ADV. MED SURGE Exam 4 (ch 32-40)

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? 1 Apply a cold pack at the insertion site. 2 Apply warm compresses to the insertion site. 3 Provide a gentle massage. 4 Assist with performing ROM exercises.

1 After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling.

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding? 1 Tear in the joint capsule 2 Fracture of the clavicle 3 Decreased bone density 4 Injury to the radial nerve

1 Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. Bone densitometry is used to estimate bone mineral density. An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.

The client's CBC with differential reveals small-shaped hemoglobin molecules. The nurse expects to administer which medication to this client? 1 Iron 2 Vitamin B12 3 Folate 4 Fresh frozen plasma

1 With iron deficiency, the erythrocytes produced by the marrow are small and low in hemoglobin. Vitamin B12 and folate deficiencies are characterized by the production of abnormally large erythrocytes. Fresh frozen plasma are infused due to a low platelet level, not light-colored hemoglobin.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? 1 Have the patient extend both hands while the nurse compares the volume of both radial pulses. 2 Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. 3 Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. 4 Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

2

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? 1 Basophils 2 Neutrophils 3 Eosinophils 4 Monocytes

2

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? 1 Hypertension 2 Osteoporosis 3 Muscle wasting 4 Truncal obesity

2 Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about? 1 Nitrous oxide 2 Nitric oxide 3 Betamethasone 4 Terbutaline

2 Inhaled nitric oxide—not nitrous oxide (laughing gas), a vasodilating agent—is believed to reduce sickling by promoting the binding of oxygen to hemoglobin. It is being used in the form of handheld inhalers to abort or relieve pain experienced during sickle cell crises. Betamethasone is a corticosteroid, and terbutaline is not used as an inhaler.

A client with suspected human immunodeficiency virus (HIV) has had two positive enzyme-linked immunosorbent assay (ELISA) tests. What diagnostic test would be run next? 1 ELISA 2 Western Blot 3 T4/T8 ratio 4 Polymerase chain reaction

2 The ELISA test, an initial HIV screening test, is positive when there are sufficient HIV antibodies; it also is positive when there are antibodies from other infectious diseases. The test is repeated if results are positive. If results of a second ELISA test are positive, the Western blot is performed. A positive result on Western blot confirms the diagnosis; however, false-positive and false-negative results on both tests are possible. A polymerase chain reaction gives the viral load of the client. The T4/T8 ratio determines the status of T lymphocytes.

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? 1 Meniscography 2 Bone densitometry 3 Arthrography 4 EMG

3

Which type of lymphocyte is responsible for cellular immunity? 1 B lymphocyte 2 Plasma cell 3 T lymphocyte 4 Basophil

3 T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells. This process is known as cellular immunity. B lymphocytes are responsible for humoral immunity. A plasma cell secretes immunoglobulin. A basophil contains histamine and is an integral part of hypersensivity reactions.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? 1 Client complains of tingling and numbness in the right shoulder. 2 Right shoulder is elevated above the left. 3 Client complains of pain in the unaffected shoulder. 4 Right shoulder slopes downward and droops inward.

4

A patient with end-stage kidney disease (ESKD) has developed anemia. What laboratory finding does the nurse understand to be significant in this stage of anemia? 1 Potassium level of 5.2 mEq/L 2 Magnesium level of 2.5 mg/dL 3 Calcium level of 9.4 mg/dL 4 Creatinine level of 6 mg/100 mL

4 The degree of anemia in patients with end-stage renal disease varies greatly; however, in general, patients do not become significantly anemic until the serum creatinine level exceeds 3 mg/100 mL.

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client? 1 The client is having an allergic reaction to the blood. 2 The client is experiencing vascular collapse. 3 The client is having decrease in tissue perfusion from a shock state. 4 The client is having a febrile nonhemolytic reaction.

4 The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills (minimal to severe) followed by fever (more than 1°C elevation). The fever typically begins within 2 hours after the transfusion is begun. Although the reaction is not life threatening, the fever, and particularly the chills and muscle stiffness, can be frightening to the client.

Basophils produce _________?

A circulating leukocyte that produces histamine.

_____________________—the most serious complication of casting and splinting—occurs when increased pressure within a confined space (e.g., cast, muscle compartment) compromises blood flow and tissue perfusion

Compartment syndrome Assess the 6 p's= pain, poikilothermia, pallor. pulselessness, paresthesia, and paralysis.

Which leukocytes arrive at the inflammation site? A. Basophils B. Eosinophils C. Monocytes D. Neutrophils

D

________________is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection: a. Cryptococcal meningitis b. Neuropathy c. Progressive multifocal leukoencephalopathy d. HIV encephalopathy

D

When could a "rebound" anaphylactic reaction occur after an initial attack even when epinephrine has been given? A. 1 hour B. 2 hours C. 3 hours D. 4 hours

D A "rebound" anaphylactic reaction can occur 4 to 10 hours after an initial attack even when epinephrine has been given

Chondrocytes means?

cartilage cells

Monocytes is a ______ that transforms into _______

*A type of white blood cell that transforms into macrophages,

A client with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alert for with cytomegalovirus? 1 diarrhea 2 hearing impairment 3 blindness 4 fatigue

3

Antiretroviral medications as post exposure prophylaxis for health care workers are started within ____ hours of exposure: a. 24 hours b. 72 hours c. 36 hours d. 12 hours

B

Is the following statement true or false? An antigen is a protein substance developed by the body in response to and interacting with a specific antibody

False An antibody, not an antigen, is a protein substance developed by the body in response to and interacting with a specific antigen, not antibody

Immune deficient patients with decreased antibody production would be given?

IVIG

_______________ - clumping effect occurring when an antibody acts as a cross-link between two antigens

agglutination:

spleen function

breaks up RBCs (FILTERS) , production of lymphocytes--immune system

Ataxia means what?

impaired coordination

Clonus means?

rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch

In adults or children over 2 years old, a positive Babinski sign happens when the toes do what? what does this indicate.

when the big toe bends up and back to the top of the foot and the other toes fan out. This can mean that you may have an underlying nervous system or brain condition that's causing your reflexes to react abnormal

natural killer cells

A type of white blood cell that can kill tumor cells and virus-infected cells; an important component of innate immunity.

Is the following statement true or false? Immunity refers to the body's nonspecific protective response to an invading foreign agent or organism

False Immunity refers to the body's specific, not nonspecific, protective response to an invading foreign agent or organism

True or False Primary immune deficiency disorders result from external factors such as infection

False Primary immune deficiency disorders are genetic

What should you assess for to detect peripheral neurovascular changes (6 p's)

Pain, Poikilothermia (temperature), pallor, pulselessness, paresthesia, and paralysis.

Osteoarthritis vs rheumatoid arthritis

The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms. Osteoarthritis is caused by mechanical wear and tear on joints. Rheumatoid arthritis is an autoimmune disease in which the body's own immune system attacks the body's joints

Induction therapy is used in attempt to achieve _____________.

The phase of treatment which is designed to obtain a remission of the cancer.

A Rebound anaphylactic reaction can occur how many hours after the initial attack even when epinephrine has been given

The symptoms can rebound, returning hours or even days after you get an epinephrine injection. Most cases of anaphylaxis happen quickly and fully resolve after they're treated. However, sometimes the symptoms get better and then start again a few hours later. Sometimes they don't improve hours or days later.

A nursing instructor in a BSN program is preparing for a lecture on disorders of the hematopoietic system. Included in the lecture are conditions caused by reduced levels or absence of blood-clotting proteins. Which of the following is the instructor most likely referring to? 1 Coagulopathy 2 Aplastic anemia 3 Pancytopenia 4 Sickle cell disease

The term coagulopathy refers to conditions in which a component that is necessary to control bleeding is missing or inadequate.

Is the following statement true or false? Polyarticular refers to a rheumatic disease affecting more than one joint

True Monoarticular (affecting a single joint) Polyarticular (affecting multiple joints

Homan's sign is what?

pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis

The ________________ are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. They control processes such as inflammation, blood flow, the formation of blood clots and the induction of labour.

prostaglandins

What is chelation therapy?

removing lead from circulating blood and some lead from organs and tissues

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? 1 "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." 2 "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." 3 "OA affects joints on both sides of the body. RA is usually unilateral." 4 "OA is more common in women. RA is more common in men."

1

A client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. What is the most important factor related to the client's assessment? 1 The client's use of other drugs 2 The client's age 3 The client's diet 4 The client's home environment

1

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? 1 physical therapy 2 discontinue use of crutches 3 cold compresses to leg for swelling 4 No options are correct.

1

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for? 1 Hemorrhage 2 Blood transfusion reaction 3 Shock 4 Splintering of bone fragments

1

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include: 1 neutrophils and monocytes. 2 plasma cells and memory cells. 3 regulator T cells and helper T cells. 4 lymphokines and suppressor T cells.

1

In which process is the antigen-antibody molecule coated with a sticky substance that facilitates phagocytosis? 1 Opsonization 2 Apoptosis 3 Agglutination 4 Immunoregulation

1

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? 1 Hypovolemic shock 2 Osteomyelitis 3 Urinary retention 4 Atelectasis

1

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? 1 "Metal pins will go through my skin to the bone." 2 "I will wear a boot with weights attached." 3 "A belt will go around my pelvis and weights will be attached." 4 "The traction can be removed once a day so I can shower."

1

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: 1 the client that he or she won't be cut. 2 that the cast cutter blade is sharp. 3 that pedal pulses are present. 4 All options are correct.

1 Casts are removed with a mechanical cast cutter. Cast cutters are noisy and frightening, and the client needs reassurance that the machine will not cut into the skin.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? 1 osteomyelitis 2 hematoma 3 hemorrhage 4 infection

1 Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

What chemical is released by cytotoxic T cells? 1 Lymphokine 2 Antigen 3 Antibody 4 Microphages

1 Cytotoxic T cells bind to invading cells, destroy the targeted invader by altering their cellular membrane and intracellular environment, and release chemicals called lymphokines. Lymphokines, a type of cytokine, attract neutrophils and monocytes to remove the debris. Options B, C, and D are incorrect.

The nurse recognizes that rheumatoid arthritis is characterized by: 1 Ulnar deviation 2 Ballottement sign 3 Clonus 4 Fasciculations

1 Rheumatoid arthritis is characterized by ulnar deviation of the fingers. The ballottement sign is used to detect fluid in the knee. Clonus is the rhythmic contractions of a muscle. Involuntary twitching of muscle fiber groups is called fasciculation.

A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? 1 The left leg is internally rotated. 2 The leg length is the same as the right leg. 3 The client has discomfort when moving in bed. 4 There are diminished peripheral pulses on the affected extremity.

1 The nurse must monitor the client for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. The length of the leg with a dislocated prosthesis may be shorter. The client's discomfort will not indicate a dislocation. Diminshed peripheral pulse of the affected extremity would be a indication of circulation issues.

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide? 1 Observe stools for blood. 2 Observe the gums for bleeding after the client brushes teeth. 3 Observe the sputum for signs of blood. 4 Observe client for facial droop.

1 GI is one of the most common areas of bleeding for older adults who have low hemoglobin levels. Iron-deficiency anemia is unusual in older adults. Normally, the body does not eliminate excessive iron, causing total body iron stores to increase with age and necessitating maintenance of hydration. If an older adult is anemic, blood loss from the gastrointestinal or genitourinary tracts is suspected. Observing the stool for blood will help detect blood from GI loss. Bleeding gums may indicate periodontal disease, or anticoagulation from medication is not related to age. Blood in sputum can be an indicator of various lung disorders that may affect all age groups. Facial droop may indicate an impending stroke or Bell's palsy and would not be a reason for blood loss.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? 1 Explain that the sensation being felt is normal and will not burn the client. 2 Remove the cast immediately, notifying the physician. 3 Administer antianxiety and pain medication. 4 Call for assistance to hold the client in the required position until the cast has dried.

1 A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

A client with multiple myeloma reports severe paresthesia in the feet. When planning care for the client, which priority nursing diagnosis will the nurse choose? 1 Acute pain 2 Risk for falls 3 Impaired tissue integrity 4 Sensory-perception disturbance

2

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? 1 1.5 mL/min 2 3 mL/min 3 6 mL/min 4 10 mL/min

2

The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is: 1 Anorexia. 2 Chronic diarrhea. 3 Nausea and vomiting. 4 Oral candida.

2

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? 1 It provides active range of motion. 2 It promotes healing by increasing circulation and movement of the knee joint. 3 It promotes healing by immobilizing the knee joint. 4 It prevents infection and controls edema and bleeding.

2

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for? 1 Bone marrow aspiration 2 Schilling test 3 Bone marrow biopsy 4 Magnetic resonance imaging (MRI) study

2 The classic method of determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12 (this aids in renal excretion of the radioactive dose).

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? 1 Blood pressure of 140/90 mm Hg 2 Crackles in the lung bases 3 Client complains of pain in the affected rib area when taking a deep breath 4 Heart rate of 94 beats/minute

2 Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 bpm is within normal range.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? 1 Crutchfield tongs 2 Thomas splint 3 Buck's 4 Balanced suspension

3

A nurse cares for a client with megaloblastic anemia who had a total gastrectomy three years ago. What statement will the nurse include in the client's teaching regarding the condition? 1 "The condition is likely caused by a folate deficiency." 2 "The condition causes abnormally small red blood cells." 3 "The condition is likely caused by a vitamin B12 deficiency." 4 "The condition causes abnormally rigid red blood cells."

3

A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material? 1 The yellow marrow is responsible for manufacturing red blood cells. 2 Long bones typically contain more red bone marrow than yellow. 3 Osteoclasts are involved in the destruction and remodeling of bone. 4 Osteocytes are transformed into osteoblasts or mature bone cells.

3 Osteoclasts are the cells involved in the destruction, resorption, and remodeling of bone. Red bone marrow is responsible for manufacturing red blood cells. Long bones contain yellow bone marrow; the sternum, ileum, vertebrae, and ribs contain red bone marrow. Osteoblasts are transformed into osteocytes, mature bone cells.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? 1 Consult a skin specialist. 2 Scrub the area vigorously to remove the crust. 3 Apply lotions and take warm baths or soaks. 4 Avoid exposure to direct sunlight.

3 The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive

After a person experiences a closure of the epiphyses, which statement is true? 1 The bone grows in length but not thickness. 2 The bone increases in thickness and is remodeled. 3 Both bone length and thickness continue to increase. 4 No further increase in bone length occurs.

4

Which hormone inhibits bone resorption and increases the deposit of calcium in the bone? 1 Growth hormone 2 Vitamin D 3 Sex hormones 4 Calcitonin

4 Calcitonin, secreted by the thyroid gland in response to elevated blood calcium levels, inhibits bone reabsorption and increases the deposit of calcium in the bone.

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? 1 Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. 2 Put on a mask, gown, and gloves when entering the client's room. 3 Provide a clear liquid, low-sodium diet. 4 Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

4 Neutropenia occurs when the absolute neutrophil count falls below 1,000/mm3, reflecting a severe risk of infection. The nurse should provide a low-bacterial diet, which means eliminating fresh fruits and vegetables, avoiding invasive procedures such as enemas, and practicing frequent hand washing. Using a soft toothbrush, avoiding straight-edged razors and enemas, and monitoring for bleeding are precautions for clients with thrombocytopenia. Putting on a mask, gown, and gloves when entering the client's room are reverse isolation measures. A neutropenic client doesn't need a clear liquid diet or sodium restrictions.

Which is an inaccurate principle of traction? 1 The weights are not removed unless intermittent treatment is prescribed. 2 The weights must hang freely. 3 The client must be in good alignment in the center of the bed. 4 Skeletal traction is interrupted to turn and reposition the client.

4 Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? 1 Bathing or hygiene self-care deficit 2 Ineffective cerebral tissue perfusion 3 Complicated grieving 4 Risk for injury

4 In a client with AIDS, central nervous system (CNS) deterioration can lead to AIDS-related dementia. This type of dementia impairs cognition and judgment, placing the client at risk for injury. Although Bathing or hygiene self-care deficit and Complicated grieving may be relevant in AIDS, these diagnoses don't take precedence in a client with AIDS-related dementia. Because CNS deterioration results from infection, Ineffective cerebral tissue perfusion isn't applicable.

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient? 1 Reactive phase, reparative phase, remodeling phase 2 Primary phase, secondary phase, third phase 3 First intention, secondary intention, third intention 4 Active phase, dormant phase, restructure phase

1

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for? 1 Essential thrombocythemia 2 Extreme leukocytosis 3 Sickle cell anemia 4 Renal transplantation

1

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site? 1 The fracture is on the diaphysis. 2 The fracture is ventrally located. 3 The fracture is on the epiphyses. 4 The fracture is on the tuberosity.

1

The nurse is assessing a client's perneal nerve. What technique will the nurse use? 1 Prick the skin mid-way between the great and second toe. 2 Ask the client to plantar flex the toes. 3 Ask the client to invert and evert the foot. 4 Prick the medial surface of the sole.

1

The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction? 1 Symptoms are localized to the area of exposure, usually the back of the hands. 2 Symptoms can be eliminated by changing glove brands. 3 Symptoms worsen when hand lotion is applied before donning latex gloves. 4 Symptoms occur within minutes after exposure to latex.

1

A 20-year-old client cut a hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which cell type to be elevated first in an attempt to prevent infection in the client's hand? 1 Eosinophils 2 Neutrophils 3 B cells 4 Monocytes

2 Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses.

Which statement best describes the function of stem cells in the bone marrow? 1 They are active against hypersensitivity reactions. 2 They defend against bacterial infection. 3 They produce all blood cells. 4 They produce antibodies against foreign antigens.

3

Splenic sequestration is diagnosed in a client admitted with splenomegaly. What is the priority of care for this client? 1 Infection 3 Hypovolemia 4 Hyperthermia 5 Hypertension

3 If the spleen is enlarged, a greater proportion of red cells and platelets can be sequestered. With less red blood cells in circulation, the client can become hypovolemic resulting in shock. Decreased white blood cells in circulation, not red blood cells, increases the chance of infection. Decreased circulatory volume results in hypotension, not hypertension. Hyperthermia is not a result of decreased red blood cells in circulation.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? 1 "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." 2 "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." 3 "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." 4 "I will receive parenteral vitamin B12 therapy for the rest of my life."

4

A patient is scheduled for a procedure that will allow the physician to visualize the knee joint in order to diagnose the patient's pain. What procedure will the nurse prepare the patient for? 1 Arthrocentesis 2 Bone scan 3 Electromyography 4 Arthroscopy

4

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated? 1 Macrophages 2 Helper T cells 3 B cells 4 Cytotoxic T cells

4

A 25-year-old client receives a knife wound to the leg in a hunting accident. Which type of immunity was compromised? 1 Specific immunity 2 Passive immunity 3 Adaptive immunity 4 Natural immunity

4 Natural immunity, which is nonspecific, provides a broad spectrum of defense against and resistance to infection. It is considered the first line of host defense following antigen exposure, because it protects the host without remembering prior contact with an infectious agent.

humoral vs. cell-mediated immunity

Humoral immunity secretes antibodies to fight against antigens, whereas cell-mediated immunity secretes cytokines and no antibodies to attack the pathogens. The Humoral immunity is rapid or quick in their action against antigens, while the Cell-mediated immunity show delay though permanent action against any pathogens.

__________ is a condition that occurs when a person has low counts for all three types of blood cells: red blood cells, white blood cells, and platelets.

Pancytopenia

_______________ is characterized by red blood cells that are larger than normal. There also aren't enough of them. It's known as vitamin B-12 or folate deficiency anemia, or macrocytic anemia, as well. It is caused when red blood cells aren't produced properly

megaloblastic anemia

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? 1 CD4+ counts 2 HIV RNA 3 Western blotting assay 4 ELISA

1

______________ are infused due to a low platelet levels

Fresh Frozen Plasma

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? 1 Phagocytosis 2 Rejection of foreign tissue 3 Destruction of tumor cells 4 Production of antibodies called immunoglobulin (Ig)

1

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets? 1 Myeloid stem cell 2 Lymphoid stem cell 3 Monocyte 4 Neutrophil

1

Which is the leading cause of disability and pain in the elderly? 1 Osteoarthritis (OA) 2 Rheumatoid arthritis (RA) 3 Systemic lupus erythematosus (SLE) 4 Scleroderma

1

A client with sickle cell anemia has a 1 low hematocrit. 2 high hematocrit. 3 normal hematocrit. 4 normal blood smear.

1 A client with sickle cell anemia has a low hematocrit and sickled cells on the smear. A client with sickle cell trait usually has a normal hemoglobin level, a normal hematocrit, and a normal blood smear.

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor? 1 Decreased level of erythropoietin 2 Decreased total iron-binding capacity 3 Increased mean corpuscular volume 4 Increased reticulocyte count

1 As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? 1 type I 2 type II 3 type III 4 type IV

1

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? 1 Radial 2 Peroneal 3 Median 4 Ulnar

2 The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

Which cells are involved in bone resorption? 1 Chondrocytes 2 Osteoblasts 3 Osteoclasts 4 Osteocytes

3 Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? 1 Facial erythema, pericarditis, pleuritis, fever, and weight loss 2 Photosensitivity, polyarthralgia, and painful mucous membrane ulcers 3 Weight gain, hypervigilance, hypothermia, and edema of the legs 4 Hypothermia, weight gain, lethargy, and edema of the arms

1 An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

A client has an exaggerated convex curvature of the thoracic spine. What is this condition called? 1 kyphosis 2 lordosis 3 scoliosis 4 diaphysis

1 Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs.

A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? 1 Induction therapy 2 Supportive therapy 3 Antimicrobial therapy 4 Standard therapy

1 Despite advances in understanding of the biology of AML, substantive advances in treatment response rates and survival rates have not occurred for decades, with the exception of advances made in treating APL (see later discussion). Even for patients with subtypes that have not benefited from advances in treatment, cure is still possible. The overall objective of treatment is to achieve complete remission, in which there is no evidence of residual leukemia in the bone marrow. Attempts are made to achieve remission by the aggressive administration of chemotherapy, called induction therapy, which usually requires hospitalization for several weeks.

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? 1 2 hours 2 6 hours 3 12 hours 4 24 hours

1 Mild systemic, anaphylactic reactions consist of peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. Nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes can also be expected. Onset of symptoms begins within the first 2 hours after exposure.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? 1 Serum IgE level 2 White blood cell count 3 Eosinophil count 4 Erythrocyte sedimentation rate

1 Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? 1 plant pollen 2 animal dander 3 dust mites 4 mold spores

1 Plant pollen (from trees, grass, and other plants) causes the most common form of allergic rhinitis, which is known as hay fever. Animal dander, dust mites, and mold spores can be triggers, but are not the most common causes.

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? 1 A serum calcium test 2 An electromyography 3 An arthroscopy 4 A magnetic resonance imaging (MRI)

2 An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.

A client with common variable immunodeficiency (CVID) comes to the ED reporting tingling and numbness in the hands and feet, muscle weakness, fatigue, and chronic diarrhea. An assessment reveals abdominal tenderness, weight loss, and loss of reflexes. A gastric biopsy shows lymphoid hyperplasia of the small intestine and spleen as well as gastric atrophy. Based on these findings, what common secondary problem has this client developed? 1 Gastric ulcer 2 Pernicious anemia 3 Hyperthyroidism 4 Sickle cell anemia

2 More than 50% of clients with CVID develop pernicious anemia. Lymphoid hyperplasia of the small intestine and spleen and gastric atrophy, which is detected by biopsy of the stomach, are common findings. Gastrointestinal malabsorption may occur.

A nursing instructor is reviewing the role and function of stem cells in the bone marrow with a group of nursing students. After providing the explanation, the instructor asks the students to use their knowledge of anatomy and physiology to determine an alternate way in which adults with diseases that destroy marrow can resume production of blood cells. Which explanation by the students is correct? 1 Fat found in yellow bone marrow can be replaced by active marrow when more blood cell production is required. 2 The remaining stem cells have the ability to continue with the process of self-replication, creating an endless supply. 3 The liver and spleen can resume production of blood cells through extramedullary haematopoiesis. 4 The three cell types—erythrocytes, leukocytes, and platelets—can resume production of stem cells.

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During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding? 1 Elevated hematocrit concentration 2 Enlarged mean corpuscular volume (MCV) 3 Low ferritin level concentration 4 Elevated red blood cell (RBC) count

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A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint? 1 Symphysis pubis 2 Skull 3 Elbow 4 Fifth thoracic vertebrae

3 A diarthrosis joint, like the elbow, is freely movable. The skull is an example of an immovable joint. The vertebral joints and symphysis pubis are amphiarthrosis joints that have limited motion.

The nurse is assessing several clients. Which client does the nurse determine is most likely to have Hodgkin lymphoma? 1 The client with painful lymph nodes under the arm. 2 The client with painful lymph nodes in the groin. 3 The client with enlarged lymph nodes in the neck. 4 The client with a painful sore throat.

3 Lymph node enlargement in Hodgkin lymphoma is not painful. The client with enlarged lymph nodes in the neck is most likely to have Hodgkin lymphoma if the enlarged nodes are painless. Sore throat is not a sign for this disorder.

A client with a history of sickle cell anemia has developed iron overload from repeated blood transfusions. What treatment does the nurse anticipate will be prescribed? 1 White blood cell filter 2 Hepatitis B immunization 3 Red blood cell phenotyping 4 Chelation therapy

4 Chelation therapy is prescribed to treat iron overload. Hepatitis B immunization helps immunize against hepatitis B. Red blood cell phenotyping helps decreased sensitization. A white blood cell filter protects against cytomegalovirus and some sensitization and febrile reactions.

The nurse is conducting the admission assessment for a client who is to undergo an arthrogram. What is the priority question the nurse should ask? 1 "Do you have any allergies?" 2 "When did you last eat?" 3 "When did you last urinate?" 4 "Are you claustrophobic?"

1 Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood. Asking about eating or urinating is important but not priority. The claustrophobia is not a concern for the the arthrogram.

Kaposi sarcoma (KS) is diagnosed through 1 skin scraping. 2 biopsy. 3 visual assessment. 4 computed tomography.

2 KS is diagnosed by biopsy of the suspected lesions. Prognosis depends on the extent of the tumor, the presence of other symptoms of HIV infection, and the CD4+ count.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification? 1 Osteoblasts 2 Cortical bone 3 Osteoclasts 4 Cancellous bone

1 Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

A group of students are reviewing the structure and function of bones. The students demonstrate understanding of the information when they state that cortical bone is found primarily in which of the following? 1 Rounded irregular ends 2 Epiphyses 3 Diaphyses 4 Osteoblasts

2 Cortical bony tissue is found chiefly in the long shafts, or diaphyses, of bones in the arms and legs. Cancellous bone is found at the rounded, irregular ends, or epiphyses, of long bones. Osteoblasts are cells that build bones

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? 1.Refer the client to a chiropractor. 2.Place heating pads on the client's back. 3. Administer pain medication, as ordered. 4. Assess renal function.

4 Chemotherapy results in the destruction of cells and tumor lysis syndrome. Uric acid and phosphorus concentrations increase, and the client is susceptible to renal failure. The nurse should assess renal function if the client complains of low-back pain, as this could be indicative of kidney stone formation. Heating pads, pain medication, and referrals could be instituted once the cause of the pain is determined. The priority is further assessment to rule out important problems.

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as 1 urticaria. 2 contact dermatitis. 3 pitting edema. 4 angioneurotic edema.

4 The area of skin demonstrating angioneurotic edema may appear normal but often has a reddish hue and does not pit. Urticaria (hives) is characterized as edematous skin elevations that vary in size and shape, itch, and cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema is the result of increased interstitial fluid and associated with disorders such as congestive heart failure.

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? 1 Sublingual-swallow immunotherapy (SLIT) 2 Desensitization 3 Sublingual-topical immunotherapy (STIT) 4 Resensitization

2 Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, what action should the nurse take? 1 Administer each unit slowly over 3-4 hours. 2 Infuse each unit over 30-60 minutes per client tolerance. 3 Monitor vital signs closely before transfusion and once per shift. 4 Flush the intravenous line with a liter of saline between units.

2 Infuse each unit of FFP over 30-60 minutes per client tolerance. Platelet clumping will occur if administered too slowly. Vital signs should be monitored before and throughout the transfusion, not just once per shift. A liter of saline is too large an amount to flush the intravenous line and would contribute to fluid overload.

Which client is most at risk for developing disseminated intravascular coagulation (DIC)? 1 A client admitted with suspected cocaine overdose 2 A client with an amniotic fluid embolism 3 A client with a stage IV pressure ulcer 4 A client with heart failure and renal failure

2 The client with the amniotic fluid embolism is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis. Possible cocaine overdose, a stage IV pressure ulcer, and heart failure and renal failure aren't risk factors for DIC.

The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? 1 Debilitating fatigue 2 Bone pain in the back of the ribs 3 Gradual muscle paralysis 4 Severe thrombocytopenia

2 Although patients can have asymptomatic bone involvement, the most common presenting symptom of multiple myeloma is bone pain, usually in the back or ribs. Unlike arthritic pain, the bone pain associated with myeloma increases with movement and decreases with rest; clients may report that they have less pain on awakening but the pain intensity increases during the day.

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? 1 Natural killer cells 2 Cytokines 3 Interleukins 4 Interferons

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Which type of cell is capable of recognizing and killing infected or stressed cells and producing cytokines? 1 Null lymphocytes 2 Natural killer cells 3 Memory cells 4 Cytotoxic T cells

2 Natural killer cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells and by secreting macrophage-activating cytokine. Natural killer cells defend against microorganisms and some types of malignant cells. Null lymphocytes do not produce or active cytokine they are stimulated to attack tumor or viral infected cells. Memory cells are important to the immune system but produces memory B cells not cytokine. Cytotoxic -T cells leads to apoptosis ,causing death in infectious cells, however they do not produce cytokine.

A client has been diagnosed with acquired immune deficiency syndrome (AIDS). Which statement correctly describes a secondary immune deficiency? 1 The normal protective immune response attacks the body, leading to tissue damage. 2 The body produces inappropriate or exaggerated responses to specific antigens. 3 An interference develops in an already developed immune system. 4 Immune cells or tissues experience an improper development.

3 A secondary immune deficiency results from some interference with an already developed immune system. A primary deficiency results from improper development of immune cells or tissues. A hypersensitivity happens when the body produces an inappropriate or exaggerated response to a specific antigen. Autoimmunity happens when the normal protective immune response pradoxically turns against or attacks the body, leading to tissue damage. It is not an immune deficiency.

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? 1 Molluscum contagiosum 2 Tuberculosis of the skin 3 Kaposi's sarcoma 4 Seborrheic dermatitis

3 Kaposi's sarcoma, the most common HIV-related malignancy, is a disease that involves the endothelial layer of blood and lymphatic vessels. Cutaneous signs may be the first manifestation of HIV; they can appear anywhere on the body and are usually brownish pink to deep purple. They may be flat or raised and surrounded by ecchymoses (hemorrhagic patches) and edema

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? 1 The patient has osteoarthritis. 2 The patient has lupus erythematosus. 3 The patient has rheumatoid arthritis. 4 The patient has neurofibromatosis.

3 The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.

The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate? 1 the immediate release of chemical mediators 2 a cross-reacting antibody that mistakes a normal constituent of the body as foreign 3 a delayed-type hypersensitivity that is mediated by T cells 4 the involvement of immune complexes formed when antigens bind to antibodies

3 Contact dermatitis is a delayed-type hypersensitivity response that can occur 24 to 72 hours after exposure to an allergen.

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia? 1 Erythrocytes that are microcytic and hypochromic 2 Erythrocytes that are macrocytic and hyperchromic 3 Clustering of platelets with sickled red blood cells 4 An increased number of erythrocytes

1 A blood smear reveals erythrocytes that are microcytic (smaller than normal) and hypochromic (lighter in color than normal). It does not reveal macrocytic (larger than normal) or hyperchromic erythrocytes. Clustering of platelets with sickled red blood cells would indicate sickle cell anemia. An increase in the number of erythrocytes would indicate polycythemia vera.

The nurse teaches the client that reducing the viral load will have what effect? 1 Shorter time to AIDS diagnosis 2 Longer survival 3 Shorter survival 4 Longer immunity

2 The lower the client's viral load, the longer the survival time and the longer the time to AIDS diagnosis.