172 Exam 4

Emerging infections can affect health care by (select all that apply) A. revealing antibiotic resistance. B. generating scientific discoveries. C. creating a strain on limited resources. D. challenging established medical traditions. E. limiting travel options for nursing personnel.

A, B, C, D. An emerging infection is an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future. Examples include drug-resistant organisms that emerged when a previously treatable organism developed resistance to antibiotics; infections for which criteria for starting antiretroviral drug therapy (ART) have changed with new scientific discoveries; and infections for which obtaining adequate treatment is difficult because of limited resources or access.

The patient with fibromyalgia is suffering with pain at 12 of the 18 identification sites, including the neck and upper back and the knees. The patient also reports non-refreshing sleep, depression, and being anxious when dealing with multiple tasks. The nurse should teach this patient about what treatments (select all that apply)? A. Low-impact aerobic exercise B. Relaxation strategy (biofeedback) C. Antiseizure drug pregabalin (Lyrica) D. Morphine sulfate extended-release tablets E. Serotonin reuptake inhibitor (e.g., sertraline [Zoloft])

A, B, C, E. Because the treatment of fibromyalgia is symptomatic, this patient will be prescribed something for pain, such as pregabalin, and a serotonin reuptake inhibitor for depression. Low- impact aerobic exercise will prevent muscle atrophy without increasing pain at the knees. Relaxation can help decrease the patient's stress and anxiety. Long-acting opioids are generally avoided unless pain cannot be relieved by other medications.

The nurse will teach the patient with fibromyalgia the importance of limiting intake of which foods (select all that apply)? A. Sugar B. Alcohol C. Caffeine D. Red meat E. Root vegetables

A, B, C. Dietitians often urge patients with fibromyalgia to limit their consumption of sugar, caffeine, and alcohol because these substances have been shown to be muscle irritants.

Which statements accurately describe HIV infection (select all that apply)? A. Untreated HIV infection has a predictable pattern of progression. B. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). C. Untreated HIV infection can remain in the early chronic stage for a decade or more. D. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. E. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

A, B, C. The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

What should the nurse teach the patients in the assisted living facility to decrease their risk for antibiotic-resistant infection (select all that apply)? A. Wash hands frequently. B. Take antibiotics as prescribed. C. Take the antibiotic until it is gone. D. Take antibiotics to prevent illnesses like colds. E. Save leftover antibiotics to take if needed later.

A, B, C. To decrease the risk for antibiotic-resistant infections, people should wash their hands frequently, follow the directions when taking the antibiotics, finish the antibiotic, do not request antibiotics for colds or flu, do not save leftover antibiotics, or take antibiotics to prevent an illness without them being prescribed by a health care provider.

Which safe sun practices would the nurse include in the teaching care plan for a patient with photosensitivity? (Select all that apply) A. Wear protective clothing. B. Apply sunscreen liberally and often. C. Emphasize the short-term use of a tanning booth. D. Avoid exposure to the sun, especially during midday. E. Wear any sunscreen as long as it's purchased at a drug store.

A, B, D. Patients should recognize that sun safety guidelines include sun avoidance, especially during the midday hours; protective clothing; and broad-spectrum sunscreen (e.g., sun protective factor [SPF] 15; SPF 30 if a patient has a history of skin cancer or sun sensitivity). Sunscreens should be applied 20 to 30 minutes before the patient goes outdoors and should be reapplied every 2 hours and after swimming. Patients should avoid tanning booths and sun lamps.

A healthy 65-year-old man who lives at home is at the clinic requesting a "flu shot." When assessing the patient, what other vaccinations should the nurse ask the patient about receiving (select all that apply)? A. Shingles B. Pneumonia C. Meningococcal D. Haemophilus influenzae type b (Hib) E. Measles, mumps, and rubella (MMR)

A, B. The patient should receive the shingles (heres zoster) vaccine, Pneumovax, and influenza. The other options do not apply to this patient. Meningococcal vaccination is recommended for adults at risk (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies). Adults born before 1957 are generally considered immune to measles and mumps. Haemophilus influenzae type b (Hib) vaccination is only considered for adults with selected conditions (e.g., sickle cell disease, leukemia, HIV infection or for those who have anatomic or functional asplenia) if they have not been previously vaccinated.

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, C, D, E. Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. The most common of these foods are bananas, avocados, chestnuts, kiwi fruit, tomatoes, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots.

An acoustic neuroma is removed from a patient, and the nurse instructs the patient about tumor recurrence. What should the nurse instruct the patient to monitor (select all that apply)? A. Episodes of dizziness B. Lack of coordination C. Worsening of hearing D. Inability to close the eye E. Clear drainage from the nose

A, C, D. An acoustic neuroma is a unilateral benign tumor that occurs where the vestibulocochlear nerve (CN VIII) enters the internal auditory canal. Clinical manifestations of tumor recurrence including facial nerve (CN VII) paralysis can be manifested by intermittent vertigo, hearing loss, and inability to close the eye. Lack of coordination and clear nasal drainage do not manifest with acoustic neuroma.

The 40-year-old African American woman has had Raynaud's phenomenon for some time. She is now reporting red spots on the hands, forearms, palms, face, and lips. What other manifestations should the nurse assess for when she is assessing for scleroderma (select all that apply)? A. Calcinosis B. Weight loss C. Sclerodactyly D. Difficulty swallowing E. Weakened leg muscles

A, C, D. This 40-year-old African American woman is at risk for scleroderma. The acronym CREST represents the clinical manifestations. C: calcinosis, painful calcium deposits in the skin; R: Raynaud's phenomenon; E: Esophageal dysfunction, difficulty swallowing; S: sclerodactyly, tightening of skin on fingers and toes; T: telangiectasia. Weight loss and weakened leg muscles are associated with polymyositis and dermatomyositis not scleroderma.

The patient is in the hospital for a surgical procedure and has dry skin and pruritus on her legs that causes her to scratch at the skin uncontrollably. What measures can the nurse use to help stop the itch/scratch cycle?(select all that apply)? A. Moisturize the skin on the legs. B. Provide a warm blanket and room. C. Administer antihistamines at bedtime. D. Use careful hand washing after rubbing her legs. E. Cleanse the legs with a saline solution twice daily.

A, C. Moisturizing the skin to decrease the dryness and the itch sensation and bedtime antihistamines to decrease a potential allergic reaction and provide some sedation will help the patient sleep since pruritis is often worse at night and the patient needs sleep for healing. Using nonallergic sheets may also help. Anything causing vasodilation, such as warmth or rubbing, should be avoided. Saline solution would only further dry the skin so would not be used on the patient's legs.

The patient has been part of a community emergency response team (CERT) for a tropical storm in Dallas where it has been 100° F (37.7° C) or more for the last 2 weeks. With assessment, the nurse finds hypotension, body temperature of 104° F (40° C), dry and ashen skin, and neurologic symptoms. What treatments should the National Disaster Medical System (NDMS) nurse anticipate (select all that apply)? A. Administer 100% O2. B. Immerse in an ice bath. C. Administer cool IV fluids. D. Cover the patient to prevent chilling. E. Administer acetaminophen (Tylenol).

A, C. The patient is experiencing heatstroke. Treatment focuses first on stabilizing the patient's ABC and rapidly reducing the core temperature. Administration of 100% O2 compensates for the patient's hypermetabolic state. Cooling the body with IV fluids is effective. Immersion in an ice bath will cause shivers that increase core temperature, so a cool water bath should be used for conductive cooling. Removing the clothing, covering the patient with wet sheets, and placing the patient in front of a fan will cause evaporative cooling. Excessive covers will not be used. Acetaminophen will not be effective because the increase in temperature is not related to infection.

Effective interventions to decrease absorption or increase elimination of an ingested poison include which of the following? A. Hemodialysis B. Milk dilution C. Eye irrigation D. Gastric lavage E. Activated charcoal

A, D, E. Options for decreasing absorption of ingested poisons include activated charcoal and gastric lavage. Administration of cathartics, whole-bowel irrigation, hemodialysis, urine alkalinization, chelating agents, and antidotes increases the elimination of poisons.

Which patient behaviors would the nurse promote for healthy eyes and ears? (select all that apply) A. Wearing protective sunglasses when bicycling. B. Supplemental intake of B vitamins and magnesium. C. Playing amplified music at 75% of maximum volume. D. Patient notifying provider of tinnitus while on antibiotics. E. A woman avoiding pregnancy for 4 weeks after receiving measles, mumps, and rubella (MMR) immunization.

A, D. Wearing sunglasses may contribute to the prevention of cataract development and age-related macular degeneration. Protective eyewear during sports activities reduces the risk of eye injuries. Antibiotics, salicylates, diuretics, and antineoplastic drugs are commonly associated with ototoxicity.

What should be included in the postoperative teaching of the patient who has undergone cataract surgery? (Select all that apply) A. Eye discomfort is often relieved with mild analgesics. B. A decline in visual acuity is common for the first week. C. Stay on bed rest and limit activity for the first few days. D. Notify the physician if an increase in redness or drainage occurs. E. Nighttime eye shielding and activity restrictions are essential to prevent eye strain.

A, D. After cataract surgery, the nurse should teach the patient and caregiver about the following topics before discharge: topical antibiotics; topical corticosteroids or other antiinflammatory agents; mild analgesia, if necessary; eye shield if used (usually worn overnight and removed during the first postoperative visit); and activity restrictions as preferred by the patient's surgeon (activities that increase the intraocular pressure, such as bending or stooping, coughing, or lifting, may be restricted). Complications that should be reported include intense pain (which may indicate hemorrhage), infection, increased intraocular pressure, increased or purulent drainage, increased redness, and any decrease in visual acuity.

A nurse assesses a 38-year-old patient with joint pain and stiffness who was diagnosed with Stage III rheumatoid arthritis (RA). What characteristics should the nurse expect to observe (select all that apply)? A. Nodules present B. Consistent muscle strength C. Localized disease symptoms D. No destructive changes on x-ray E. Subluxation of joints without fibrous ankylosis

A, E. In Stage III severe RA, there may be extraarticular soft tissue lesions or nodules present, and there is subluxation without fibrous or bony ankylosis. The muscle strength is decreased because there is extensive muscle atrophy. The manifestations are systemic not localized. There is x-ray evidence of cartilage and bone destruction in addition to osteoporosis.

The nurse provides information to a laboratory employee who was accidentally exposed to anthrax by inhalation. The nurse determines the teaching has been successful if the patient makes which statement? A. "An antibiotic will be prescribed for 2 months." B. "I will need to wear a mask for the next 2 weeks." C. "Anthrax can be spread by person-to-person contact." D. "Antibiotics are only indicated for an active infection."

A. "An antibiotic will be prescribed for 2 months." Postexposure prophylaxis includes a 60-day course of antibiotics. Ciprofloxacin (Cipro) is the treatment of choice. Antibiotics are indicated after exposure to inhaled anthrax. A mask is not needed. Anthrax is not spread by person-to-person contact; anthrax is spread by direct contact with the bacteria and its spores.

When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."

A. "I will need to isolate any tissues I use so as not to infect my family." HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

A 24-year-old female patient with systemic lupus erythematosus (SLE) tells the nurse she wants to have a baby and is considering getting pregnant. Which response by the nurse is most appropriate? A. "Infertility can result from the medications used to control your disease." B. "Pregnancy will result in a temporary remission of your signs and symptoms." C. "Autoantibodies transferred to the baby during pregnancy will cause heart defects." D. "The baby is at high risk for neonatal lupus erythematosus being diagnosed at birth."

A. "Infertility can result from the medications used to control your disease." Infertility may be caused by renal involvement and the previous use of high-dose corticosteroid and chemotherapy drugs. Neonatal lupus erythematosus rarely occurs in infants born to women with SLE. Exacerbation is common following pregnancy during the postpartum period. Spontaneous abortion, stillbirth, and intrauterine growth retardation are common problems with pregnancy related to deposits of immune complexes in the placenta and because of inflammatory responses in the placental blood vessels. There is not an increased risk for heart defects.

Which patient would be more likely to have the highest risk of developing malignant melanoma? A. A fair-skinned woman who uses a tanning booth regularly B. An African American patient with a family history of cancer C. An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia D. A Hispanic male with a history of psoriasis and eczema that responded poorly to treatment

A. A fair-skinned woman who uses a tanning booth regularly Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

Which finding related to primary open-angle glaucoma would the nurse expect to find when reviewing a patient's history and physical examination report? A. Absence of pain or pressure B. Blurred vision in the morning C. Seeing colored halos around lights D. Eye pain accompanied with nausea and vomiting

A. Absence of pain or pressure Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before a diagnosis is made unless regular eye examinations are being performed. Primary angle-closure glaucoma manifestations include sudden, excruciating pain in or around the eye, seeing colored halos around lights, and nausea and vomiting.

An 18-year-old male who fell through the ice on a pond near his farm was admitted to the ED with somnolence. Vital signs are BP 82 mm Hg systolic with Doppler, respirations 9/min, and core temperature of 90° F (32.2° C). The nurse should anticipate which intervention? A. Active core rewarming B. Immersion in a hot bath C. Rehydration and massage D. Passive external rewarming

A. Active core rewarming Active internal or core rewarming is used for moderate to severe hypothermia and involves the application of heat directly to the core. Immersion in a hot bath, rehydration, and massage are not appropriate interventions in the treatment of severe hypothermia. Passive rewarming is used in mild hypothermia.

A 47-year-old man who was lost in the mountains for 2 days is admitted to the emergency department with cold exposure and a core body temperature of 86.6 F (30.3 C). Which action is most appropriate for the nurse to take? A. Administer warmed IV fluids. B. Position patient under a radiant heat lamp. C. Place an air-filled warming blanket on the patient. D. Immerse the extremities in a water bath (102° to 108° F [38.9° to 42.2° C]).

A. Administer warmed IV fluids. A patient with a core body temperature of 86.6 F (30.3 C) has moderate hypothermia. Active core rewarming is used for moderate to severe hypothermia and includes administration of warmed IV fluids (109.4° F [43° C]). Patients with moderate to severe hypothermia should have the core warmed before the extremities to prevent after drop (or further drop in core temperature). This occurs when cold peripheral blood returns to the central circulation. Use passive or active external rewarming for mild hypothermia. Active external rewarming involves fluid-filled warming blankets or radiant heat lamps. Immersion of extremities in a water bath is indicated for frostbite.

A hospitalized patient with AIDS has a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements related to nausea and anorexia. Which nursing action is most appropriate to delegate to an LPN/LVN who is providing care to this patient? A. Administering oxandrolone (Oxandrin) 5 mg daily B. Assessing the patient for other nutritional risk factors C. Developing a plan of care to improve the patient's appetite D. Providing instructions about a high-calorie, high-protein diet

A. Administering oxandrolone (Oxandrin) 5 mg daily Administration of oral medication is included in LPN/LVN education and scope of practice. Assessment, planning of care, and teaching are more complex RN-level interventions.

The nurse reminds the staff that standard precautions should be used when providing care for which type of patient? A. All patients regardless of diagnosis B. Pediatric and gerontologic patients C. Patients who are immunocompromised D. Patients with a history of infectious diseases

A. All patients regardless of diagnosis Standard precautions are designed for all care of all patients in hospitals and health care facilities.

Which nursing intervention would be most helpful in managing a patient newly admitted with cellulitis of the right foot? A. Applying warm, moist heat B. Wrapping the foot snugly in blankets C. Limiting ambulation to three times daily D. Keeping the foot at or below heart level

A. Applying warm, moist heat The application of warm, moist heat speeds the resolution of inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris. Immobilization and elevation is also used. Snug blankets would not be helpful and could decrease circulation to this sensitive tissue.

On initial assessment of an older patient, the nurse knows to look for certain types of diseases because which immunologic response increases with age? A. Autoimmune response B. Cell-mediated immunity C. Hypersensitivity response D. Humoral immune response

A. Autoimmune response With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosus, acute glomerulonephritis, rheumatoid arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased thymic output of T cells and decreased activation of both T and B cells. There is a decreased or absent delayed hypersensitivity reaction. Immunoglobulin levels decrease and lead to a suppressed humoral immune response in older adults.

Which assessment parameter will the nurse address during the secondary survey of a patient in triage? A. Blood pressure and heart rate B. Patency of the patient's airway C. Neurologic status and level of consciousness D. Presence or absence of breath sound and quality of breathing

A. Blood pressure and heart rate Vital signs are considered to be a part of the secondary survey in the triage process. Airway, breathing, circulation, and a brief neurologic assessment are components of the primary survey that is done to identify life-threatening conditions.

The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities

A. Delaying disease progression These health promotion activities along with mental health counseling, support groups, and a therapeutic relationship with health care providers will promote a healthy immune system, which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.

Which instruction is most appropriate for a patient using contact lenses who is diagnosed with bacterial conjunctivitis? A. Discard all opened or used lens care products. B. Disinfect contact lenses by soaking in a cleaning solution for 48 hours. C. Put all used 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 opened or used lens care products. The patient who wears contact lenses and develops infections should discard all opened or used lens care products and cosmetics to decrease the risk of reinfection from contaminated products. The risk of conjunctivitis is increased with not disinfecting lenses properly, wearing contact lenses too long, or using water or homemade solutions to store and clean lenses.

The nurse teaches a 64-year-old man with gouty arthritis about food that may be consumed on a low-purine diet. Which food item, if selected by the patient, would indicate an understanding of the instructions? A. Eggs B. Liver C. Salmon D. Chicken

A. Eggs Gout is caused by an increase in uric acid production, underexcretion of uric acid by the kidneys, or increased intake of foods containing purines, which are metabolized to uric acid by the body. Liver is high in purine, and chicken and salmon are moderately high in purine.

A patient with SLE is admitted to the hospital for evaluation and management of acute joint inflammation. Which information obtained in the admission laboratory testing concerns you most? A. Elevated blood urea nitrogen level B. Increased C-reactive protein level C. Positive antinuclear antibody test result D. Positive lupus erythematosus cell preparation

A. Elevated blood urea nitrogen level A high number of patients with SLE develop nephropathy, so an increase in blood urea nitrogen level may indicate a need for a change in therapy or for further diagnostic testing such as a creatinine clearance test or renal biopsy. The other laboratory results are expected in patients with SLE.

A 34-year-old female patient who has systemic lupus erythematosus is receiving plasmapheresis to treat an acute attack. What symptoms will the nurse monitor to determine if the patient develops complications related to the procedure? A. Hypotension, paresthesias, and dizziness B. Polyuria, decreased reflexes, and lethargy C. Intense thirst, flushed skin, and weight gain D. Abdominal cramping, diarrhea, and leg weakness

A. Hypotension, paresthesias, and dizziness Common complications associated with plasmapheresis are hypotension and citrate toxicity. Citrate is used as an anticoagulant and may cause hypocalcemia, which may manifest as headache, paresthesias, and dizziness. Polyuria, decreased reflexes, and lethargy are symptoms of hypercalcemia. Abdominal cramping, diarrhea, and leg weakness indicate hyperkalemia. Intense thirst, flushed skin, and weight gain indicate hypernatremia with normal or increased extracellular fluid volume.

The reason newborns are protected for the first 6 months of life from bacterial infections is because of the maternal transmission of A. IgG B. IgA C. IgM D. IgE

A. IgG Immunoglobulin G (IgG) crosses the placental membrane and provides the newborn with passive acquired immunity for at least 3 months. Infants also may obtain some passive immunity from immunoglobulin A (IgA) in breast milk and colostrum.

The patient has been diagnosed with tinea unguium (Onychomycosis) under her nails. She does not like the oral antifungal medication. What is the best alternate treatment the nurse should describe for her? A. Nail avulsion B. Antifungal cream C. Thinning of fingernails D. Soaking nails in salt water

A. Nail avulsion Nail avulsion is the best alternate treatment to the oral antifungal medication. Antifungal cream is minimally effective. Thinning fingernails is not needed if the tinea unguium is under her toenails. Soaking the nails will not be helpful.

The patient with a stage IV pressure ulcer on the coccyx will need a skin graft to close the wound. What postoperative care should the nurse expect to use to facilitate healing? A. No straining of the grafted site B. The wound will be exposed to air. C. Soft tissue expansion will be done daily. D. The pressure dressing will not be removed.

A. No straining of the grafted site Straining or stretching of the grafted site must be avoided to allow the graft to be vascularized and fixed to the new site for healing. The wound may or may not be exposed to air depending on the type of graft, and the donor site will be covered with a protective dressing to prevent further damage. Soft tissue expansion and pressure dressings will not be used after this wound's skin graft.

A patient with newly diagnosed acquired immunodeficiency syndrome (AIDS) has a negative result on a skin test for tuberculosis (TB). Which action will you anticipate taking next? A. Obtain a chest radiograph and sputum smear. B. Tell the patient that the TB test results are negative. C. Teach the patient about the anti-TB drug isoniazid. D. Schedule TB testing again in 12 months.

A. Obtain a chest radiograph and sputum smear. Patients with severe immunodeficiency may be unable to produce an immune response, so a negative TB skin test result does not completely rule out a TB diagnosis for this patient. The next steps in diagnosis are chest radiography and sputum culture. Teaching about isoniazid and follow-up TB testing may be required, depending on the radiographic findings and sputum culture results.

The nurse would assess a patient admitted with cellulitis for what localized manifestation? A. Pain B. Fever C. Chills D. Malaise

A. Pain Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection.

Which guideline for the assessment of intimate partner violence (IPV) should the emergency nurse follow? A. Patients should be routinely screened for family and IPV. B. Patients whom the nurse deems high risk should be assessed for IPV. C. All female patients and patients under 18 should be assessed for IPV. D. Patients should be assessed for IPV provided corroborating evidence exists.

A. Patients should be routinely screened for family and IPV. In the ED, the nurse needs to screen for family and IPV. Routine screening for this risk factor is required. Such assessment should not be limited to female, high-risk, or young patients, and evidence need not be present in order to screen for the problem.

The nurse is caring for four newly diagnosed patients with various connective tissue disorders. The nurse should be most aware of safety issues and interstitial lung involvement in the patient with which diagnosis? A. Polymyositis B. Reactive arthritis C. Sjögren's syndrome D. Systemic lupus erythematosus (SLE)

A. Polymyositis Polymyositis is an inflammatory disease affecting striated muscle and resulting in muscle weakness that increases the patient's risk of falls and injury. Weakened pharyngeal muscles increase the risk for aspiration with interstitial lung disease in up to 65% of patients. The treatment of polymyositis starts with high-dose corticosteroids that cause immunosuppression. If this does not work, other immunosuppressive drugs may be used. Reactive arthritis (Reiter's syndrome) occurs with urethritis, conjunctivitis, and mucocutaneous lesions with the asymmetric arthritis involving large joints of the lower extremities and toes. This patient is not at increased risk for safety problems. Sjögren's syndrome decreases moisture produced by exocrine glands, especially in the mouth and eyes and is without increased risk of injury or interstitial lung involvement. Systemic lupus erythematosus (SLE) is a multisystem inflammatory autoimmune disorder treated with NSAIDs, antimalarial agents. Safety would not be an important issue early in the disease.

In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse 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 Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

A patient has sought care 3 days after experiencing a series of tick bites. Which manifestation would indicate that a patient is experiencing tick paralysis? A. Respiratory distress B. Aggression and frequent falls C. Decreased level of consciousness D. Fever and necrosis at the bite sites

A. Respiratory distress A classic manifestation of tick paralysis is flaccid ascending paralysis, which develops over 1 to 2 days. Without tick removal, the patient dies as respiratory muscles become paralyzed. Aggression, decreased level of consciousness, fever, and necrosis at the bite sites are not characteristic of the problem.

As the nurse manager in a public health department, you are implementing a plan to reduce the incidence of infection with the human immunodeficiency virus (HIV) in the community. Which nursing action will you delegate to health assistants working for the agency? A. Supplying injection drug users with sterile inection equipment such as needles and syringes B. Interviewing patients about behaviors that indicate a need for annual HIV testing C. Teaching high-risk community members about the use of condoms in preventing HIV infection D. Assessing the community to determine which population groups to target for education

A. Supplying injection drug users with sterile injection equipment such as needles and syringes As the nurse manager in a public health department, you are implementing a plan to reduce the incidence of infection with the human immunodeficiency virus (HIV) in the community. Which nursing action will you delegate to health assistants working for the agency?Rationale: Supplying sterile injection supplies to patients who are at risk for HIV infection can be done by staff members with health assistant education. Assessing for high-risk behaviors, education, and community assessment are RN-level skills.

The nurse should teach a patient who is taking which drug to avoid prolonged sun exposure? A. Tetracycline B. Ipratropium C. Morphine sulfate D. Oral contraceptive

A. Tetracycline Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

A 67-year-old woman admitted with heart failure is also diagnosed with herpes zoster (shingles) and draining vesicles. Which action, if observed by the nurse, would require additional teaching for that individual? A. The dietitian wears a mask when entering the patient's room. B. The patient keeps the draining vesicles covered with a dressing. C. The student nurse who takes prednisone requests a different patient assignment. D. The nursing assistant washes hands frequently and wears gloves when in the room.

A. The dietitian wears a mask when entering the patient's room. Herpes zoster (shingles) is spread by contact with fluid draining from the vesicles (not by coughing, sneezing, or casual contact). Shingles is not contagious before the vesicles appear or after the vesicles have crusted over. The risk of a person with shingles spreading the virus is low if the rash is covered. Wearing a mask would not prevent the spread of infection. Until the rash develops crusts, the patient should not have contact with an immune compromised person (e.g., a person taking prednisone). Frequent hand washing helps to prevent the spread of varicella zoster virus.

A patient with chronic hepatitis C has been receiving interferon alfa-2a (Roferon-A) injections for the last month. Which information gathered during a home visit is most important to communicate to the physician? A. The patient has persistent nausea and vomiting. B. The patient injects the medication into the thigh by the intramuscular route. C. The patient's temperature is 99.7° F (37.6° C) orally. D. The patient reports chronic fatigue, muscle aches, and anorexia.

A. The patient has persistent nausea and vomiting. Nausea and vomiting are common adverse effects of interferon alfa-2a, but continued vomiting should be reported to the physician, because dehydration may occur. The medication may be given by either the subcutaneous or intramuscular route. Flulike symptoms such as a mild temperature elevation, headache, muscle aches, and anorexia are common after initiation of therapy but tend to decrease over time.

A 62-year-old patient has acquired immunodeficiency syndrome (AIDS), and the viral load is reported as undetectable. What patient teaching should be provided by the nurse related to this laboratory study result? A. The patient has the virus present and can transmit the infection to others. B. The patient is not able to transmit the virus to others through sexual contact. C. The patient will be prescribed lower doses of antiretroviral medications for 2 months. D. The syndrome has been cured, and the patient will be able to discontinue all medications.

A. The patient has the virus present and can transmit the infection to others. In human immunodeficiency virus (HIV) infections, viral loads are reported as real numbers of copies/ìL or as undetectable. "Undetectable" indicates that the viral load is lower than the test is able to report. "Undetectable" does not mean that the virus has been eliminated from the body or that the individual can no longer transmit HIV to others.

An 82-year-old woman is brought to her physician by her daughter with complaints of some confusion. What testing should the nurse suggest for this patient? A. Urinalysis B. Sputum culture C. Red blood cell count D. White blood cell count

A. Urinalysis The developments of urinary tract infections commonly contribute to atypical manifestations such as cognitive and behavior changes in older adults. Sputum culture, red blood cell count, and white blood cell count may be done, but the first step would be to assess for a possible urinary tract infection.

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? A. Using sterile equipment to inject drugs B. Cleaning equipment used to inject drugs C. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy D. Using latex or polyurethane barriers to cover genitalia during sexual contact

A. Using sterile equipment to inject drugs Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment.

Which antibiotic-resistant organisms cannot be killed by normal hand soap? A. Vancomycin-resistant enterococci B. Methicillin-resistant Staphylococcus pneumoniae C. Penicillin-resistant Streptococcus pneumoniae D. B-Lactamase-producing Klebsiella pneumoniae

A. Vancomycin-resistant enterococci Vancomycin-resistant enterococci (VRE) can remain viable on environmental surfaces for weeks. An antiseptic soap such as chlorhexidine is needed to kill these bacteria.

A diagnosis of AIDS is made when an HIV-infected patient has A. a CD4+ T cell count below 200/uL. B. a high level of HIV in the blood and saliva. C. lipodystrophy with metabolic abnormalities. D. oral hairy leukoplakia, and infection caused by Epstein-Barr virus.

A. a CD4+ T cell count below 200/uL. AIDS is diagnosed when an individual with HIV infection meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/L.

A mother and her two children have been diagnosed with pediculosis corporis at a health care center. An appropriate measure in treating this condition is A. applying pyrethrins to the body. B. topical application of griseofulvin. C. moist compresses applied frequently. D. administration of systemic antibodies.

A. applying pyrethrins to the body. Pediculosis corporis (i.e., body lice) is treated with γ-benzene hexachloride or pyrethrins.

Inflammation and infection of the eye A. are caused by irritants and microorganisms. B. have a higher incidence in sexually active patients. C. are chronic problems that result in loss of vision. D. are frequently treated with cold compresses and antibiotics.

A. are caused by irritants and microorganisms. Inflammation or infection of the eye is caused by external irritants or microorganisms. The nurse teaches the patient appropriate interventions related to the specific disorder. Common interventions include the application of warm, moist compresses and administration of antibiotics.

Important patient teaching after a chemical peel includes A. avoidance of sun exposure. B. application of firm bandages. C. limitation of vigorous exercise. D. use of moist heat to relieve discomfort.

A. avoidance of sun exposure. Patient teaching after a chemical peel should include instructions to use sunscreen and to avoid sun exposure for 6 months to prevent hyperpigmentation.

The most common cause of secondary immunodeficiencies is A. drugs B. stress C. malnutrition D. human immunodeficiency virus

A. drugs Drug-induced immunosuppression is the most common cause of secondary immunodeficiency disorders.

The nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular penicillin by the development of A. edema and itching at the injection site. B. sneezing and itching of the nose and eyes. C. a wheal-and-flare reaction at the injection site. D. chest tightness and production of thick sputum.

A. edema and itching at the injection site. Initial symptoms include edema and itching at the site of the exposure to the allergen.

The patient who has a conductive hearing loss A. hears better in a noisy environment. B. hears sound but does not understand speech. C. often speaks loudly because his or her own voices seems low. D. experiences clearer sound with a hearing aid if the loss is less than 30 dB.

A. hears better in a noisy environment. The patient with conductive hearing loss often speaks softly because hearing his or her own voice (which is conducted by bone) seems loud. This patient hears better in a noisy environment. The first step is to identify and treat the cause if possible. If correction of the cause is not possible, a hearing aid may help if the loss is greater than 40 to 50 dB.

The nurse should teach the patient with ankylosing spondylitis the importance of A. regularly exercising and maintaining proper posture. B. avoiding extremes in environmental temperatures. C. maintaining usual physical activity during flare-ups. D. applying hot and cool compresses for relief of local symptoms.

A. regularly exercising and maintaining proper posture. Patients with ankylosing spondylitis (AS) should exercise after pain and stiffness are managed. Postural control is important for minimizing spinal deformity. The exercise regimen should include back, neck, and chest stretches. The nurse should educate the patient with AS about regular exercise and attention to posture, local moist-heat applications, and knowledgeable use of drugs. The nurse should discourage excessive physical exertion during periods of active flare-up of the disease. Proper positioning at rest is essential. The mattress should be firm, and the patient should sleep on their back with a flat pillow, avoiding positions that encourage flexion deformity. Postural training emphasizes avoiding spinal flexion (e.g., leaning over a desk), heavy lifting, and prolonged walking, standing, or sitting.

In teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on A. the thickness of the lesion. B. the degree of asymmetry in the lesion. C. the amount of ulceration in the lesion. D. how much the lesion has spread superficially.

A. the thickness of the lesion. The most important prognostic factor is tumor thickness at the time of diagnosis. Two methods are used to determine thickness. The Breslow measurement indicates the depth of the tumor in millimeters, and the Clark level indicates the depth of invasion of the tumor. The higher the number, the deeper the melanoma.

Transmission of HIV from an infected individual to another most commonly occurs as a result of A. unprotected anal or vaginal sexual intercourse. B. low levels of virus in the blood and high levels of CD4+ T cells. C. transmission from mother to infant during labor and delivery and breastfeeding. D. sharing of drug-using equipment, including needles, syringes, pipes, and straws.

A. unprotected anal or vaginal sexual intercourse. Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner infected with human immunodeficiency virus (HIV) is the most common mode of HIV transmission.

Which statement about metabolic side effects of ART is true (select all that apply)? A. These are annoying symptoms that are ultimately harmless. B. ART-related body changes include central fat accumulation and peripheral wasting. C. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. D. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. E. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients.

B, C, D. Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.

Instruct the patient who is newly fitted with bilateral hearing aids to (select all that apply) A. replace the batteries monthly. B. clean the ear molds weekly or as needed. C. clean the ears with cotton tipped applicators daily. D. disconnect or remove the batteries when not in use. E. initially restrict usage to quiet listening in the home.

B, D, E. Initially, use of the hearing aid should be restricted to quiet situations in the home. As adjustment to the increase in sounds and background noise occurs, the patient can progress to using the hearing aid in situations in which several people are talking simultaneously. Next, use can be expanded to the outdoors and then shopping malls or grocery stores. When the hearing aid is not being worn, it should be should be disconnected or removed when not in use. Battery life averages 1 week. Ear molds should be cleaned weekly or as needed.

Dermatologic manifestations of Addison's disease can include (select all that apply) A. urticaria. B. loss of body hair. C. increased sweating. D. generalized hyperpigmentation. E. hypopigmentation in the legs and trunk.

B, D. Dermatologic manifestations of Addison's disease include loss of body hair, especially in the axillary area and generalized hyperpigmentation that is accentuated in the folds of the skin.

In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (select all that apply) A. the cream form is the most effective form of delivery. B. short-term use of topical corticosteroids usually does not cause systemic side effects. C. creams and ointments should be applied with a glove in small amounts to prevent further infection. D. abruptly discontinuing the use of topical corticosteroids may cause a reappearance of the dermatitis. E. systemic side effects may be experienced from topical corticosteroids if the person is malnourished.

B, D. Systemic corticosteroids often have undesirable systemic effects. Topical corticosteroids for short-term therapy have fewer systemic effects. Rebound dermatitis is common when therapy is stopped abruptly; this effect can be reduced by tapering the use of topical corticosteroids.

The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? A. Assessment of lung sounds B. Assessment of sexual behavior C. Assessment of living conditions D. Assessment of drug and syringe use E. Assessment of exposure to an ill person

B, D. With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).

A patient will rheumatoid arthritis is experiencing articular involvement of the joints. The nurse recognizes that these characteristic changes include (select all that apply) A. bamboo-shaped fingers. B. metatarsal head dislocation in feet. C. noninflammatory pain in large joints. D. asymmetric involvement of small joints. E. morning stiffness lasting 60 minutes or more.

B, E. Morning stiffness may last from 60 minutes to several hours or more, depending on disease activity. Metatarsal head dislocation and subluxation in the feet may cause pain and walking disability. Joint symptoms occur symmetrically and frequently affect the small joints of the hands (proximal interphalangeal [PIP] and metacarpophalangeal [MCP] joints) and feet (metatarsophalangeal [MTP] joints). Larger peripheral joints such as the wrists, elbows, shoulders, knees, hips, ankles, and jaw may also be involved. Rheumatoid arthritis (RA) is an inflammatory disorder. In early disease, the fingers may become spindle-shaped from synovial hypertrophy and thickening of the joint capsule.

In a person having an acute rejection of a transplanted kidney, what would help the nurse understand the course of events (select all that apply)? A. A new transplant should be considered. B. Acute rejection can be treated with OKT3. C. Acute rejection usually leads to chronic rejection. D. Corticosteroids are the most successful drugs used to treat acute rejection. E. Acute rejection is common after a transplant and can be treated with drug therapy.

B, E. Acute rejection is treatable and does not usually necessitate replacement transplantation. Monoclonal antibodies such as muromonab-CD3 (Orthoclone OKT3) are used for preventing and treating acute rejection episodes. Calcineurin inhibitors are the most effective immunosuppressants available to treat organ rejection. It is not uncommon to have at least one acute rejection episode, especially with organs from deceased donors. These episodes are usually reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies.

Which strategies would best assist the nurse in communicating with a patient who has hearing loss? (Select all that apply) A. Overenunciate speech. B. Speak normally and slowly. C. Exaggerate facial expressions. D. Raise the voice to a higher pitch. E. Write out names or difficult words.

B, E. Speak normally and slowly directly into the patient's better ear. Do not exaggerate facial expressions. Do not overenunciate. Use simple sentences; rephrase sentences; use different words. Write out names or difficult words. Avoid shouting.

A 58-year-old man who is waiting for a kidney transplant asks the nurse to explain the difference between a negative and positive cross match. Which statement by the nurse would be the most accurate response? A. "A negative cross match means that both the donor and recipient are Rh negative, and the transplant is safe." B. "A negative cross match means that no preformed antibodies are present and the transplant would be safe." C. "A positive cross match means the blood type is the same between donor and recipient, and the transplant is safe." D. "A positive cross match means that both the donor and the recipient have antigens that are similar, and the transplant would be safe."

B. "A negative cross match means that no preformed antibodies are present and the transplant would be safe." A cross match uses serum from the recipient mixed with donor lymphocytes to test for any preformed antibodies to the potential donor organ. A positive cross match indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation. A negative cross match indicates that no preformed antibodies are present and it is safe to proceed with transplantation.

The patient calls the clinic about a "sty" that she has had for some time on her upper eyelid. She says she has used warm moist compresses, but it is no better. What should the nurse tell her to do? A. "Go to the pharmacy to get some eye drops." B. "Come in so the ophthalmologist can remove the lesion for you." C. "The health care provider will need to inject it with an antibiotic." D. "Wash the lid margins with baby shampoo to remove the crusting."

B. "Come in so the ophthalmologist can remove the lesion for you." A chalazion may evolve from a "sty" or hordeolum as it did for this patient. Initial treatment is with warm compresses, but when they are ineffective, the lesion may be surgically removed or injected with corticosteroids. Washing the lid margins with baby shampoo is done with blepharitis.

A 19-year-old patient reports to the clinic nurse the following symptoms: a ring-like itchy rash on the upper leg, low-grade fever, nausea, and joint pain for the past 3 weeks. What question is important for the nurse to ask the patient? A. "Is the itching worse at night?" B. "Have you had a tick bite recently?" C. "Have you been exposed to pubic lice?" D. "Have you had unprotected sexual contact?"

B. "Have you had a tick bite recently?" Symptoms are consistent with Lyme disease caused by the organism Borrelia burgdorferi, which is transmitted by a tick bite.

A 66-year-old man with type 2 diabetes mellitus and atrial fibrillation has begun taking glucosamine and chondroitin for osteoarthritis. Which question is most important for the nurse to ask? A. "Did you have any hypoglycemic reactions?" B. "Have you noticed any bruising or bleeding?" C. "Have you had any dizzy spells when standing up?" D. "Do you have any numbness or tingling in your feet?"

B. "Have you noticed any bruising or bleeding?" Glucosamine and chondroitin are dietary supplements commonly used to treat osteoarthritis. Both glucosamine and chondroitin may increase the risk of bleeding. Anticoagulant therapy is indicated for patients with atrial fibrillation to reduce the risk of a thromboembolism and a stroke. Use of glucosamine and chondroitin along with an anticoagulant may precipitate excessive bleeding. Glucosamine may decrease the effectiveness of insulin or other drugs used to control blood glucose levels, and hyperglycemia may occur. Peripheral neuropathy symptoms that can develop with prolonged hyperglycemia include numbness and tingling in the feet.

The nurse teaches a 50-year-old woman with chronic kidney disease several interventions to reduce pruritus associated with dry skin and uremia. Which statement, if made by the patient to the nurse, indicates further teaching is required? A. "I will avoid taking hot showers." B. "I can rub my skin instead of scratching." C. "Menthol can be used to numb the itch sensation." D. "A lubricating lotion right after bathing will help."

B. "I can rub my skin instead of scratching." Any activity that causes vasodilation, such as rubbing or bathing and showering in hot water should be avoided as vasodilation leads to increased itching. Menthol in skin products provides a sensation that may distract the patient from the sensation of itchiness. Applying lotion right after bathing helps retain moisture in the skin.

When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement? A. "I should take the Naprosyn as prescribed to help control the pain." B. "I should try to stay standing all day to keep my joints from becoming stiff." C. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." D. "A warm shower in the morning will help relieve the stiffness I have when I get up."

B. "I should try to stay standing all day to keep my joints from becoming stiff." It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA. Naproxen (Naprosyn) may be used for moderate to severe OA pain. Using a cane and warm shower to help relieve pain and morning stiffness are helpful.

You are providing care for a 73-year-old male patient who has sought care because of a loss in his hearing acuity over the past several years. Which statement by the nurse is most accurate? A. "This is often due to an infection that will resolve on its own." B. "Many people experience an age-related decline in their hearing." C. "This is likely an effect of your medications. Try stopping them for a few days." D. "You can likely accommodate for your hearing loss with a few small changes in your routine."

B. "Many people experience an age-related decline in their hearing." Presbycusis is a loss of hearing that is both common and age-related. Infections are most often accompanied by different symptoms. It would be inappropriate to counsel the patient to stop his medications. It would be simplistic to advise the patient to accommodate the hearing loss rather than seek intervention.

When teaching a patient about the pathophysiology related to open-angle glaucoma, which statement is most appropriate? A. "The retinal nerve is damaged by an abnormal increase in the production of aqueous humor." B. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." C. "The lens enlarges with normal aging, pushing the iris forward, which then covers the outflow channels of the eye." D. "There is a decreased flow of aqueous humor into the anterior chamber by the lens of the eye blocking the papillary opening."

B. "There is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve." With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time. Primary angle-closure glaucoma is caused by the lens bulging forward and blocking the flow of aqueous humor into the anterior chamber.

A 71-year-old woman arrives in the emergency department after ingesting 8 g of acetaminophen (Tylenol). Which question is most important for the nurse to ask? A. "Do you feel like you have a fever?" B. "What time did you take the medication?" C. "Have you tried to commit suicide before?" D. "Are you experiencing any abdominal pain?"

B. "What time did you take the medication?" Acetaminophen will bind to activated charcoal and pass through the gastrointestinal tract without being absorbed. Activated charcoal is most effective if administered within 1 hour of ingestion of acetaminophen and other select poisons.

Which statement made by the nurse is most appropriate in teaching patient interventions to minimize the effects of seasonal allergic rhinitis? A. "You will need to get rid of your pets." B. "You should sleep in an air-conditioned room." C. "You would do best to stay indoors during the winter months." D. "You will need to dust your house with a dry feather duster twice a week."

B. "You should sleep in an air-conditioned room." Seasonal allergic rhinitis is most commonly caused by pollens from trees, weeds, and grasses. Airborne allergies can be controlled by sleeping in an air-conditioned room, daily damp dusting, covering the mattress and pillows with hypoallergenic covers, and wearing a mask outdoors.

A nurse is performing triage in the emergency department. Which patient should the nurse see first? A. 18-year-old patient with type 1 diabetes mellitus who has a 4-cm laceration on right leg B. 32-year-old patient with drug overdose who is unresponsive with a poor respiratory effort C. 56-year-old patient with substernal chest pain who is diaphoretic with shortness of breath D. 78-year-old patient with right hip fracture who is confused; blood pressure is 98/62 mm Hg

B. 32-year-old patient with drug overdose who is unresponsive with a poor respiratory effort The patient with a drug overdose is unstable and needs to be seen immediately. Patient with chest pain (possible myocardial infarction) should be seen second. Patient with hip fracture should be seen third. Patient with laceration is the most stable and should be seen last.

The nurse should recognize which patient as likely to have the poorest prognosis? A. A 60-year-old diagnosed with nodular ulcerative basal cell carcinoma B. A 59-year-old man who is being treated for stage IV malignant melanoma C. A 70-year-old woman who has been diagnosed with late squamous cell carcinoma D. A 51-year-old woman whose biopsy has revealed superficial squamous cell carcinoma

B. A 59-year-old man who is being treated for stage IV malignant melanoma Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late squamous cell carcinoma (SCC) has worse outcomes than superficial SCC, these are both exceeded in mortality by late-stage malignant melanoma.

When using the otoscope, the nurse is unable to see the landmarks or light reflex of the tympanic membrane. The tympanic membrane is bulging and red. What does the nurse think is most likely occurring in the patient's ear? A. Swimmer's ear B. Acute otitis media C. Impacted cerumen D. Chronic otitis media

B. Acute otitis media The manifestations of inability to see the landmarks or light reflex of the tympanic membrane and the bulging and redness of the tympanic membrane are those of acute otitis media. With swimmer's ear and chronic otitis media, there is frequently drainage in the external auditory canal. Impacted cerumen would block the visualization of the tympanic membrane.

The patient with Ménière's disease had decompression of the endolymphatic sac to reduce the frequent and incapacitating attacks she was experiencing. What should the nurse include in the discharge teaching for this patient? A. Airplane travel will be more comfortable now. B. Avoid sudden head movements or position changes. C. Cough or blow the nose to keep the Eustachian tube clear. D. Take antihistamines, antiemetics, and sedatives for recovery.

B. Avoid sudden head movements or position changes. After ear surgery the patient should avoid sudden head movements or position changes. The patient should not cough or blow the nose because this increases pressure in the Eustachian tube and middle ear cavity and may disrupt healing. Airplane travel should be avoided at first as increased pressure and ear popping is normally experienced, which will disrupt healing. Antihistamines, antiemetics, and sedatives are used to decrease the symptoms of acute attacks of Ménière's disease

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count below 200/µL C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µL

B. CD4+ T cell count below 200/µL Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.

Because the incidence of Lyme disease is very high in Wisconsin, the public health nurse is planning to provide community education to increase the number of people who seek health care promptly after a tick bite. What information should the nurse provide when teaching people who are at risk for a tick bite? A. The best therapy for the acute illness is an IV antibiotic. B. Check for an enlarging reddened area with a clear center. C. Surveillance is necessary during the summer months only. D. Antibiotics will prevent Lyme disease if taken for 10 days.

B. Check for an enlarging reddened area with a clear center. Following a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that usually occurs in 3 to 30 days. There may also be flu-like symptoms and migrating joint and muscle pain. Active lesions are treated with oral antibiotics for 2 to 3 weeks, and doxycycline is effective in preventing Lyme disease when given within 3 days after the bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors.

You are working in an AIDS hospice facility that is also staffed with LPNs/LVNs and UAPs. Which nursing action will you delegate to the LPN/LVN you are supervising? A. Assessing patients' nutritional needs and individualizing diet plans to improve nutrition B. Collecting data about the patients' responses to medications used for pain and anorexia C. Teaching the UAPs about how to lower the risk for spreading infections D. Assisting patients with personal hygiene and other activities of daily living as needed

B. Collecting data about the patients' responses to medications used for pain and anorexia The collection of data used to evaluate the therapeutic and adverse effects of medications is included in LPN/LVN education and scope of practice. Assessment, planning, and teaching are more complex skills that require RN education. Assistance with hygiene and activities of daily living should be delegated to the UAP.

The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager

B. Combination antiretroviral therapy Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

The patient has vancomycin-resistant enterococci (VRE) infection in a surgical wound. What infection precautions should the nurse use to best prevent transmission of the infection to the nurse, other patients, staff, and those outside the hospital? A. Droplet precautions B. Contact precautions C. Airborne precautions D. Standard precautions

B. Contact precautions Contact precautions are used to minimize the spread of pathogens that are acquired from direct or indirect contact. Droplet precautions are used with pathogens that are spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g., influenza, pertussis). Airborne precautions are used if the organism can cause infection over long distances when suspended in the air (e.g., TB, rubeola). Standard precautions are used with all patients and included in the transmission-based precautions above.

A nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient uses which description of the condition? A. Joint destruction caused by an autoimmune process B. Degeneration of articular cartilage in synovial joints C. Overproduction of synovial fluid resulting in joint destruction D. Breakdown of tissue in non-weight-bearing joints by enzymes

B. Degeneration of articular cartilage in synovial joints OA is a degeneration of the articular cartilage in diarthrodial (synovial) joints from damage to the cartilage. The condition has also been referred to as degenerative joint disease. OA is not an autoimmune disease. There is no overproduction of synovial fluid causing destruction or breakdown of tissue by enzymes.

When administering medications to the patient with gout, the nurse would recognize that which drug is used as a treatment for this disease? A. Colchicine B. Febuxostat C. Sulfaslazine D. Cyclosporine

B. Febuxostat Febuxostat (Uloric), a selective inhibitor of xanthine oxidase, is administered for long-term management of hyperuricemia in persons with chronic gout. An acute episode of gout is treated with colchicine and nonsteroidal antiinflammatory drugs (NSAIDs).

A hospital has seen a recent increase in the incidence of hospital care-associated infections (HAIs). Which measure should be prioritized in the response to this trend? A. Use of gloves during patient contact B. Frequent and thorough hand washing C. Prophylactic, broad-spectrum antibiotics D. Fitting and appropriate use of N95 masks

B. Frequent and thorough hand washing Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing between patients and when moving from one task to another, even with the same patient.

An 18-year-old college student with an exacerbation of systemic lupus erythematosus (SLE) has been receiving prednisone (Deltasone) 20 mg daily for 4 days. Which medical order should you question? A. Discontinue prednisone after today's dose. B. Give a "catch-up" dose of varicella vaccine. C. Check the patient's C-reactive protein level. D. Administer ibuprofen (Advil) 800 mg PO.

B. Give a "catch-up" dose of varicella vaccine. The varicella (chickenpox) vaccine is a live-virus vaccine and should not be administered to patients who are receiving immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone doses should be tapered gradually when patients have received long-term steroid therapy, but tapering is not necessary for short-term prednisone use. Measurement of C-reactive protein level is not the most specific test for monitoring treatment, but the test is inexpensive and frequently used. High doses of NSAIDs such as ibuprofen are more likely to cause side effects such as gastrointestinal bleeding but are useful in treating the joint pain associated with SLE exacerbations.

You are working with a student nurse to care for an HIV-positive patient with severe esophagitis caused by Candida albicans. Which action by the student indicates that you need to intervene most quickly? A. Putting on a mask and gown before entering the patient's room B. Giving the patient a glass of water after administering the ordered oral nystatin (Mycostatin) suspension C. Suggesting that the patient should order chile con carne or chicken soup for the next meal D. Placing a "No Visitors" sign on the door of the patient's room

B. Giving the patient a glass of water after administering the ordered oral nystatin (Mycostatin) suspension Nystatin should be in contact with the oral and esophageal tissues as long as possible for maximum effect. The other actions are also inappropriate and should be discussed with the student but do not require action as quickly. HIV-positive patients do not require droplet/contact precautions or visitor restrictions to prevent opportunistic infections. Hot or spicy foods are not usually well tolerated by patients with oral or esophageal fungal infections.

The nurse is teaching a group of young adults who live in a dormitory about the prevention of antibiotic-resistant infections. What should be included in the teaching plan? A. Save leftover antibiotics for future uses. B. Hand washing can prevent many infections. C. Antibiotics are indicated for preventing most colds. D. Stop taking prescribed antibiotics when symptoms improve.

B. Hand washing can prevent many infections.B. Hand washing can prevent many infections. Hand washing is the single most important action to prevent infections. Antibiotics are used to treat bacterial infections, not viral colds and flu. Patients should complete the entire prescription of antibiotics to prevent the development of resistant bacteria. Antibiotics should not be taken to prevent infections unless they are given prophylactically before undergoing certain surgeries and dental work.

The nurse determines that a patient with a diagnosis of which disorder is most at risk for spreading the disease? A. Tinea pedis B. Impetigo on the face C. Candidiasis of the nails D. Psoriasis on the palms and soles

B. Impetigo on the face Impetigo is caused by a bacterial infection (group A β-hemolytic streptococci or staphylococci) and is highly contagious. Good skin hygiene and infection control practices are necessary to prevent the spread of this infection. Tinea pedis and candidiasis are fungal infections. Psoriasis is an autoimmune chronic dermatitis and is not contagious.

The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which finding should the nurse expect to be present on examination of the patient's knees? A. Ulnar drift B. Pain with joint movement C. Reddened, swollen affected joints D. Stiffness that increases with movement

B. Pain with joint movement OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis (RA) not osteoarthritis. Not all joints are reddened or swollen. Only Heberden's and Bouchard's nodes may be. Stiffness decreases with movement.

A patient has severe myopia. Which type of correction is the patient planning to have if she tells you, "I can't wait to be able to see after they implant a contact lens over my lens"? A. Photorefractive keratectomy (PRK) B. Phakic intraocular lenses (phakic IOLs) C. Refractive intraocular lens (refractive IOL) D. Laser-assisted in situ keratomileusis (LASIK)

B. Phakic intraocular lenses (phakic IOLs) Phakic intraocular lenses (phakic IOLs) is the implantation of a contact lens in front of the natural lens. PRK is used with low to moderate amounts of myopia, and the epithelium is removed and the laser sculpts the cornea to correct the refractive error. Refractive IOL is also for patients with a high degree of myopia or hyperopia and involves removing the natural lens and implanting an intraocular lens. LASIK surgery is similar to PRK except that the epithelium is replaced after surgery.

As the hospital employee health nurse, you are completing a health history for a newly-hired staff member. Which information given by the new employee most indicates the need for further nursing action before he or she begins orientation to patient care? A. The employee takes enalapril (Vasotec) for hypertension. B. The employee has an allergy to bananas, avocados, and papayas. C. The employee received a tetanus vaccination 3 years ago. D. TB skin test site has a 5-mm induration at 48 hours.

B. The employee has an allergy to bananas, avocados, and papayas. A high incidence of latex allergy in seen in individuals with allergic reactions to these fruits. More information and/or testing is needed to determine whether the new employee has a latex allergy, which might affect his or her ability to provide direct patient care. The other findings are important to include in documenting the employee's health history but do not affect the ability to provide patient care.

A patient who is HIV-positive and is taking nucleoside reverse transcriptase inhibitors and a protease inhibitor is admitted to the psychiatric unit with a panic attack. Which information about the patient is most important to discuss with the health care provider? A. The patient states, "I'm afraid I'm going to die right here!" B. The patient has an order for midazolam (Versed) 2 mg IV immediately (STAT). C. The patient is diaphoretic and tremulous, and reports dizziness. D. The patient's symptoms occurred suddenly while she was driving to work.

B. The patient has an order for midazolam (Versed) 2 mg IV immediately (STAT). Because protease inhibitors decrease the metabolism of many drugs, including midazolam, serious toxicity can develop when protease inhibitors are given with other medications. Midazolam should not be given to this patient. The other patient data are consistent with the patient's diagnosis of panic attack and do not indicate an urgent need to communicate with the provider.

You assess a 24-year-old patient with RA who is considering using methotrexate (Rheumatrex) for treatment. Which patient information is most important to communicate to the health care provider? A. The patient has many concerns about the safety of the drug. B. The patient has been trying to get pregnant. C. The patient takes a daily multivitamin tablet. D. The patient says that she has taken methotrexate in the past.

B. The patient has been trying to get pregnant. Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching, but does not indicate that methotrexate may be contraindicated for the patient.

After interviewing an HIV-positive patient who is considering starting highly active antiretroviral therapy (HAART), which patient information concerns you the most? A. The patient has been HIV positive for 8 years and has never taken any drug therapy for the HIV infection. B. The patient tells you, "I have never been very consistent about taking medications." C. The patient is sexually active with multiple partners and says "I always use a condom." D. The patient has many questions and concerns regarding the effectiveness and safety of the medications.

B. The patient tells you, "I have never been very consistent about taking medications." Drug therapy for HIV infection requires taking medications very consistently. Failure to take the medications daily can lead to mutations and the emergence of more virulent forms of the virus. Although the other data indicate the need for further assessments or interventions, they will not affect the decision to initiate antiretroviral therapy for this patient.

Which assessment finding of a 70-year-old male patient's skin should the nurse prioritize? A. The patient's complaint of dry skin that is frequently itchy B. The presence of an irregularly shaped mole that the patient states is new C. The presence of veins on the back of the patient's leg that are blue and tortuous D. The presence of a rash on the patient's hand and forearm to which the patient applies a corticosteroid ointment

B. The presence of an irregularly shaped mole that the patient states is new Although all of the noted assessment findings are significant, the presence of an irregular mole that is new is suggestive of a neoplasm and warrants immediate follow-up.

The mother does not want her child to have any extra immunizations for diseases that no longer occur. What teaching about immunization should the nurse provide this mother? A. There is currently no need for those older vaccines. B. There is a reemergence of some of the infections, such as pertussis. C. There is no longer an immunization available for some of those diseases. D. The only way to protect your child is to have the federally required vaccines.

B. There is a reemergence of some of the infections, such as pertussis. Teaching the mother that some of the diseases are reemerging and the damage they can do to her child gives the mother the information to make an informed decision. The immunizations still exist and do protect individuals.

A patient's low hemoglobin and hematocrit have necessitated a transfusion of packed red blood cells (RBCs). Shortly after the first unit of RBCs starts to infuse, the patient develops signs and symptoms of a transfusion reaction. Which type of hypersensitivity reaction has the patient experienced? A. Type I B. Type II C. Type III D. Type IV

B. Type II Transfusion reactions are characterized as a type II (cytotoxic) reaction in which agglutination and cytolysis occur. Type I hypersensitivity reactions are IgE-mediated reactions to specific allergens (e.g., exogenous pollen, food, drugs, or dust). Type III reactions are immune-complex reactions that occur secondary to antigen-antibody complexes. Type IV reactions are delayed cell-mediated immune response reactions.

A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs.

B. Viral replication will be inhibited. The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

The patient has had rashes and alopecia. What vitamin in which foods should be encouraged as a nutritional aid to these problems? A. Vitamin A in sweet potatoes, carrots, dark leafy greens B. Vitamin B7 (biotin) in liver, cauliflower, salmon, carrots C. Vitamin C in peppers, dark leafy greens, broccoli, and kiwi D. Vitamin D in canned salmon, sardines, fortified dairy, and eggs

B. Vitamin B7 (biotin) in liver, cauliflower, salmon, carrots A deficiency of Vitamin B7 (biotin) may result in rashes and alopecia. Eating foods with biotin will help decrease these problems. Vitamins A and C are needed for wound healing. Vitamin D is needed for bone and body health.

Which laboratory result is the best indicator that a patient with cellulitis is recovering from this infection? A. WBC of 2900/μL B. WBC of 8200/μL C. WBC of 12,700/μL D. WBC of 16,300/μL

B. WBC of 8200/μL The normal white blood cell count is generally 4000 to 11,000/μL. For this reason, the patient's level would be returning to normal if it was 8200/μL, indicating recovery from cellulitis. The 2900/µL is too low and indicates another problem is occurring. The 12,700/µL and 16,300/µL are evidence of continuing infection.

The nurse cares for a 41-year-old male patient admitted for uncontrolled seizures who is also diagnosed with impetigo on the face and neck. Which action is appropriate for the nurse to take? A. Put on a protective gown before entering the room. B. Wash hands for 1 to 2 minutes when leaving the room. C. Wear gloves to leave a diet menu on the patient's table. D. Wear a particulate mask when within 3 feet of the patient.

B. Wash hands for 1 to 2 minutes when leaving the room. Impetigo is a bacterial skin infection with group A β-hemolytic streptococci or staphylococci. Meticulous hygiene (including hand washing) is essential to prevent the spread of infection. A particulate mask or a gown would not be necessary to prevent the spread of impetigo. Gloves would not be needed to make a delivery to the room.

A patient has a core temperature of 90 F (32.2 C). The most appropriate rewarming technique would be A. passive rewarming with warm blankets. B. active internal rewarming using warmed IV fluids. C. passive rewarming using air-filled warming blankets. D. active external rewarming by submersing in a warm bath.

B. active internal rewarming using warmed IV fluids. Moderate hypothermia (temperature of 86° to 93.2° F) causes rigidity, bradycardia, slowed respiratory rate, blood pressure obtainable only by Doppler measurement, metabolic and respiratory acidosis, and hypovolemia. Techniques include heated (up to 111.2° F [44° C]), humidified oxygen; warmed IV fluids (up to 98.6° F [37° C]); peritoneal lavage with warmed (up to 113° F [45° C]) fluids; and extracorporeal circulation with cardiopulmonary bypass, rapid fluid infuser, or hemodialysis.

An older man arrives in triage disoriented and tachypneic. His skin is hot and dry. His wife states that he was fine earlier today. The nurse's next priority would be to A. obtain a detailed medical history from his wife. B. assess his vital signs, including a rectal temperature. C. determine the kind of insurance he has before treating him. D. start supplemental oxygen and have the ED physician see him.

B. assess his vital signs, including a rectal temperature. After the primary survey, the triage nurse should obtain a full set of vital sign measurements (including temperature). Core body temperature can be obtained rectally. Clinical manifestations of heatstroke include hot, dry skin; altered mental status (ranging from confusion to coma); hypotension; tachycardia; weakness, and a temperature higher than 104° F (40° C).

Antiretroviral drugs are used to A. cure acute HIV infection. B. decrease viral RNA levels. C. treat opportunistic diseases. D. decrease pain and symptoms in terminal disease.

B. decrease viral RNA levels. The goals of drug therapy in HIV infection are to (1) decrease the viral load, (2) maintain or raise CD4+ T cell counts, and (3) delay onset of HIV infection-related symptoms and opportunistic diseases.

In assessing the joints of a patient with osteoarthritis, the nurse understands that Heberden's nodes A. are often red, swollen, and tender. B. indicate osteophyte formation at the DIP joints. C. are the result of pannus formation at the PIP joints. D. occur from deterioration of cartilage by proteolytic enzymes.

B. indicate osteophyte formation at the DIP joints. Heberden's nodes are bony deformities in the distal interphalangeal joints that are indicative of osteophyte formation and loss of joint space in osteoarthritis.

During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You recognize this finding as A. lentigo. B. psoriasis. C. actinic keratosis. D. seborrheic keratosis.

B. psoriasis. Clinical manifestations of psoriasis include sharply demarcated, silvery scaling plaques on reddish skin, commonly on the scalp, elbows, knees, palms, soles, and fingernails; itching, burning, and pain; localized or general, intermittent or continuous pattern; and symptoms that vary in intensity from mild to severe.

Presbyopia occurs in older individuals because A. the eyeball elongates. B. the lens becomes inflexible. C. the corneal curvature becomes irregular. D. light rays are focusing in front of the retina.

B. the lens becomes inflexible. Presbyopia is the loss of accommodation in association with age. As the eye ages, the lens becomes larger, firmer, and less elastic.

The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.

C, D, E. Using male or female condoms, having monthly HIV testing for the patient and her husband, and the woman taking emtricitabine and tenofovir regularly has shown to decrease the infection of heterosexual women having sex with a partner who participates in high-risk behavior. Fluconazole and amphotericin B are taken for Candida albicans, Coccidioides immitis, and Cryptococcosus neoformans, which are all opportunistic diseases associate with HIV infection.

The nurse is providing preoperative teaching for the patient having a face-lift (rhytidectomy) surgery. Which patient response indicates the patient understands the teaching? A. "I am afraid of the pain afterwards, while it is healing." B. "I can't wait to have my forehead and lip wrinkles eliminated." C. "I have some time off work so I will not look so bad when I go back." D. "Now I can be excited to go to my 50th high school reunion this week."

C. "I have some time off work so I will not look so bad when I go back." A rhytidectomy or face-lift surgery will not have immediate results and will take time to heal, so taking time off from work will allow more healing to be accomplished before returning to work. There is not much pain with most cosmetic surgeries. A rhytidectomy will not eliminate forehead lines and vertical lip wrinkles.

A female patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease? A. "I'll try my best to stay out of the sun this summer." B. "I know that I probably have a high chance of getting arthritis." C. "I'm hoping that surgery will be an option for me in the future." D. "I understand that I'm going to be vulnerable to getting infections."

C. "I'm hoping that surgery will be an option for me in the future." Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. SLE carries an increased risk of infection, sun damage, and arthritis.

A 62-year-old woman diagnosed with fibromyalgia syndrome (FMS) reports difficulty sleeping at night. Which suggestion should the nurse give to the patient? A. "Drinking a glass of red wine 30 minutes before bedtime will reduce anxiety and help you fall asleep." B. "Evening primrose oil is an herbal supplement that can be used as a sleep aid and to relieve anxiety." C. "Melatonin is a hormone that is often used in supplements to improve sleep and ease fibromyalgia pain." D. "Diphenhydramine (Benadryl) is a nonprescription sleep aid that is effective and does not cause tolerance."

C. "Melatonin is a hormone that is often used in supplements to improve sleep and ease fibromyalgia pain." Melatonin is a hormone prepared as a supplement. Scientific evidence suggests that melatonin decreases sleep latency and may increase the duration of sleep. In addition, melatonin may decrease fatigue and pain in individuals with fibromyalgia. Alcohol should not be consumed 4 to 6 hours before bedtime. Evening primrose oil is an herbal product used for breast pain (oral form) and skin disorders (topical form). Long-term use of diphenhydramine for sleep causes tolerance.

A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

Which statement is most appropriate when teaching a patient about timolol (Timoptic) eye drops in the treatment of glaucoma? A. "You may feel some palpitations after instilling these eye drops." B. "You should withhold this medication if your blood pressure becomes elevated." C. "You may have some temporary blurring of vision after instilling these eye drops." D. "You should keep your eyes closed for 15 minutes after instilling these eye drops."

C. "You may have some temporary blurring of vision after instilling these eye drops." It is common for patients to have a temporary blurring of vision for a few minutes after instilling eye drops. This should not cause concern to the patient. Because timolol is a β-blocker, heart rate may slow, and blood pressure is more likely to decrease if absorbed systemically.

The nurse is teaching about skin cancer prevention at the community center. Which individual is most at risk for developing skin cancer? A. A 67-year-old bald-headed man with psoriasis and type 2 diabetes mellitus B. A 76-year-old Hispanic man who has a latex allergy and numerous acrochordons C. A 55-year-old woman with fair skin and red hair who has a family history of skin cancer D. A 62-year-old woman with chronic kidney disease who has blond hair with dry, pale skin and pruritus

C. A 55-year-old woman with fair skin and red hair who has a family history of skin cancer Risk factors for skin cancer include having fair skin (with red hair) and a family history of skin cancer. Allergies, acrochordons (skin tags), psoriasis, type 2 diabetes mellitus, and chronic kidney disease are not risk factors associated with the development of skin cancer.

A patient with a history of liver transplantation is receiving cyclosporine (Sandimmune), prednisone (Deltasone), and mycophenolate (CellCept). Which finding is of most concern? A. Gums that appear very pink and swollen B. A blood glucose level that is increased to 162 mg/dL C. A nontender lump above the clavicle D. Grade 1+ pitting edema in the feet and ankles

C. A nontender lump above the clavicle Patients taking immunosuppressive medications are at increased risk for development of cancer. A nontender swelling or lump may signify that the patient has lymphoma. The other data indicate that the patient is experiencing common side effects of the immunosuppressive medications.

The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

C. A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

An 18-year-old female has been admitted to the emergency department (ED) after ingesting an entire bottle of chewable multivitamins in a suicide attempt. The nurse should anticipate which intervention? A. Induced vomiting B. Whole bowel irrigation C. Administration of activated charcoal D. Administration of fresh frozen plasma

C. Administration of activated charcoal Among the most common treatments for poisoning is the administration of activated charcoal. Induced vomiting is not typically indicated, and there is no need for plasma administration. Whole bowel irrigation may be used as an adjunct therapy later in treatment, but the use of activated charcoal is central to the treatment of poisonings.

The patient developed gout while hospitalized for a heart attack. When doing discharge teaching for this patient who takes aspirin for its antiplatelet effect, what should the nurse include about preventing future attacks of gout? A. Limit fluid intake. B. Administration of probenecid (Benemid) C. Administration of allopurinol (Zyloprim) D. Administration of nonsteroidal antiinflammatory drugs (NSAIDs)

C. Administration of allopurinol (Zyloprim) To prevent future attacks of gout, the urate-lowering drug allopurinol may be administered. Increased fluid will be encouraged to prevent precipitation of uric acid in the renal tubules. This patient will not be able to take the uricosuric drug probenecid because the aspirin the patient must take will inactivate its effect, resulting in urate retention. NSAIDs for pain management will not be used, related to the aspirin, because of the potential for increased side effects.

A patient with wheezing and coughing caused by an allergic reaction to penicillin is admitted to the emergency department. Which medication do you anticipate administering first? A. Methylprednisolone (Solu-Medrol) 100 mg IV B. Cromolyn (Intal) 20 mg via nebulizer C. Albuterol (Proventil) 3 mL via nebulizer D. Aminophylline (Theophylline) 500 mg IV

C. Albuterol (Proventil) 3 mL via nebulizer Albuterol is the most rapidly acting of the medications listed. Corticosteroids are helpful in preventing allergic reactions but are not rapidly acting. Cromolyn is used as a prophylactic medication to prevent asthma attacks but not to treat acute attacks. Aminophylline is not a first-line treatment for bronchospasm.

What should be included in the nursing plan for a patient who needs to administer antibiotic eardrops? A. Cool the drops so that they decrease swelling in the canal. B. Avoid placing a cotton wick to assist in administering the drops. C. Be careful to avoid touching the tip of the dropper bottle to the ear. D. Keep the head titled 5 to 7 minutes after administration of the drops.

C. Be careful to avoid touching the tip of the dropper bottle to the ear. Hands should be washed before and after administration of otic drops (eardrops). The drops should be administered at room temperature, because cold drops can cause vertigo and heated drops can burn the tympanum. To prevent contamination of the entire bottle of drops, the tip of the dropper should not touch the ear during administration. The ear is positioned so that the drops can run into the canal. This position should be maintained for 2 minutes after eardrop administration to allow the drops to become instilled. Drops can be placed onto a wick of cotton that is placed in the canal. Instruct the patient not to push the cotton farther into the ear. Material saturated with drainage should be carefully handled and discarded.

In teaching a patient with Sjögren's syndrome about drug therapy for this disorder, the nurse includes instruction on use of which drug? A. Pregabalin B. Etanercept C. Cyclosporine D. Cyclobenzaprine

C. Cyclosporine Cyclosporine (Restasis) ophthalmic drops can be used to treat the chronic dry eye associated with Sjögren's syndrome.

The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do what? A. Use a wheelchair to avoid walking as much as possible. B. Sit in chairs that cause the hips to be lower than the knees. C. Eat a well-balanced diet to maintain a healthy body weight. D. Use a walker for ambulation to relieve the pressure on the hips.

C. Eat a well-balanced diet to maintain a healthy body weight. maintain an optimal overall body weight or lose weight if overweight. Walking is encouraged. The chairs that would be best for this patient have a higher seat and armrests to facilitate sitting and rising from the chair. Relieving pressure on the hips is not important for OA of the knees.

When planning care for a patient with disturbed sensory perception related to increased intraocular pressure caused by primary open-angle glaucoma, what should the nurse focus on? A. Recognizing that eye damage caused by glaucoma can be reversed in the early stages B. Giving anticipatory guidance about the eventual loss of central vision that will occur C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision D. Managing the pain experienced by patients with glaucoma that persists until the optic nerve atrophies

C. Encouraging compliance with drug therapy for the glaucoma to prevent loss of vision Drug therapy is necessary to prevent the eventual vision loss that may occur as a consequence of glaucoma. For this reason, encourage the patient to remain compliant with drug therapy.

An older woman arrives in the ED complaining of severe pain in her right shoulder. The nurse notes that her clothes are soiled with urine and feces. She tells the nurse that she lives with her son and that she "fell." She is tearful and asks you if she can be admitted. What possibility should the nurse consider? A. Paranoia B. Possible cancer C. Family violence D. Orthostatic hypotension

C. Family violence. Family and intimate partner violence is a pattern of coercive behavior in a relationship that involves fear, humiliation, intimidation, neglect, and intentional physical, emotional, financial, or sexual injury.

A few minutes after you have given an intradermal injection of an allergen to a patient who is undergoing skin testing for allergies, the patient reports feeling anxious, short of breath, and dizzy. Which action included in the emergency protocol should you take first? A. Start oxygen at 4 L/min using a nasal cannula. B. Obtain IV access with a large-bore IV catheter. C. Give epinephrine (Adrenalin) 0.3 mL intramuscularly. D. Administer 3 mL of nebulized albuterol (Proventil) 0.083%.

C. Give epinephrine (Adrenalin) 0.3 mL intramuscularly. Epinephrine is the initial drug of choice for treatment of anaphylaxis. Giving epinephrine rapidly at the onset of an anaphylactic reaction may prevent or reverse cardiovascular collapse as well as airway narrowing caused by bronchospasm and inflammation. Oxygen use is also appropriate, but oxygen would be administered using a nonrebreather mask in order to achieve a fraction of inspired oxygen closer to 100%. Albuterol may also be administered to decrease airway narrowing but would not be the first therapy used for anaphylaxis. IV access will take longer to establish and should not be the first intervention.

When administering eye drops to a patient with glaucoma, which nursing measure is most appropriate to minimize systemic effects of the medication? A. Apply pressure to each eyeball for a few seconds after administration. B. Have the patient close the eyes and move them back and forth several times. C. Have the patient put pressure on the inner canthus of the eye after administration. D. Have the patient try to blink out excess medication immediately after administration.

C. Have the patient put pressure on the inner canthus of the eye after administration. Systemic absorption can be minimized by applying pressure to the inner canthus of the eye. The other options will not minimize systemic effects of the medication.

The nurse is monitoring the effectiveness of antiretroviral therapy (ART) for a 56-year-old man with acquired immunodeficiency syndrome (AIDS). What laboratory study result indicates the medications have been effective? A. Increased viral load B. Decreased neutrophil count C. Increased CD4+ T cell count D. Decreased white blood cell count

C. Increased CD4+ T cell count Antiretroviral therapy is effective if there are decreased viral loads and increased CD4+ T cell counts.

The patient with an autoimmune disease will be treated with plasmapheresis. What should the nurse teach the patient about this treatment? A. It will gather platelets for use later when needed. B. It will cause anemia because it removes whole blood and RBCs are damaged. C. It will remove the IgG autoantibodies and antigen complexes from the plasma. D. It will remove the peripheral stem cells in order to cure the autoimmune disease.

C. It will remove the IgG autoantibodies and antigen complexes from the plasma. Plasmapheresis removes plasma that contains autoantibodies (usually IgG class) and antigen-antibody complexes to remove the pathologic substances in the plasma without causing anemia. Plateletpheresis removes platelets from normal individuals for use by patients with low platelet counts. Apheresis is used to collect stem cells from peripheral blood that does not cure autoimmune disease.

A 21-year-old student had taken amoxicillin once as a child for an ear infection. She is given an injection of Penicillin V and develops a systemic anaphylactic reaction. What manifestations would be seen first? A. Dyspnea B. Dilated pupils C. Itching and edema D. Wheal-and-flare reaction

C. Itching and edema A systemic anaphylactic reaction starts with edema and itching at the site of exposure to the antigen. Shock can rapidly develop with rapid, weak pulse; hypotension; dilated pupils; dyspnea, and possible cyanosis. The wheal-and-flare reaction occurs with a localized anaphylactic reaction such as a mosquito bite.

A nurse teaches the emergency department staff about their roles during a disaster with mass casualties. Which primary responsibility should the nurse describe that is expected of all licensed and unlicensed health care staff? A. Notify local, state, and national authorities. B. Assist security personnel to patrol the area. C. Learn the hospital emergency response plan. D. Contact the American Red Cross for assistance.

C. Learn the hospital emergency response plan. All health care providers must be prepared for a mass casualty incident. The priority responsibility is to know the agency's emergency response plan.

The patient with diabetes mellitus has peripheral vascular disease. Knowing this, for which dermatologic manifestations should the nurse expect to assess? A. Redness of exposed areas of the skin on the hand, foot, face, or neck and infected dermatitis B. Leathery, brownish skin on lower leg, pruritis, concave lesions with edema, scar tissue with healing C. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing D. Atrophy, epidermal thinning, increased vascular fragility, impaired wound healing, thin loose dermis, and excess fat at the back of the neck

C. Loss of hair in periphery, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing The patient with diabetes mellitus and peripheral vascular disease is likely to have loss of peripheral hair, delayed capillary filling, dependent rubor, neuropathy, and delayed wound healing. The patient with a nicotinic acid (niacin) deficiency manifests redness of exposed areas of the skin on the hand or foot, face, or neck and infected dermatitis. The patient with venous ulcers will have leathery, brownish skin on the lower leg, pruritus, concave lesions with edema, and scar tissue with healing. The patient with glucocorticoid excess (Cushing syndrome) may have atrophy, epidermal thinning, increased vascular fragility, impaired wound healing, thin loose dermis, and excess fat at the back of the neck, clavicles, abdomen, and face.

A male patient is brought into the ED with multiple stab wounds to the legs, one stab wound to the left abdomen, and gang tattoos on both arms. He refused to identify his attacker and then loses consciousness. Police identify him as the assailant in the fatal stabbing of another man. What is the nurse's priority? A. Guard locked access doors. B. Maintain patient safety from revenge. C. Maintain personal and work place safety. D. Attain open patient airway and breathing.

C. Maintain personal and work place safety. The nurse's priority is to maintain personal and work place safety. Violence can erupt in the ED when treating gang members if the rival gang seeks revenge, or the patient's gang members seek to protect the patient with their presence. Staff members can be victims of that violence, so they should maintain a safe work environment by seeking law enforcement and security assistance in maintaining safety for the staff and the patient. ABCs are the usual priority, but this situation does not show any problem with the patient's airway or breathing.

A patient has begun immunotherapy for the treatment of intractable environmental allergies. When administering the patient's immunotherapy, what is the nurse's priority action? A. Monitor the patient's fluid balance. B. Assess the patient's need for analgesia. C. Monitor for signs and symptoms of an adverse reaction. D. Assess the patient for changes in level of consciousness.

C. Monitor for signs and symptoms of an adverse reaction. When administering immunotherapy, it is imperative to closely monitor the patient for any signs of an adverse reaction. The high risk and significant consequence of an adverse reaction supersede the need to assess the patient's fluid balance. Pain and changes in level of consciousness are not likely events when administering immunotherapy.

A patient who has received a kidney transplant has been admitted to the medical unit with acute rejection and is receiving IV cyclosporine (Sandimmune) and methylprednisolone (Solu-Medrol). Which staff member is best to assign to care for this patient? A. RN who floated to the medical unit from the coronary care unit for the day B. RN with 3 years of experience in the operating room who is orienting to the medical unit C. RN who has worked on the medical unit for 5 years and is working a double shift today D. Newly graduated RN who needs experience with IV medication administration

C. RN who has worked on the medical unit for 5 years and is working a double shift today To be most effective, cyclosporine must be mixed and administered in accordance with the manufacturer's instructions, so the RN who is likely to have the most experience with the medication should care for this patient or monitor the new graduate carefully during medication preparation and administration. The coronary care unit float nurse and the nurse who is new to the unit would not have experience with this medication.

A 56-year-old white patient presents with a flat, dry, scaly area on her eyebrows that is treated with a chemical peel. What should the nurse include in the discharge teaching? A. Metastasis of this type of cancer is rare. B. The patient has an increased risk for melanoma. C. Recurrence of the premalignant lesion is possible. D. Untreated lesions may metastasize to regional lymph nodes.

C. Recurrence of the premalignant lesion is possible. The flat or elevated dry scaly area is actinic keratosis from sun damage and is a premalignant skin lesion common in older whites with possible recurrence even with adequate treatment. Metastasis of basal cell carcinoma is rare; it is a small slowly enlarging papule. There is an increased risk for melanoma with atypical or dysplastic nevi. With squamous cell carcinoma, untreated lesions may metastasize to regional lymph nodes and distant organs, but it has a high cure rate with early detection and treatment.

A nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which activity pattern? A. Bed rest with bathroom privileges B. Daily high-impact aerobic exercise C. Regular exercise program of walking D. Frequent rest periods with minimal exercise

C. Regular exercise program of walking A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis. A balance of rest and activity is needed. High-impact aerobic exercises would cause stress to affected joints and further damage.

A 19-year-old male being tested for multiple allergies develops localized redness and swelling in reaction to a patch skin test. Which intervention by the nurse would have the highest priority? A. Notify the primary care provider B. Apply a topical antiinflammatory C. Remove the patch and extract from the skin D. Administer oral diphenhydramine (Benadryl)

C. Remove the patch and extract from the skin If a severe reaction to a patch skin test occurs, the nurse should immediately remove the patch and the extract from the skin. Next the nurse should apply a topical antiinflammatory cream to the site. A subcutaneous injection of epinephrine may also be necessary but would need a health care provider's order.

A male patient is recovering from a motor vehicle accident that left him blind. He is withdrawn and refuses to get out of bed. What is the nurse's priority goal for this patient? A. Use suitable coping strategies to reduce stress. B. Identify patient's strengths and support system. C. Verbalize feelings related to visual impairment. D. Transition successfully to the sudden vision loss.

C. Verbalize feelings related to visual impairment. The nurse's priority is to help the patient express his feelings about his vision loss because he is not coping effectively with his situation. Until the patient expresses how he feels, he will be unable to progress in his rehabilitation process.

A common site for the lesions associated with atopic dermatitis is the A. buttocks. B. temporal area. C. antecubital space. D. plantar surface of the feet.

C. antecubital space. The most common location for atopic dermatitis in adults is the antecubital or popliteal space.

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to A. remove T lymphocytes in her blood that are producing antinuclear antibodies. B. remove normal particles in her blood that are being damaged by autoantibodies. C. exchange her plasma that contains antinuclear antibodies with a substitute field. D. replace viral-damaged cellular components of her blood with replacement whole blood.

C. exchange her plasma that contains antinuclear antibodies with a substitute field. The rationale for performing therapeutic plasmapheresis in patients with autoimmune disorders such as SLE is to remove pathologic substances (i.e., antinuclear antibodies) from plasma.

Screening for HIV infection generally involves A. laboratory analysis of blood to detect HIV antigen. B. electrophoretic analysis for HIV antigen in plasma. C. laboratory analysis of blood to detect HIV antibodies. D. analysis of lymph tissues for the presence of HIV RNA.

C. laboratory analysis of blood to detect HIV antibodies. The most useful screening tests for HIV detect HIV-specific antibodies.

Opportunistic diseases in HIV infection A. are usually benign. B. are generally slow to develop and progress. C. occur in the presence of immunosuppression. D. are curable with appropriate drug interventions.

C. occur in the presence of immunosuppression. Management of HIV infection is complicated by the many opportunistic diseases that can develop as the immune system deteriorates (see Table 15-10).

The patient with diabetes mellitus has been ill for some time with a severe lung infection needing corticosteroids and antibiotics. The patient does not feel like eating. The nurse understands that this patient is likely to develop A. major histoincompatibility. B. primary immunodeficiency. C. secondary immunodeficiency. D. acute hypersensitivity reaction.

C. secondary immunodeficiency. Secondary immunodeficiency is most commonly caused by immunosuppressive drugs, such as corticosteroids. It can also be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient. The other options are not possible for this patient. Histoincompatibility occurs when the human leukocyte antigen (HLA) system of the donor is not compatible with the recipient's HLA genes. Primary immunodeficiency is rare and includes phagocytic defects, B cell deficiency, T cell deficiency, or a combination of B cell and T cell deficiency. Acute hypersensitivity reaction is an anaphylactic-type allergic reaction to an antigen.

One function of cell-mediated immunity is A. formation of antibodies. B. activation of the complement system. C. surveillance for malignant cell changes. D. opsonization of antigens to allow phagocytosis by neutrophils.

C. surveillance for malignant cell changes. One role of cell-mediated immunity is immune surveillance to detect any malignant changes in cells and then destroy them.

During HIV infection A. the virus replicates mainly in B-cells before spreading to CD4+ T cells. B. infection of monocytes may occur, but antibodies quickly destroy these cells. C. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. D. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.

C. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells. Immune dysfunction in HIV disease is caused predominantly by damage to and destruction of CD4+ T cells (i.e., T helper cells or CD4+ T lymphocytes).

The nurse is teaching a 24-year-old female patient who has 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. "I should avoid foods such as bananas, avocados, and kiwi." C. "I will use vinyl gloves for activities such as housekeeping." D. "Because my reactions are not severe, I will not need an EpiPen."

D. "Because my reactions are not severe, I will not need an EpiPen." An individual with latex allergies should carry an injectable epinephrine pen. The proteins in latex are similar to the proteins in certain foods and may cause an allergic reaction in people who are allergic to latex. Foods to avoid include banana, avocado, chestnut, kiwi, tomato, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, and apricots. Vinyl gloves are not latex and are safe to use. Individuals with latex allergies need to share this information with all health care providers and wear a medical alert bracelet.

The nurse obtains a history from a 46-year-old woman with rheumatoid arthritis. It is most important for the nurse to follow up on which patient statement? A. "I perform range of motion exercises at least twice a day." B. "I use a heating pad for 20 minutes to reduce morning stiffness." C. "I take a 20-minute nap in the afternoon even if I sleep 9 hours at night." D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."

D. "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)." Methotrexate can affect renal function. Patients should be well hydrated to prevent nephropathy. Heat application, range of motion, and rest are appropriate interventions to manage rheumatoid arthritis.

When performing teaching with a patient with glaucoma while administering a scheduled dose of pilocarpine, the nurse would include which statement? A. "Prolonged eye irritation is an expected adverse effect of this medication." B. "This medication will help to raise intraocular pressure to a near normal level." C. "This medication needs to be continued for at least 5 years after your initial diagnosis." D. "It is important not to do activities requiring visual acuity immediately after administration."

D. "It is important not to do activities requiring visual acuity immediately after administration." Pilocarpine causes blurred vision and difficulty in focusing, so it is important not to engage in any activities requiring visual acuity until the vision clears.

Which patient statement most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)? A. "My right elbow has become red and swollen over the last few days." B. "I wake up stiff every morning, and my knees just don't want to bend." C. "My husband tells me that my posture has become so stooped this winter." D. "My lower back pain seems to be getting worse all the time, and nothing seems to help."

D. "My lower back pain seems to be getting worse all the time, and nothing seems to help." AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.

Which statement by the patient who has had an organ transplant would indicate that the patient understands the teaching about the immunosuppressive medications? A. "My drug dosages will be lower because the medications enhance each other." B. "Taking more than one medication will put me at risk for developing allergies." C. "I will be more prone to malignancies because I will be taking more than one drug." D. "The lower doses of my medications can prevent rejection and minimize the side effects."

D. "The lower doses of my medications can prevent rejection and minimize the side effects." Because immunosuppressants work at different phases of the immune response, lower doses of each drug can be used to produce effective immunosuppression while minimizing side effects. The use of several medications is not because they enhance each other and does not increase the risk of allergies or of malignancies.

A 26-year-old patient is looking down as she tells the nurse that she is afraid to use the treatment recommended for her psoriasis because her mother had a lot of problems with all the creams she used to try to treat her psoriasis. How should the nurse respond to the patient? A. "You will only know if you try it and see." B. "You may need to get counseling to help you cope." C. "No treatment is medically necessary, but it can be removed." D. "Topical, light therapy, and systemic medications are now available."

D. "Topical, light therapy, and systemic medications are now available." Treatment of psoriasis usually involves a combination of strategies including topical treatments, phototherapy, and/or systemic medications including biologic drugs. Telling her that she will only know if she tries or that she may need counseling is denying the patient's concern. Psoriasis is treated to manage the disease as the patient may have a weakened immune system and be at risk for cardiovascular disease.

Which patient is at highest risk for developing graft-versus-host disease? A. A 65-year-old man who received an autologous blood transfusion B. A 40-year-old man who received a kidney transplant from a living donor C. A 65-year-old woman who received a pancreas and kidney from a deceased donor D. A 40-year-old woman who received a bone marrow transplant from a close relative

D. A 40-year-old woman who received a bone marrow transplant from a close relative Graft-versus-host disease occurs when an immunoincompetent patient is transfused or transplanted with immunocompetent cells. Examples include blood transfusions or the transplantation of bone marrow, fetal thymus, or fetal liver. An autologous blood transfusion is the collection and reinfusion of the individual's own blood or blood components. There is no risk for graft-versus-host disease in this situation.

To the nurse, a patient describes small, firm, reddened raised lesions with flat, rough patches that are causing intense pruritus. What should be the nurse's next assessment? A. History of seasonal allergies B. Initiation of new medication C. Previous pruritic skin lesions D. Activities in past 2 to 7 days

D. Activities in past 2 to 7 days The patient's lesions are papules and plaques characteristic of contact dermatitis. The nurse should ask the patient about activities over the past 2 to 7 days to identify potential allergens because contact dermatitis has a delayed onset. Even if an offending agent is not identified, the nurse can provide patient teaching about managing the pruritus and preventing infection by decreasing scratching. Seasonal allergies and new medications are more likely to cause urticaria than papules and plaque. The nurse should also ask about pruritic rashes in the past to determine potential illnesses that can cause dermatologic manifestations.

There has been a mass casualty incident. Which patient would likely be designated "red" during triage at the site of this occurrence? A. An individual who is distraught at the violence of the incident B. An individual who has experienced an open arm fracture from falling debris C. An individual who is not expected to survive a crushing head and neck wound D. An individual whose femoral artery has been severed and is bleeding profusely

D. An individual whose femoral artery has been severed and is bleeding profusely Red indicates a life-threatening injury requiring immediate intervention, such as severe bleeding. Emotional trauma would not warrant a "red" designation, whereas a fracture would likely be deemed "yellow," urgent, but not life-threatening. Those not expected to survive are categorized "blue."

What practice should the nurse teach a patient to follow when the patient is applying topical medication? A. Avoid applying medications directly onto dressings. B. Use a tongue blade whenever the patient's skin integrity allows. C. Avoid covering skin regions that have topical medication in place. D. Apply a layer of medication that is just thick enough to ensure coverage.

D. Apply a layer of medication that is just thick enough to ensure coverage. Patients should be directed to avoid applying topical medications too thickly. Medications may be applied directly on to dressings, and regions with medications may be covered. A tongue blade is not normally used for the application of a thin coat.

A patient with poor visual acuity is diagnosed with age-related macular degeneration (AMD). Which nursing intervention should be the nurse's priority? A. Teach about visual enhancement techniques. B. Teach nutritional strategies to improve vision. C. Assess coping strategies and support systems. D. Assess impact of vision on normal functioning.

D. Assess impact of vision on normal functioning. The most important nursing intervention is to assess the patient's ability to function with the visual impairment. The nurse will use this information to plan nursing care including assessment of the patient's coping strategies and teaching about vision enhancement techniques and nutrition.

What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? A. "Set up" a drug pillbox for the patient every week. B. Give the patient a video and a brochure to view and read at home. C. Tell the patient that the side effects of the drugs are bad but that they go away after a while. D. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances.

D. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances. The best approach to improve adherence to a treatment regimen is to learn about the patient's life and assist with problem solving within the confines of that life.

Association between HLA antigens and diseases is most commonly found in what disease conditions? A. Malignancies B. Infectious diseases C. Neurologic diseases D. Autoimmune diseases

D. Autoimmune diseases Most of the human leukocyte antigen (HLA)-associated diseases are classified as autoimmune disorders. Examples of associations between HLA types and disease include (1) that of HLA-B27 with ankylosing spondylitis, (2) those of HLA-DR2 and HLA-DR3 with systemic lupus erythematosus (SLE), and (3) those of HLA-DR3 and HLA-DR4 with diabetes mellitus.

You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP) pneumonia. Which information is most important to communicate to the physician? A. The patient is reporting pain at the site of the infusion. B. The patient is not taking in an adequate amount of oral fluids. C. Blood pressure is 104/76 mm Hg after pentamidine administration. D. Blood glucose level is 55 mg/dL after medication administration.

D. Blood glucose level is 55 mg/dL after medication administration. Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may need to be slowed. The other responses indicate a need for independent nursing actions (such as establishing a new IV site and encouraging oral intake) but are not associated with pentamidine infusion.

Ten days after receiving a bone marrow transplant, a patient develops a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A. The patient is experiencing a type I allergic reaction. B. An atopic reaction is causing the patient's symptoms. C. The patient is experiencing rejection of the bone marrow. D. Cells in the transplanted bone marrow are attacking the host tissue.

D. Cells in the transplanted bone marrow are attacking the host tissue. The patient's symptoms are characteristic of graft-versus-host-disease (GVHD) in which transplanted cells mount an immune response to the host's tissue. GVHD is not a type I allergic response or an atopic reaction, and it differs from transplant rejection in that the graft rejects the host rather than the host rejecting the graft.

Before administrating timolol (Timoptic) eye drops for treatment of glaucoma, the nurse would assess the patient for which contraindication for the use of this medicine? A. Sinusitis B. Migraine headaches C. Chronic urinary tract infection D. Chronic obstructive pulmonary disease

D. Chronic obstructive pulmonary disease Timolol is a nonselective β-adrenergic blocker that could lead to bronchoconstriction and bronchospasm. For this reason, it should not be used in patients with COPD. Timolol may be used to treat migraine headaches, and it does not affect sinusitis or chronic urinary tract infections.

A mailroom worker was exposed to anthrax (Bacillus anthracis). He is not sure if he inhaled any of it or if it got on his skin because he dropped the envelope when he saw the powder. What treatment(s) should the nurse anticipate? A. Induce vomiting and administer antitoxin. B. Patient isolation to prevent spread of virus C. Immediate vaccinia immune globulin (VIG) D. Ciprofloxacin (Cipro) to prevent systemic manifestations

D. Ciprofloxacin (Cipro) to prevent systemic manifestations To treat someone exposed to anthrax, antibiotics are effective to prevent systemic manifestations if treatment is begun early. Ciprofloxacin is the treatment of choice. Botulism is treated by inducing vomiting and administering antitoxin. A patient with hemorrhagic fever will be isolated to prevent the spread of the virus. Vaccinia immune globulin (VIG) is used for smallpox.

Your patient with rheumatoid arthritis (RA) is taking prednisone (Deltasone) and naproxen (Aleve) to reduce inflammation and joint pain. Which symptom is most important to communicate to the health care provider? A. RA symptoms are worst in the morning B. Dry eyes C. Round and moveable nodules just under the skin D. Dark-colored stools

D. Dark-colored stools Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications.

A patient seen in the sexually-transmitted disease clinic has just tested positive for HIV with a rapid HIV test. Which action will you take next? A. Ask about patient risk factors for HIV infection. B. Send a blood specimen for Western blot testing. C. Provide information about antiretroviral therapy. D. Discuss the positive test results with the patient.

D. Discuss the positive test results with the patient. A major purpose of HIV testing for asymptomatic patients is to ensure that HIV-positive individuals are aware of their HIV status, take actions to prevent HIV transmission, and effectively treat the HIV infection. According to current national guidelines, the other actions are also appropriate. Rapid HIV testing must be confirmed by another test, usually the Western blot test. Antiretroviral therapy is recommended for all HIV-positive patients. Risk factor information will be used in tracking patient contacts and in teaching the patient how to reduce the risk for transmission to others.

A 52-year-old female patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? A. Cough, diarrhea, headaches, blurred vision, muscle fatigue B. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy C. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lympadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

What accurately describes rejection following transplantation? A. Hyperacute rejection can be treated with OTK3. B. Acute rejection can be treated with sirolimus or tacrolimus. C. Chronic rejection can be treated with tacrolimus or cyclosporine. D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation. A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor's antigens and is an absolute contraindication to transplantation. If transplanted, the organ would undergo hyperacute rejection.

The nurse is teaching the residents of an independent living facility about preventing skin infections and infestations. What should be included in the teaching? A. Use cool compresses if an infection occurs. B. Oral antibiotics will be needed for any skin changes. C. Antiviral agents will be needed to prevent outbreaks. D. Inspect skin for changes when bathing with mild soap.

D. Inspect skin for changes when bathing with mild soap. Individuals living in independent living facilities are usually older, which means their skin does not need cleaning with hot water and vigorous scrubbing or as often as a younger person. Mild soap (e.g., Ivory) should be used to avoid loss of protection from neutralization of the skin's surface. The skin should be inspected for changes with bathing. Cool compresses are used with ringworm or stings for the antiinflammatory effect. Oral antibiotics are used for Lyme disease from ticks. Antiviral agents are used for viral infections but not to prevent outbreaks.

What is important for the nurse to include in postoperative care of the patient following tympanoplasty? A. Check the gag reflex. B. Encourage independence. C. Avoid changing the cotton padding. D. Instruct the patient to refrain from forceful nose blowing.

D. Instruct the patient to refrain from forceful nose blowing. Sudden pressure changes in the ear and postoperative infections can disrupt the surgical repair during the healing phase or cause facial nerve paralysis.

When administering a scheduled dose of pilocarpine, in which area should the nurse place the drops? A. Inner canthus B. Outer canthus C. Center of the eyeball D. Lower conjunctival sac

D. Lower conjunctival sac Ocular medications such as pilocarpine should be instilled into the lower conjunctival sac. Never apply eye drops directly to the cornea. Applying the drops to the inner canthus will cause them to be distributed systemically.

The patient with an allergy to bee stings was just stung by a bee. After administering oxygen, removing the stinger, and administering epinephrine, the nurse notices the patient is hypotensive. What should be the nurse's first action? A. Administer IV diphenhydramine (Benadryl). B. Administer nitroprusside as soon as possible. C. Anticipate tracheostomy with laryngeal edema. D. Place the patient recumbent and elevate the legs.

D. Place the patient recumbent and elevate the legs. In this emergency situation, the ABCs (airway, breathing, circulation) are being followed. For hypotension the patient should be placed in a recumbent position with the legs elevated, epinephrine will continue to be administered every 2-5 minutes, and fluids will be administered with vasopressors. Diphenhydramine is an antihistamine used to treat allergy symptoms. Anticipating a tracheostomy may occur with ongoing patient monitoring. Nitroprusside is a vasodilator and would not be used now.

The nurse is providing postoperative care for a 30-year-old female patient after an appendectomy. The patient has tested positive for human immunodeficiency virus (HIV). What type of precautions should the nurse observe to prevent the transmission of this disease? A. Droplet precautions B. Contact precautions C. Airborne precautions D. Standard precautions

D. Standard precautions Standard precautions are indicated for prevention of transmission of HIV to the health care worker. HIV is not transmitted by casual contact or respiratory droplets. HIV may be transmitted through sexual intercourse with an infected partner, exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or though breastfeeding.

The patient needs, but does not want, a corneal transplant because of the difficulty with vision that may last for up to 12 months after the transplant. What can the nurse teach the patient about this? A. If the transplant is done soon after the donor dies, there will not be as much trouble recovering vision. B. The astigmatism the patient is experiencing may be corrected with glasses or rigid contact lenses. C. Increasing the amount of light and using a magnifier to read will be helpful if a transplant is not wanted. D. There are newer procedures where only the damaged cornea epithelial layer is replaced, and they have a faster recovery.

D. There are newer procedures where only the damaged cornea epithelial layer is replaced, and they have a faster recovery. The new procedures are called Descemet's stripping endothelial keratoplasty (DSEK) and Descemet's membrane endothelial keratoplasty (DMEK). Corneal transplants should be done as soon as possible, but this does not affect the rate of visual recovery. Astigmatism is not experienced with corneal scars and opacities requiring a corneal transplant. Increasing light and magnification helps a person with cataracts to read.

A patient with septic shock is receiving multiple medications. Which IV medication is most likely to cause a hearing loss? A. Dopamine (Intropin) B. Ampicillin (Principen) C. Aspirin (Bayer Aspirin) D. Vancomycin (Vancocin)

D. Vancomycin (Vancocin) The IV medication in use that is most likely to cause a hearing loss is vancomycin (Vancocin) because it is an ototoxic medication. For that reason, serum drug levels are monitored to maintain therapeutic levels and reduce the risk of ototoxicity. Aspirin can also cause hearing loss, but it is not administered IV. Neither dopamine nor ampicillin is likely to cause hearing loss.

An HIV-positive patient who has been started on HAART is seen in the clinic for follow-up. Which test will be most helpful in determining the response to therapy? A. CD4 level B. Complete blood count C. Total lymphocyte percent D. Viral load

D. Viral load Viral load testing measures the amount of HIV genetic material in the blood, so a decrease in viral load indicates that the HAART is effective. The CD4 level, total lymphocytes, and complete blood count will also be used to assess the impact of HIV on immune function but will not directly measure the effectiveness of antiretroviral therapy.

The function of monocytes in immunity is related to their ability to A. stimulate the production of T and B lymphocytes. B. produce antibodies on exposure to foreign substances. C. bind antigens and stimulate natural killer cell activation. D. capture antigens by phagocytosis and present them to lymphocytes.

D. capture antigens by phagocytosis and present them to lymphocytes. The mononuclear phagocyte system includes monocytes in the blood and macrophages found throughout the body. Mononuclear phagocytes have a critical role in the immune system. They are responsible for capturing, processing, and presenting the antigen to the lymphocytes.

The nurse advises a friend who asks him to administer his allergy shots that A. it is illegal for nurses to administer injections outside of a medical setting. B. he is qualified to do it if the friend has epinephrine in an injectable syringe provided with his extract. C. avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. D. immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

D. immunotherapy should only be administered in a setting where emergency equipment and drugs are available. Anaphylactic reactions occur suddenly in hypersensitive patients after exposure to the offending allergen. They may occur after an allergy shot (i.e., parenteral injection). The cardinal principle in therapeutic management is speed in (1) recognition of signs and symptoms of an anaphylactic reaction, (2) maintenance of a patent airway, (3) prevention of spread of the allergen by use of a tourniquet, (4) administration of drugs, and (5) treatment for shock.

Patients with permanent visual impairment A. feel more comfortable with other visually impaired people. B. may feel threatened when others make eye contact during a conversation. C. usually need others to speak louder so they can communicate appropriately. D. may experience the same grieving process that is associated with other losses.

D. may experience the same grieving process that is associated with other losses. When the patient has lost visual function or even the entire eye, he or she will grieve the loss. The nurse should help the patient through the grieving process.

In a type I hypersensitivity reaction the primary immunologic disorder appears to be A. binding of IgG to an antigen on a cell surface. B. deposit of antigen-antibody complexes in small vessels. C. release of cytokines used to interact with specific antigens. D. release of chemical mediators from IgE-bound mast cells and basophils.

D. release of chemical mediators from IgE-bound mast cells and basophils. Type I hypersensitivity reactions occur only in susceptible persons who are highly sensitized to specific allergens. Immunoglobulin E (IgE) antibodies, produced in response to the allergen, have a characteristic property of attaching to mast cells and basophils.

A patient with acne vulgaris tells the nurse that she has quit her job as a receptionist because she believes her facial appearance is unattractive to customers. The nursing diagnosis that best describes this patient response is A. ineffective coping related to lack of social support. B. impaired skin integrity related to presence of lesions. C. anxiety related to lack of knowledge of the disease process. D. social isolation related to decreased activities secondary to fear of rejection.

D. social isolation related to decreased activities secondary to fear of rejection. Acne can develop and persist into adulthood, with flares occurring during menses and with the use of androgen-dominant birth control pills. Affected patients may withdraw from social contacts because of visible lesions.

The most important intervention for the patient with epidemic keratoconjunctivitis is A. cleansing the affected area with baby shampoo. B. monitoring spread of infection to the opposing eye. C. regular installation of artificial tears to the affected eye. D. teaching the patient and family members good hygiene techniques.

D. teaching the patient and family members good hygiene techniques. Epidemic keratoconjunctivitis (EKC) is the most serious ocular adenoviral disease. EKC is spread by direct contact, including sexual activity. The nurse should teach the patient and caregiver the importance of good hygienic practices to avoid spreading the disease.

A chemical explosion occurs at a nearby industrial site. The first responders report that victims are being decontaminated at the scene and approximately 125 workers will need medical evaluation and care. The nurse receiving this report should know that this will first require activation of A. a code blue alert. B. a disaster medical assistance team. C. the local police and fire departments. D. the hospital's emergency response plan.

D. the hospital's emergency response plan. The term emergency usually refers to any extraordinary event (e.g., multicasualty train crash) that necessitates a rapid and skilled response and that the community's existing resources can manage.

In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes A. circulating immune complexes formed from IgG autoantibodies reacting with IgG. B. an autoimmune T cell reaction that results in destruction of the deep dermal skin layer. C. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. D. the production of a variety of autoantibodies directed against components of the cell nucleus.

D. the production of a variety of autoantibodies directed against components of the cell nucleus. Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.