C.Z.'s psychological status.(Rheumatoid Arthritis Case Study)
*pt with verbalize positive coping mechanisms *pt will express positive qualities about themselves *pt will use financial, social and health services
May put cotton ball in outermost part of canal of ear for ____________ min.
-15-20mins
Ask the client to remain in the side-position for __________ min.
-5mins
This prevents medication from running out of the eye and down the duct, preventing systemic absorption. If the client has two types of eye medication, wait ____________ minutes between the types of eye medications.
-5mins
What is Seroconversion and what is the time frame in which it is found?
-Development of HIV specific antibodies -may be 2mos between infection and detection of antibodies(HIV positive)
What qualifies a person as having AIDS?
-Having one or more of the following * CD4 T-cell count is below 200 cells/uL(compromised immune system) *Opportunistic Infections *Cancers *Wasting Syndrome *AIDS Dementia Complex
What are the 2 ways used to screen for HIV?
-Rapid HIV Antibody testing(test for antigens not antibodies. If positive then must follow up with EIA and/or antibody/antigen testing) -Enzyme Immunoassay(EIA) at 3wks, 6wks and 3mos after exposure
4. Most tympanostomy tubes fall out within ______ to ___________ months.
6-12mos
Which of the following instructions by the nurse is most appropriate for a client using contact lenses who is diagnosed with bacterial conjunctivitis? A. Discard all open or used lens care products. B. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C. Put all cosmetics in a plastic bag for 1 week to kill any bacteria before reusing. D. Disinfect all lens care products with the prescribed antibiotic drops for 1 week after infection.
A. Discard all open or used lens care products.
Three friends arrive at the camp infirmary with lesions they said were oozing and painful at first and now are terribly itchy, swollen, red blisters. What should the nurse do initially? A. Put on a pair of unsterile gloves. B. Ask where the campers have been. C. Rub the lesions with alcohol wipes. D. Scrub the area with antibacterial soap.
A. Put on a pair of unsterile gloves.
Which of the following care measures should the nurse include when teaching home-care of a child who has bilateral bacterial conjunctivitis. (Select all that apply-3 correct answers.) A. Use of warm, most disposable compresses to remove crusting. B. Use of oral antihistamine medication to relieve eye itching. C. Use of topical anesthetics applied to relieve discomfort. D. Teach the parents to administer the antibiotic eye medication. E. Teach the child to wash hands frequently throughout the day.
A. Use of warm, most disposable compresses to remove crusting. D. Teach the parents to administer the antibiotic eye medication. E. Teach the child to wash hands frequently throughout the day.
A __________ number of persons treated with antibiotics may have lingering fatigue or joint and muscle pain. Antibiotic treatment is then extended. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
small
What are some drug interactions that can occur with antiretroviral medications?
Herbal therapies • St. John's wort Commonly used drugs OTC drugs • Antacids, proton pump inhibitors, supplements
What diagnostic testing would you expect the health care provider to order for T.S.(a patient who potentially has Rheumatoid Arthritis)?
Lab tests (see Table 64-8 in the textbook) ➢ CBC ➢ ESR: active inflammation ➢ CRP: active inflammation ➢ RF (positive in 80% of adults) ➢ Anti-CCP: antibody specific to RA ➢ ANA: autoimmune reaction Other: ➢ Bone scans: early joint changes ➢ X-rays: progression ➢ Synovial fluid analysis: cloudy, straw-colored fluid with fibrin flecks and MMP-3
If possible administer eye ointment at ______________.
-bedtime
After instilling drops, ask the client to __________ eyes gently.
-blink
For children under 3 years of age straighten the ear canal by pulling the auricle _______ and _______.
-down and back
If the client has eye drops and eye ointment ordered at the same time, the nurse should administer the eye _______________ first.
-drops
The client can also press firmly on the _____________________ duct for at least 30 seconds.
-nasal lacrimal duct
Before administering ear medication warm the medication container in your hand, or place it in warm water for a short time. This promotes client comfort and prevents nerve stimulation, dizziness, and pain. When administering ear medications have the client lie in the ___________________ position with the ear being treated uppermost.
-side lying
Instill prescribed drops by holding the dropper tip above the ear canal. Press gently a few times on the ___________ of the ear to assist the flow of medication into the ear canal.
-tragus
How is HIV transmitted?
-unprotected sex -contact with blood or blood products -perinatal(during pregnancy, breastfeeding, or delivery)
For adults straighten the ear canal by pulling the ear canal _______ and _______.
-up and back
Normal creatnine level for adult?
0.6-1.5 mg/dL
Hold the eye dropper ______ cm above the __________________.
1-2cm eye
The ________-_____ rash occurs in 80% of infected persons. It appears at the site of the tick bite within _____ month after exposure. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
1. bulls-eye(might be warm to touch) 2. 1 month
Oral antibiotics used for treating early-stage infection and preventing later stages of the disease are _____________________, ____________________, and ___________________. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
1. doxycycline 2. cefuroxine 3. amoxicillin
Human bites can cause laceration, puncture, crush injury, soft tissue tearing and even amputation. The most common sites of human bites are hands, fingers, ears, nose, vagina, and penis. Often these injuries are due to violence or sexual activity. There is a high risk for __________________ from oral flora, most often ___________________ aureus, _______________, and _____________ virus.
1. infection 2. staphylococcus 3. streptococcus 4. hepatitis
Puncture wounds are left ________. Lacerations may be loosely ___________. Plastic surgery consultation may be needed for disfiguring facial wounds. Report animal and human bites to the police as required.
1. open 2. sutured
1. Patients with certain neurologic or cardiac complications may need IV antibiotic therapy with ________________________ and ____________________. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
1. penicillin 2. ceftrizone
normal BUN
10-20 mg/dL
How long should heat be applied?
15-20 minutes
The nurse is educating a patient with a latex allergy on which foods to avoid that may trigger latex-food syndrome. Which foods should the nurse include? Select all that apply 1. pears 2. kiwifruit 3. potatoes 4.avocados 5. tomatoes 6. pineapple
2. kiwifruit 3. potatoes 4.avocados 5. tomatoes
1. This child exhibits manifestations of Stage _____ Lyme disease. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
3
The series of _______ injections of rabies vaccine (human diploid cell rabies vaccine-HDCV, Imovax Rabies) are given on days 0, 3, 7, and 14 to provide active immunity.
4
Normal range of WBC count
5,000-10,000
Infection rates are as high as ________% when victims do not seek medical care within 24 hours of injury.
50%
Anaphylaxis is a potentially severe or life-threatening allergic reaction that can occur very quickly-as fast as within a couple of minutes of exposure to the allergen. A. _____ True B. _____ False
A. _____ True
It is important for the patient to know to refill the EpiPen prescription before their EpiPen expires. A. _____True B. ______False
A. _____True
The effects of an EpiPen only lasts 15-20 minutes. A. _____True B. _____False
A. _____True
What is the treatment for HIV
Antiretroviral therapy (ART) this begins with confirmation of HIV
The nurse conducts a briefing for the camp on the prevention of Lyme disease. What information should be included in the presentation? A. Wear dark clothing, tightly tucked in, with dark socks and dark shoes. B. Apply insect repellents containing diethyltoluamide (DEET) to the face and hands C. Dress in light-colored clothing so that any ticks can be spotted fairly easily. D. Scrub vigorously in the shower immediately after returning from the woods.
C. Dress in light-colored clothing so that any ticks can be spotted fairly easily
What assessment data would you use to determine whether C.Z.'s condition is improving? (Rheumatoid Arthritis Case Study)
Assess -reflexes -joints -skin -pain -ESR, CRP(if ESR = improving = shows inlammation)
A 12-year-old comes to the infirmary 4 days after returning from sleeping out in the woods with the rest of his group. A small, red rash has appeared near an area where he may have been bitten. He denies seeing anything bite him. What would the nurse expect to do for the patient after the physician sees him? A. Wash off the affected area with an antibacterial soap. B. Administer an initial dose of doxycycline. C. Apply an antiseptic cream to the area with the rash. D. Monitor the boy for signs and symptoms of tick-borne diseases
B. Administer an initial dose of doxycycline.
2. When developing the postoperative plan of care for a child who is scheduled to have a tympanostomy tubes inserted into the right ear, which of the following interventions would the nurse identify to facilitate drainage? A. Applying warm compresses to the right ear. B. Positioning the child to lie on the right ear. C. Applying a gauze dressing to the left ear. D. Applying an ice pack to the left ear.
B. Positioning the child to lie on the right ear.
1. The rabies virus is passed on by contact with what part of an infected animal? A. Skin B. Saliva C. Blood D. Claws E. B and C
B. Saliva
How soon after a potentially infectious bite should a person be treated for rabies? A. Within 6 hours B. Within 24 hours C. Within a week D. Within 2 weeks
B. Within 24 hours
Clinical manifestations exhibited during an anaphylactic reaction include: (Select all that apply)(There are five correct answers) A. _____ Hypertension B. _____Wheezing C. _____Dypsnea D. _____Urticaria E. _____Tachycardia F. _____Feeling of impending doom
B. _____Wheezing C. _____Dypsnea D. _____Urticaria E. _____Tachycardia F. _____Feeling of impending doom (Blood pressure drops)
How soon do symptoms typically appear after a person is infected with the rabies virus? A. 48 hours B. 1 week C. 1 month D. 1 year
C. 1 month
3. Following the insertion of tympanostomy tubes, offering liquid or soft foods to keep the child from chewing is written on the postoperative plan of care. Which of the following nursing diagnoses would this intervention address? A. Hyperthermia related to infectious process. B. Risk for Impaired Skin Integrity related to ear drainage. C. Pain related to the inflammatory process. D. Anxiety related to unfamiliar situation.
C. Pain related to the inflammatory process.
If you have been bitten or scratched by a wild animal, what should you do? A. Clean the wound with soap and water to remove any saliva B. Call your health care provider as soon as possible C. Call your state or local health department as soon as possible D. All of the above
D. All of the above
What can you do to prevent getting rabies? A. Have your pets and other domesticated animals regularly vaccinated against rabies B. Keep your dog on a leash when you take it outside your yard C. Don't approach wild animals D. All of the above
D. All of the above
1. When teaching the parents of a 1-year-old child who is scheduled for placement of tympanostomy tubes, which of the following would the nurse include as the purpose for these tubes? A. Allow distribution of antibiotic solution into the middle ear. B. Assist in shrinking the mucosal lining of the middle ear. C. Increase the pressure in the middle ear. D. Allow ventilation and drainage of the middle ear.
D. Allow ventilation and drainage of the middle ear
What is the drug of choice for treating children experiencing anaphylaxis from a bee or wasp sting? A. Prednisone (Deltasone) B. Benadryl (diphenhydramine) C. Claritin (loratadine) D. Epinephrine (adrenalin)
D. Epinephrine (adrenalin)
Prevention of sunburn is one of the major information sessions the nurse presents to the campers as well as the counselors. What information is most important for the nurse to stress during these sessions? A. Once sunscreens are applied, they are effective for 2 to 3 hours. B. Sunscreens without p-aminobenzoic acid (PABA) prevent fewer allergic reactions in children. C. A sunscreen with a sun protection factor (SPF) of 20 provides protection for approximately 200 minutes. D. Sunscreen must be reapplied at frequent intervals and in liberal amounts.
D. Sunscreen must be reapplied at frequent intervals and in liberal amounts.
After teaching C.Z to use heat and cold therapy to relieve symptoms, you determine teaching has been effective when she states: a. "taking a warm shower can help ease morning stiffness." b. "cold therapy can be applied for 30mins to relieve joint stiffness." c. "I can use heat therapy for 20mins to relieve the symptoms of an acute flare up." d. "When my joints are swollen, a heating pad for 10-15mins can relieve the pain." (Rheumatoid Arthritis Case Study)
a. "taking a warm shower can help ease morning stiffness." *30mins is too long for cold or hot *morning stiffness is treated with a warm shower *an acute flare up is treated with cold *swollen joints are treated with cold
6. The nurse is providing discharge teaching to a patient who has been diagnosed with a latex allergy. What should the nurse instruct the patient to avoid? a. Applying elastic bandages. b. Eating leafy green vegetables. c. Using cotton-tip applicators. d. Putting on vinyl gloves.
a. Applying elastic bandages.
Which of the following interventions would be most helpful in managing a patient newly admitted with cellulitis of the right foot? a. Applying warm, moist heat b. Limiting ambulation to three times daily c. Keeping the foot at or below heart level d. Wrapping the foot snugly in warm blankets
a. Applying warm, moist heat vasodilations, softens the area, comfort of pt
5. The nurse believes that a patient who states he is in pain is "faking it" and is hoping to get "high." The nurse decides to give the patient a placebo instead of the pain medication that was ordered for the patient. The nurse is violating which principle(s) of ethics? (Select all that apply- 4 correct answers) a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas e. Veracity
a. Autonomy b. Utilitarianism c. Beneficence e. Veracity
5. Individuals who have latex allergy are known to experience cross-sensitization to all of the following foods except: a. Corn. b. Papayas. c. Bananas. d. Kiwis
a. Corn.
The nurse is caring for a patient who is receiving antiretroviral therapy (ART) for treatment of HIV infection. Which assessment best indicates that the patient's condition is improving? a. Decreased viral load b. Increased drug resistance c. Decreased CD4+ T-cell count d. Increased aminotransferase levels
a. Decreased viral load
4. To help identify the risk of exposing a patient to latex, healthcare providers should: a. Give patients a written or verbal questionnaire prior to treatment. b. Test a patient's latex sensitivity by touching his or her hand with latex gloves. c. Ask for a detailed family history to determine genetic predisposition to latex allergies. d. Ask patients if they are currently taking any allergy medications.
a. Give patients a written or verbal questionnaire prior to treatment.
2. When caring for a patient with a known latex allergy, the nurse would monitor the patient closely for a cross-sensitivity to which foods? (Select all that apply.) a. Grapes b. Oranges c. Bananas d. Potatoes e. Tomatoes
a. Grapes c. Bananas d. Potatoes e. Tomatoes
9. The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP for several hours, and the medication is due to be administered. Which action should the nurse take? a. Hold the dose and contact the nursing supervisor. b. Administer the recommended dose until the HCP can be located. c. Hold the dose.
a. Hold the dose and contact the nursing supervisor.
The nurse would assess a patient admitted with cellulitis for which of the following localized signs? a. Pain b. Fever c. Chills d. Malaise
a. Pain
In a patient admitted with cellulitis of the left foot, which of the following clinical manifestations would you expect to find on assessment of the left foot? a. Redness and swelling b. Pallor and poor turgor c. Cyanosis and coolness d. Edema and brown skin discoloration
a. Redness and swelling
1. A homeless man presents to the emergency room with hypothermia. He tells the nurse that he is positive for human immunodeficiency virus (HIV) and sought revenge by deliberately having sex with his significant other, who does not know of his HIV status. This patient is violating which ethical principle? a. Veracity b. Beneficence c. Nonmaleficence d. Autonomy
a. Veracity c. Nonmaleficence
Which of the following laboratory results is the best indicator that a patient with cellulitis is recovering from this infection? a. WBC of 8200/μl b. WBC of 2900/μl c. WBC of 16,300/μl d. WBC of 12,700/μl
a. WBC of 8200/μl
Which information should be included when teaching Terry how to manage her chronic pain due to her RA?(SATA) a. protect joints from stress b. apply cold packs to affected joints c. alternate scheduled rest periods with activity throughout the day d. only use analgesics for severe pain episodes e. avoid topical analgesics
a. protect joints from stress c. alternate scheduled rest periods with activity throughout the day
1. The nurse is teaching a patient with a latex allergy about preventing and treating allergic reactions. Which statement, if made by the patient, indicates a need for further teaching? a. "My dentist should be told about my latex allergy." b. "My reactions are not severe; I will not need an EpiPen." c. "I should avoid foods such as bananas, avocados, and kiwi." d. "I will use vinyl gloves for activities such as housekeeping."
b. "My reactions are not severe; I will not need an EpiPen."
6. A woman takes the hospital elevator to the fifth floor to visit her husband who is a patient. The woman overhears two nurses speaking about her husband. The nurses are discussing his possible prognosis. What ethical principle have the nurses violated? a. Autonomy b. Confidentiality c. Beneficence d. Justice
b. Confidentiality
2. A patient and her husband used in-vitro fertilization to become pregnant. The unused sperm were frozen so the couple could have more children later. They bore a little girl who was diagnosed with leukemia when she was 5 years old. The child now needs a bone marrow transplant (BMT). The best chance of a match for the BMT is a sibling. The couple would like to use the sperm to have another child so that they can increase the likelihood of a match. The nurse realizes that the unborn child poses an ethical dilemma involving which principle? a. Beneficence b. Human dignity c. Justice d. Veracity
b. Human dignity
The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is: a. antibiotics should have been used to prevent pneumonia. b. all of the supplied antibiotics should be taken even when symptoms have resolved. c. enough antibiotics for 2 days' treatment should be reserved in case symptoms recur. d. patients should get antibiotics for any infection to prevent development of streptococcal-related diseases.
b. all of the supplied antibiotics should be taken even when symptoms have resolved.
Which tasks can be delegated to the UAP?(SATA a. ask Terry to rate her pain while taking vital signs b. apply antiembolic hose c. identify potential problems to be added to the plan of care d. mark the drainage on Terry's postoperative dressing and report to RN e. remove the CPM machine while assisting Terry to bathe
b. apply antiembolic hose e. remove the CPM machine while assisting Terry to bathe
4. A 28-year-old married woman received word that she is pregnant. Sadly, the patient is not able to carry the pregnancy because she suffers from long QT syndrome, which causes an abnormality of the heart, meaning any rush of adrenaline could prove fatal. The pregnant patient states, "I want to have this baby." The nurse realizes that this is a conflict that involves which ethical principle? a. Utilitarianism b. Deontology c. Autonomy d. Veracity
c. Autonomy
8. The nurse who works on the night shift enters the medication room and finds a co-worker take a medication from the pyxis and put the medication in their mouth. Which is the most appropriate action by the nurse? a. Call security. b. Call the police c. Call the nursing supervisor. d. Lock the co-worker in the medication room until help is obtained.
c. Call the nursing supervisor.
Etanercept (Enbrel) is prescribed for a patient with stage II rheumatoid arthritis. The nurse determines that the medication is effective if what is observed? a. Decreased lymphocyte count b. Absence of Rh factor in the blood c. Decreased C-reactive protein (CRP) d. Increased serum immunoglobulin G
c. Decreased C-reactive protein (CRP)
7. Beneficence means: a. Freedom to make decisions for oneself. b. Doing no harm, either deliberately or unintentionally. c. Doing good for the benefit of others. d. Treating everyone equally, regardless of gender, race, religion, or disease.
c. Doing good for the benefit of others.
3. Which ethical term matches this statement: "A problem for which in order to do something right you have to do something wrong"? a. Justice b. Veracity c. Ethical dilemma d. Fidelity
c. Ethical dilemma
3. When receiving medical or dental treatment, individuals who suffer from latex allergy should: a. Refuse treatment in any office that uses rubber products. b. Wear a mask to prevent accidental inhalation of aerosol allergens. c. Inform healthcare providers of their allergy in advance. d. Wash their hands thoroughly with soap and water after treatment.
c. Inform healthcare providers of their allergy in advance.
Ask the client to look at the _______________.
ceiling
The Rabies virus spreads through the ______________ nervous system via peripheral nerves.
central
Drop the prescribed number of drops into the ______________.
conjunctival sac
Initial treatment for animal and human bites includes cleaning, ____________ irrigation, debridement, tetanus prophylaxis, and analgesics as needed.
copious
List the manifestations of Stage 1 Lyme disease for which children should be instructed to observe in to prevent Stage 2 disease. (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
stage 1 = bulls-eye rash
What bacterium can cause cellulitis?
streptococcus and staphylococcus aureus
1. When instilling eye drops ask the client to lie ______________ or sit back in a chair with head tilted slightly _______________.
supine back
The most appropriate response by the nurse to the mother is: a. "Try one of the brand-name eye products available over-the-counter for the conjunctivitis, instilling drops every 2 hours for 8 hours. Call back if the eyes do not clear up in 24 hours." b. "Cleanse the eyes with warm soap and water, and apply continuous warm compresses. Call back in 24 hours if the eyes have not improved." c. "Cleanse the eyes using warm water and antibacterial soap, before applying an over-the-counter water-soluble lubricant to each eye several times during waking hours." d. "Cleanse the eyes from inside to outside with a clean washcloth and warm water; wash hands carefully before and after care. The child should see her pediatrician within 24 hours."
d. "Cleanse the eyes from inside to outside with a clean washcloth and warm water; wash hands carefully before and after care. The child should see her pediatrician within 24 hours."
The nurse is teaching a newly diagnosed 34-year-old male about his HIV infection. Which statement by the patient would indicate the patient needs additional education? a. "I will need to take my HIV medication daily for the rest of my life." b. "Although I only take one pill, it has multiple medications combined into a single tablet." c. "I should notify my HIV provider if I get fevers that do not go away with Tylenol or aspirin." d. "Once my viral load is undetectable I don't have to worry about taking my medication every day."
d. "Once my viral load is undetectable I don't have to worry about taking my medication every day."
A patient is undergoing diagnostic testing for symptoms of polyarthralgia, fatigue, and hair loss. Laboratory results include the presence of anti-DNA, antinuclear antibodies, and anti-Smith in the blood. The nurse recognizes that these findings are most likely to be related to which diagnosis? a. Systemic sclerosis b. Rheumatoid arthritis c. Chronic fatigue syndrome d. Systemic lupus erythematosus
d. Systemic lupus erythematosus
which assessment findings may indicate aspirin toxicity?(SATA) a. anorexia and weakness b. hypoventilation and bradycardia c. tachycardia and anxiety d. headache and confusion e. hyperventilation and agitation
d. headache and confusion e. hyperventilation and agitation
A diagnosis of AIDS can be made for a patient with HIV with a. a WBC count less than 3000/µL. b. a CD4+ T-cell count less than 500/µL. c. development of oral candidiasis (thrush). d. onset of Pneumocystis jiroveci pneumonia.
d. onset of Pneumocystis jiroveci pneumonia.
Dog bites usually occur on the ____________________.
extremities
__________ bites are common in small children.
facial
Since rabies is nearly always __________, management efforts are directed at preventing the transmission and onset of the disease.
fatal
People who develop rabies may have ______-______ symptoms, confusion, paresthesias, or numbness resulting in death. Always provide postexposure vaccinations when the animal is not found, or a wild animal causes the bite.
flu-like
The bite may cause a simple __________________ or be associated with crush injury, puncture wound, or tearing of multiple layers of tissue.
laceration
Rabies is caused by a ______________ virus in the saliva of an infected animal.
neurotoxic
Also, an initial weight-based dose of rabies immune globulin (RIG-HyerRab S/D) is given at the same time as the first dose of the vaccine. This rabies immune globulin provides ___________ immunity.
passive
____________________ antibiotics are used for animal and human bites at risk for infection such as wounds over joints, puncture wounds, and bites of the hand or foot.
prophylactic
Cat bites result in deep _______________ wounds which can involve tendons and joint capsules.
puncture
The mother tells the nurse that she has two other children at home. She tells the nurse that her family recently moved to a new home, and the back yard has a lot of trees and grassy areas. List several suggestions the nurse might offer the mother to help prevent tick infestations in her children (other than staying inside). (Scenario: A 5-year-old child is hospitalized with Lyme disease. His symptoms include heart failure, confusion, and decreased level of consciousness. (Questions 1-4 pertain to this scenario)
wear pants and boots cut the grass/remove brush spray the yard check children when coming in from play check for bites
Most rabies carriers are ___________ animals, like raccoons, skunks, bats, foxes, and coyotes.
wild
What are some abnormal blood tests that are commonly caused by HIV?
• Decreased WBC counts, especially lymphopenia neutropenia • Low platelet counts (thrombocytopenia) • Anemia is associated with ART • Altered liver function
When is Leflunomide (Arava) use for Rheumatoid Arthritis? What are the considerations with this med?
➢ Blocks immune cell overproduction ➢ Not used during pregnancy; teratogenic
When is Methotrexate use for Rheumatoid Arthritis? What are the considerations with this med?
➢ Early treatment ➢ Lower toxicity ➢ Side effects (rare): bone marrow suppression and hepatotoxicity ➢ Need to monitor CBC and blood chemistry ➢ Therapeutic effects in 4 to 6 weeks; may be given alone or with biologic response modifiers
Stage III of Rheumatoid Arthritis
➢ Formation of synovial pannus ➢ X-ray: extensive cartilage loss, erosion at joint margins, possible deformity
Stage II of Rheumatoid Arthritis
➢ Increased joint inflammation ➢ Gradual destruction in joint cartilage ➢ Narrowing joint space from loss of cartilage
Stage IV of Rheumatoid Arthritis
➢ Inflammatory process subsides ➢ Loss of joint function ➢ Formation of subcutaneous nodules
When is Tofacitinib (Xeljanz) use for Rheumatoid Arthritis? What are the considerations with this med?
➢ JAK (Janus kinase) inhibitor: interferes with enzymes that cause joint inflammation ➢ Moderate to severe active disease ➢ No live vaccines
Stage I of Rheumatoid Arthritis
➢ Synovitis ➢ X-ray: soft tissue swelling, possible osteoporosis, no joint destruction
When is use for Sulfasalazine (Azulfidine) and hydroxychloroquine (Plaquenil) Rheumatoid Arthritis? What are the considerations with these meds?
➢ Used for mild to moderate disease ➢ Drink fluids ➢ Wear sunscreen ➢ Eye exam: baseline, then every 6 to 12 months