Adv. Med-Surg Exam 4: Chapters 35-42
The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate?
3 mL/min
The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?
45 degrees onto the unoperated side if the affected hip is kept abducted
The nurse is caring for a client with renal failure. Which factor indicates a compromised immune system?
A deficiency of circulating lymphocytes
Which of the following is an example of a gliding joint?
Carpal bones in the wrist
Colles fracture occurs in which area?
Distal radius
The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:
Elevate the affected area.
T-cells can be either regulator T cells or effector T cells. Regulator T cells are made up of helper and suppressor cells. What function are helper T-cells important in?
Fighting infection
An infant that is 10 hours postdelivery is observed to have tetanic contractions. What symptom does the nurse recognize can indicate DiGeorge syndrome?
Hypocalcemia
Which immunoglobulin assumes a major role in bloodborne and tissue infections?
IgG
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?
Increase fiber intake
A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment?
Joint pain, crepitus, Heberden's nodes
What chemical is released by cytotoxic T cells?
Lymphokine
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?
Raloxifene (Evista)
A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." What reaction will the nurse suspect?
Rhinitis medicamentosa
A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which reason?
Use of anti-rejection drugs
There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting:
movement of skeletal bones
Which cells are involved in bone resorption?
osteoclasts
Which adverse effect should the nurse closely monitor in a client who takes immunosuppressive drugs?
Respiratory or urinary system infections
A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?
"Describe the pain and rate it on the pain scale."
The nurse is preparing the client for magnetic resonance imaging after reports of low back pain. What statement by the client requires action by the nurse?
"I didn't remove my Transderm-Nitro patch."
Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply.
-Apply cold packs -Administer analgesics -Elevate the involved part
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
Bank autologous blood
A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?
Hematoma
Which of the following positions should be avoided in severe back pain?
Prone
The nurse working in the emergency department is asked to explain allergy testing to a client who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction?
Serum-specific IgE test
A client is scheduled to receive an intravenous immunoglobulin (IVIG) infusion. The client asks the nurse about the infusion's administration and its adverse effects. Which condition should the nurse instruct this client to report immediately?
Tickle in the throat
A pediatric client is recovering from an anaphylactic reaction to an allergen which brought him to the ED. The client's mother is quite concerned with the potential reoccurrence of her child's reaction. In attempting to narrow down the possible allergen, it is important to consider that clinical manifestations generally correlate with:
route of exposure.
After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client makes which statement?
"I should avoid being around other people who have an infection."
Which microorganism is known to cause retinitis in people with HIV/AIDS?
Cytomegalovirus
The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?
"I was worried I would have an incision and scar."
The nurse is teaching the client who has an immunodeficiency disorder how to avoid infection at home. Which statement indicates that additional teaching is needed?
"I will be sure to eat lots of fresh fruits and vegetables every day."
The nursing instructor is discussing allergic reactions with her clinical group. What allergic reactions would the nursing instructor talk about? Select all that apply.
-Cytotoxic -Atopic -Immune complex
A nurse is preparing to give a client an infusion of gamma globulin. The nurse knows to stop the infusion if the client experiences which symptoms? Select all that apply.
-Flank pain -Shaking chills -Tightness in the chest
Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend.
1,200 mg; 1,000 IU
The nurse is caring for a client experiencing an anaphylactic reaction. The nurse prepares for the maximum intensity of histamine response to occur within which time frame?
5 to 10 minutes
Which of the following procedures involves a surgical fusion of the joint?
Arthrodesis
A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?
Assist with a gradual introduction of activity.
A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?
Bone abscess formation
Nursing students are reviewing information about the various types of primary immunodeficiencies. The students demonstrate understanding of the material when they identify which of the following as an example of a primary immunodeficiency involving B-lymphocyte dysfunction?
CVID
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?
Corn
The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication?
Foot drop
A woman infected with HIV comes into the clinic. What symptoms may be the focus of a medical complaint in women infected with HIV?
Gynecologic problems
In which deformity does the great toe deviate laterally?
Hallux valgus
During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding?
Hammer toe
When describing the effects of treatment for phagocytic cell disorders, which of the following would the nurse include as being the most successful?
Hematopoietic stem cell transplantation
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
Left hip arthroplasty
A parent has brought a child to the clinic for a wellness check. While talking with the nurse, the parent asks the nurse to suggest a diet that will maximize the immune function of growing children. What dietary pattern should the nurse suggest?
Moderate diet that is balanced and varied
A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings?
Osteomyelitis
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?
Paget disease
Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment?
Past substance abuse
A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?
The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
With the leg on the affected side abducted
A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement?
"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling."
What intervention is a priority when treating a client with HIV/AIDS?
Assessing fluid and electrolyte balance
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?
Carpal tunnel syndrome
Activation of a natural immunity response is enhanced by physical and chemical barriers. Which of the following is a physical barrier, which the nurse knows can be altered by illness, nutrition, or lifestyle?
Cilia of the respiratory tract
Which finding is consistent with the diagnosis of rheumatoid arthritis?
Cloudy synovial fluid
The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?
Cool skin
Which of the following is a age-related change associated with the immune system?
Decreased antibody production
A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used?
Digestive enzymes destroy its protein structure.
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?
Dislocation of the hip
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?
Dupuytren's contracture
A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for?
Enzyme-linked immunosorbent assay
The nurse is caring for a female patient who has an exacerbation of lupus erythematosus. What does the nurse understand is the reason that females tend to develop autoimmune disorders more frequently than men?
Estrogen tends to enhance immunity.
A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client?
Exploring factors related to the client's home environment
A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
Keeping a pillow between the client's legs at all times
A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class?
Leukotriene-receptor antagonist
A client is receiving ganciclovir as part of the treatment for cytomegalovirus retinitis. What would the nurse monitor the results of the client's laboratory tests for?
Neutropenia
Which medication classification is known to inhibit prostaglandin synthesis or release?
Nonsteroidal anti-inflammatory drugs (in large doses)
Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?
Peroneal
A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?
Sicca syndrome
A nurse is teaching a community group about healthy lifestyles. A participant asks about how to maintain a healthy immune system. The nurse informs the group that which factor will positively affect the immune system?
Strong family and community connections
T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do?
T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person.
The anatomy and physiology instructor is explaining a cell-mediated response to the pre-nursing students. What actions would the instructor explain occur in a cell-mediated response?
T-cell lymphocytes survey proteins in the body and attack the invading antigens.
A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment?
TMP-SMZ
A 64-year-old male client, who leads a sedentary life-style, and a 31-year-old female client, who has a very stressful and active life-style, require a vaccine against a particular viral disorder. As the nurse, you would know that in one of these clients the vaccine will be less effective. In which client is the vaccine more likely to be less effective and why?
The male client because of his age
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
A client is scheduled to have a prick test to determine what specific allergens are creating problems for the client. What should the nurse inform the client is involved with the testing?
The skin will be scratched, and applying a small amount of the liquid test antigen to the scratch, usually on the back.
A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?
Use of isometric exercises
Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis?
Vascular lesions
The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what?
Vascular lesions caused by dilated blood vessels
What test will the nurse assess to determine the client's response to antiretroviral therapy?
Viral load
A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?
Volkmann's ischemic contracture
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest?
Walking
The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder?
contact dermatitis
A nurse has developed a latex allergy and now uses latex-free purple gloves to avoid a hypersensitivity response. What in this nurse's reaction to latex differs from all other types of hypersensitivity responses?
no antibody production
A client has had several recent clinical visits for allergic contact dermatitis. The nurse explains to the client that allergy testing is indicated. Which test will most likely be performed?
patch test
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact?
photoallergic
The client asks the nurse about types of exercise that do not stress the joints. What exercise will the nurse include in the teaching plan?
t'ai chi
A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?
traction
In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type of hypersensitivity response?
type I
The term used to define the amount of virus in the body after the initial immune response subsides is
viral set point.
A client with a history of anaphylactic reactions to insect stings has just been stung by a wasp. Place the steps in the correct order that the client will follow for self-administration of an EpiPen. Use all options.
-Remove the gray safety-release cap -Inject the black tip into the outer thigh -Massage the injection area -Call the emergency medical response number (911)
Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?
Any chronic disorder or recent injury
A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?
Apply a tourniquet.
The nurse is conducting discharge teaching for a client who is being discharged from the emergency department after an anaphylactic reaction to peanuts. Which education should the nurse include in the teaching? Select all that apply.
-Wearing a medical alert bracelet -Avoiding allergens
A health care provider prescribed fluticasone for a client with a severe case of allergic rhinitis. The client took a first dose on February 2. What is the latest date by which the drug will be fully effective?
February 15
A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?
A bone biopsy
Which statement describes paresthesia?
Abnormal sensations
A nurse is working in a pediatric clinic. After giving a hepatitis B immunization to an infant, the parent asks what kind of protection this provides for the child. What is the nurse's best response?
Active acquired immunity, which lasts many years or a lifetime
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase
A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?
An arthroscopy