CH 13, 14 quiz
A patient developed a latex allergy caused by chemicals used in manufacturing of gloves used in hospitals. Which type of allergy would the nurse provide the patient information about? 1 Type I 2 Type II 3 Type III 4 Type IV
Correct answer Type IV Rationale: Contact dermatitis caused by the chemicals used in the manufacturing process of latex gloves is a type IV hypersensitivity reaction. It is a delayed reaction. It occurs within 6 to 48 hours. Type II and Type III are not types of latex allergies. A Type I allergic reaction is related to the natural rubber latex proteins and occurs within minutes of contact with the proteins.
Which type of hypersensitivity would the nurse document when a patient reports experiencing a runny nose, sneezing, and itchy eyes after visiting the botanical gardens today? 1 Type-I 2 Type-II 3 Type-III 4 Type-IV
Correct answer Type-1 Rationale: A botanical garden is full of trees and flowers. Pollen grains in the flowers can precipitate an allergic reaction. Allergic rhinitis is an inflammatory condition of the nasal airways that results when the patient inhales pollens, dust, and animal dander. Type I hypersensitivity reaction is precipitated by exogenous pollen, dust, food, and drugs such as antigens. Therefore, allergic rhinitis involves type I hypersensitivity reaction. Type II hypersensitivity reaction is associated with antibodies directed toward antigens presented on the cell surface of red blood cells and the basement membrane of cells. Presence of extracellular bacteria, viruses, and fungi precipitates type III hypersensitivity. Intercellular or extracellular contents precipitate type IV hypersensitivity reaction.
A patient, premedicated with acetaminophen (Tylenol), diphenhydramine (Benadryl), and IV methylprednisolone (Medrol) prior to receiving muromonab-CD3 (Orthocione OKT3), asked the nurse why he or she received those medications. Which explanations will the nurse utilize? Select all that apply. 1 This premedication regimen assists in preventing rigors. 2 Those medications increase the production of T cells. 3 The medications provide protection against infection. 4 The premedication therapy hastens the action of muromonab-CD3. 5 The goal is to prevent various gastrointestinal (GI) disturbances.
Correct answer (1, 5) This premedication regimen assists in preventing rigors. The goal is to prevent various gastrointestinal (GI) disturbances. Rationale: Administration of muromonab-CD3 is associated with side effects such as GI disturbances, fever, rigors, and headache. Administration of acetaminophen, diphenhydramine, and IV methylprednisolone prior to muromonab-CD3 therapy helps to reduce the side effects of muromonab-CD3. The medications neither hasten the action of muromonab-CD3 nor protect against any infection or increase the protection of T cells.
Which statement would concern the nurse the most when a patient with human immunodeficiency virus (HIV) comes to the clinic with a temperature of 102o F? 1 "I vomited once this morning and I am still nauseated." 2 "I woke up this morning with a mild headache and this temperature." 3 "I have a rash that appeared on my stomach this morning." 4 "I started coughing up some clear mucus when I woke up this morning."
Correct answer "I have a rash that appeared on my stomach this morning." Rationale: Although all of these are signs and symptoms that the patient may be experiencing a complication and should be reported, a new rash accompanied by a fever should be reported immediately by a patient with HIV infection. Reporting headache, vomiting, and coughing can be delayed up to 24 hours.
In which order will the nurse prioritize tasks in the management of a severe allergic response?
Correct answer 1.Recognize signs and symptoms of anaphylaxis. 2.Maintain a patent airway. 3.Administer drugs. 4.Treat shock. Rationale: The first step in the management of a severe allergic response is to recognize signs and symptoms of anaphylaxis. The next priority is to maintain a patent airway. Once a patent airway is secured, drugs are administered. Finally, attention is turned to treat shock.
When a patient presents at the clinic with allergic rhinitis and urticaria, the mechanism of action of which medication classification treats the patient's symptoms the best? 1 Antihistamines 2 Corticosteroids 3 Decongestant drugs 4 Mast cell-stabilizing drugs
Correct answer Antihistamines Rationale: Antihistamines act by competing with histamines for H1-receptor sites and blocking their effect. Allergic rhinitis and urticaria involve excess release of histamines; therefore, antihistamines are the most effective treatment. Nasal corticosteroid sprays may be useful for relieving the symptoms of allergic rhinitis but are not the most commonly used drug. Decongestant drugs may be used for treating anaphylactic reactions. Mast cell-stabilizing drugs may be used to manage allergic rhinitis but not urticaria.
A newly admitted patient reports allergies to eggs, nuts, and latex during the nurse's admission assessment. Which intervention would the nurse implement upon receiving this information? 1 Place epinephrine (Epi-Pen) at the patient's bedside. 2 Obtain an order for a consult with the dietitian. 3 Document allergies in the patient's medical record and in the room. 4 Notify the health care provider of the patient's allergies.
Correct answer Document allergies in the patient's medical record and in the room. Rationale: Because health professionals wear latex gloves when caring for patients, the nurse would first document any allergies in the patient's medical record and in the patient's room so that the information is available to all health care providers. Following this action, the nurse can also report this information to the health care provider. Placing an Epi-Pen at the bedside in the hospital setting is not appropriate at this time. The nurse does not yet have enough information to determine whether the patient should consult a dietitian.
A patient experiencing an anaphylactic reaction after eating seafood has a BP of 80/42, the heart rate is 116, pulses are weak and thready, and disorientation is present. Which medication addresses the priority concern in this patient? 1 Albuterol (Proventil) 2 Dopamine (Intropin) 3 Diphenhydramine (Benadryl) 4 Methylprednisolone (Medrol)
Correct answer Dopamine (Intropin) Rationale: A BP of 80/42 mm Hg in a patient with anaphylactic reaction indicates hypotension. The patient is in the decompensated stage of anaphylactic shock. A vasopressor helps increase the BP and improve perfusion to the organs. Dopamine, which is a vasopressor, addresses the priority concern in the patient. Albuterol is a bronchodilator, which opens the patient's airway. Diphenhydramine is an antihistamine, which reduces allergic symptoms like sneezing and running nose. Methylprednisolone is a steroid that reduces inflammatory reaction.
Which item would the nurse wear to prevent the spread of pathogens when preparing to disconnect IV fluid tubing from the access port of a patient wanting to ambulate to the bathroom? 1 A cap 2 Gloves 3 Shoe covers 4 An isolation gown
Correct answer Gloves Rationale: When disconnecting IV fluid tubing, the nurse may come into contact with blood. Therefore, personal protective equipment such as gloves should be used. This also helps the nurse to avoid an infection by not touching contaminated items or surfaces. Caps, gowns, and boots are not required when disconnecting IV tubing.
A patient, with a recent history of 10% body mass loss and herpes simplex with chronic ulcers, has a CD4+ cell count of <200 cells/µL and is diagnosed with Burkitt's lymphoma. Which infection would the nurse associate these clinical manifestations? 1 Parvovirus 2 Varicella-zoster 3 Adenovirus 4 Human immunodeficiency virus
Correct answer Human immunodeficiency virus Rationale: In human immunodeficiency virus infection, the CD4+ T-cell count drops below 200 cells/µL due to the destruction of the white blood cells. As a result, immunity decreases. Due to the decreased immunity, opportunistic infections, such as herpes simplex and Burkitt's lymphoma, may occur. Because of the ongoing infectious processes, the body goes into a state of catabolism, resulting in significant weight loss. Parvovirus produces gastroenteritis. Varicella-zoster virus causes chickenpox and shingles. Adenoviruses cause upper respiratory tract infections and pneumonia.
The nurse, who was accidently stuck with a needle used for a patient with human immunodeficiency virus (HIV), reported the incident to the charge nurse. Which action would the injured employee implement next? 1 Medical evaluation and testing of exposed nurse 2 Postexposure prophylaxis via antiretroviral therapy 3 Evaluation of the patient source, including testing 4 Immediate care of the exposed site with soap and water
Correct answer Immediate care of the exposed site with soap and water Rationale: The injured nurse immediately cares for the exposed site (puncture wound) by washing with soap and water. Then the injured nurse is evaluated immediately by the health care provider on duty and testing (with consent) occurs. The patient source (if known) is evaluated as soon as feasible. Potential postexposure prophylaxis with antiretroviral therapy occurs after consultation with infectious disease specialist.
Which side effects would the nurse teach the patient with human immunodeficiency virus (HIV) to monitor when receiving antiretroviral therapy (ART) for a long time? 1 Nausea 2 Vomiting 3 Diarrhea 4 Lipodystrophy
Correct answer Lipodystrophy Rationale: HIV-infected patients on antiretroviral therapy may develop a metabolic disorder called lipodystrophy, which is the deposition of fat in the abdomen, upper back, and breasts. There may be simultaneous loss of fat in the arms, legs, and face. Nausea, vomiting, and diarrhea are short-term side effects of ART and tend to subside with regular use.
Which diagnostic test would the nurse prepare for the patient who is taking antiretroviral therapy (ART) for human immunodeficiency virus (HIV) and reports feeling like he or she did prior to starting ART? Correct1 Phenotype assay 2 Rapid HIV-antibody test 3 Standard antibody assay test 4 White blood cell count laboratory test
Correct answer Phenotype assay Rationale: The patient may have developed a resistance to the medications, and either a genotype or phenotype assay will let the nurse know whether this is the reason the ART may not be working effectively. The rapid HIV-antibody test is an in-home or clinic test to screen for HIV antibodies, and the patient is already diagnosed with the infection. The standard antibody assay test is done to test for HIV antibodies. White blood cell count laboratory tests are done to test for possible infection.
When providing educational content for parents preparing their children for school, which infection would the nurse teach is preventable with vaccines? 1 Avian flu 2 Poliomyelitis 3 West Nile virus 4 Human immunodeficiency virus (HIV)
Correct answer Poliomyelitis Rationale:The polio vaccine prevents the outbreak of the infection. There are currently no vaccines available to prevent the avian flu, HIV, or West Nile virus.
Which method of transmission precaution would the nurse use when providing care for a patient suspected of being positive for human immunodeficiency virus (HIV) in the hospital setting? 1 Contact precautions 2 Airborne precautions 3 Droplet precautions 4 Standard precautions
Correct answer Standard precautions Rationale: The standard precautions system applies to (1) blood; (2) all body fluids, secretions, and excretions; (3) non-intact skin; and (4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms in hospitals. Standard precautions should be applied to all patients regardless of diagnosis or presumed infection status. It is not necessary to use airborne, contact, or droplet precautions.
To cope with the side effects of receiving efavirenz (Sustiva) once a day, which instruction would the nurse provide the patient? 1 Use electronic reminders, timers, and beepers. 2 Take the dose at bedtime. 3 Have tests performed regularly to assess viral load in the body. 4 Inform the health care provider about other drugs being taken.
Correct answer Take the dose at bedtime. Rationale: The antiretroviral drug efavirenz is associated with side effects like dizziness and confusion. Therefore the nurse should teach the patient to take the drug dose at bedtime to cope with the side effects. Electronic reminders, timers, and beepers are used to increase adherence to drug regimens. Informing the health care provider about concurrent medicines is important to decrease adverse drug interactions but may not help in coping with side effects of the drug. Regular testing should be done to assess the viral load on the body and, in turn, indicate the efficacy of the drug therapy, but it does not assist with the side effects.
When interpreting laboratory diagnostics, which statement would the nurse identify as pathophysiology for the human immunodeficiency virus (HIV) infection? 1 The HIV infection can replicate outside a living cell. 2 The virus replicates going from DNA to RNA. 3 The immune system is impaired from CD4+ T-cell destruction. 4 Infection of monocytes occur, but antibodies quickly destroy these cells.
Correct answer The immune system is impaired from CD4+ T-cell destruction. Rationale: Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells (also known as T helper cells or CD4+ T lymphocytes). HIV cannot replicate unless it is inside a living cell. HIV replicates in a "backward" manner (going from RNA to DNA). Antibodies do not destroy the infected monocytes.
Which type of hypersensitivity reaction would the nurse identify as a risk in the plan of care when a patient reports a history of blood transfusion reactions? 1 Type I: IgE-mediated 2 Type II: Cytotoxic 3 Type III: Immune-complex 4 Type IV: Delayed hypersensitivity
Correct answer Type II: Cytotoxic A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. An example of a Type I-IgE-mediated reaction would be anaphylaxis. A Type III reaction would be seen more with autoimmune disorders (such as systemic lupus erythematosus). A Type IV reaction is contact dermatitis.
A patient reports a positive pregnancy test, despite use of a condom. Which information would the nurse share with the patient? Select all that apply. 1 Discuss antiretroviral therapy (ART). 2 Tell her that failure of condoms does occur. 3 Offer access to voluntary human immunodeficiency virus (HIV) antibody testing. 4 Provide information related to options for an unwanted pregnancy. 5 Advise having her partner tested for HIV.
Correct answer (2, 3, 4) Tell her that failure of condoms does occur. Offer access to voluntary human immunodeficiency virus (HIV) antibody testing. Provide information related to options for an unwanted pregnancy. Rationale: Condoms are used for contraception and prevention of sexually transmitted diseases. Condoms may slip off the penis after ejaculation or break due to improper application or physical damage. If she wants to choose abortion, she can do so without consent from her partner. The current standard of care is for all women who are pregnant to be routinely offered access to voluntary HIV-antibody testing, and, if infected, offered optimal ART. Because she is not yet diagnosed with HIV infection, ART is not required. There is no need to get her partner tested for HIV because she is not diagnosed with HIV infection.
Which treatment plan medications would the nurse be prepared to administer to a patient hospitalized with allergic rhinitis? Select all that apply. 1 Antipruritics 2 Antihistamines 3 Epinephrine 4 Mast cell stabilizers 5 Oral corticosteroids
Correct answer (2, 3, 5) Antihistamines Mast cell stabilizers Oral corticosteroids Rationale: Antihistamines are the best drugs to treat allergic rhinitis because they act by competing with histamine for H1-receptor sites and thus block the effect of histamine. Mast cell-stabilizing drugs inhibit the release of histamines and are used in management of allergic rhinitis. If there is a severe manifestation of allergic rhinitis, a brief course of oral corticosteroids is indicated. Antipruritic drugs are used for insect bites to protect the skin and provide relief from itching. The major sympathomimetic—epinephrine—is used in anaphylactic reaction. Minor sympathomimetic drugs are used to treat allergic rhinitis.
A patient with pruritus and a rash over the trunk and arms develops audible wheezes and difficulty breathing. Per the facility's protocol, which action would the nurse implement? 1 Administer an antihistamine 2 Administer cromolyn (Nedocromil) 3 Administer epinephrine (Adrenaline) 4 Begin cardiopulmonary resuscitation (CPR)
Correct answer: Administer epinephrine (Adrenaline) Rationale: The major sympathomimetic drug is epinephrine, which is the drug of choice to treat an anaphylactic reaction. Epinephrine is produced by the adrenal medulla and stimulates α- and β-adrenergic receptors. Stimulation of the α-adrenergic receptors causes vasoconstriction of peripheral blood vessels. β-receptor stimulation relaxes bronchial smooth muscles. Epinephrine also acts directly on mast cells to stabilize them against further degranulation. The action of epinephrine lasts only a few minutes. For the treatment of anaphylaxis, the drug must be given parenterally. Antihistamines can be used effectively to treat edema and pruritus but are relatively ineffective in preventing bronchoconstriction. CPR is not indicated since the patient is not in respiratory arrest. Cromolyn is used in the management of allergic rhinitis.
Which precautionary measures would the nurse teach a patient who is planning a jungle trek and is allergic to insect stings? Select all that apply. 1 Always wear a Medic Alert bracelet. 2 Learn how to self-inject epinephrine (Epi-Pen). 3 Carry an automatic epinephrine injector. 4 Take methdilazine orally as a preventive measure. 5 Apply calamine lotion topically as a preventive measure.
Correct answers (1, 2, 3) Always wear a Medic Alert bracelet. Learn how to self-inject epinephrine (Epi-Pen). Carry an automatic epinephrine injector. Rationale: Wearing a Medic Alert bracelet is important because it gives an indication to the health care provider about the patient's medical history. The patient should carry automatic epinephrine. The patient should be taught the technique of applying a tourniquet and the method of self-injecting epinephrine in case of emergency. Methdilazine is an antipruritic agent that requires a prescription, and it should be used with great caution. Also, because it is antipruritic, it will not protect against insect sting. Calamine lotion is also antipruritic. It will help to relieve itching but will not act as a preventive measure for insect stings.
A health care organization, which maintains compliance with the Occupational Safety and Health Administration (OSHA), provides which type of personal protective equipment (PPE) for their health care workers? Select all that apply. 1 Gowns 2 Aprons 3 Gloves 4 Hand gel 5 Face protection 6 Protective barrier wipes
Correct answers (1, 2, 3, 5) Gowns Aprons Gloves Face protection Rationale: A health care organization compliant with OSHA provides face protection and clothing such as gowns, aprons, and gloves for health care workers. Hand gel and protective barrier wipes are not considered PPE.
When discussing human immunodeficiency virus (HIV) infection with a patient, which statements would the nurse use? Select all that apply. 1 "Untreated HIV infection has a predictable pattern of progression." 2 "Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS)." 3 "Untreated HIV infection usually remains in the early chronic stage for one year or less." 4 "The interval between untreated HIV infection and a diagnosis of AIDS is about five years." 5 "Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection."
Correct answers (1, 2, 5) "Untreated HIV infection has a predictable pattern of progression." "Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS)." "Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection." Rationale: The typical course of untreated HIV infection follows a predictable pattern. Late chronic HIV infection is known as AIDS. The most common infection associated with the symptomatic phase of HIV infection is oropharyngeal candidiasis. The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years. Untreated HIV infection usually remains in the early chronic stage for about 8 years.
When reviewing the home medications of a patient receiving antiretroviral therapy (ART), which medications and over-the-counter pills would the nurse assess their presence for potential interactions? Select all that apply. 1 Antacids 2 St. John's wort 3 Protease inhibitors 4 Integrase inhibitors 5 Proton-pump inhibitors
Correct answers (1, 2, 5) Antacids St. John's wort Proton-pump inhibitors Rationale: Antacids, proton-pump inhibitors, and St. John's wort all interact with HIV drug therapy. Protease inhibitors and integrase inhibitors are drugs used to treat HIV.
Which routes of transmission and infective periods would the nurse share with the patient who is human immunodeficiency virus (HIV) positive and pregnant? Select all that apply. 1 HIV can be transmitted by breastfeeding. 2 HIV can be transmitted by contact with vomitus. 3 HIV can be transmitted by hugging and dry kissing. 4 HIV can be transmitted lifelong once a person is HIV-positive. 5 HIV can be transmitted even before it is detected on a screening test.
Correct answers (1, 4, 5) HIV can be transmitted by breastfeeding. HIV can be transmitted lifelong once a person is HIV-positive. HIV can be transmitted even before it is detected on a screening test. Rationale: HIV can be transmitted through contact with infected blood, semen, vaginal secretions, or breast milk. Transmission of HIV occurs through sexual intercourse with an infected partner; exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV-infected individuals can transmit HIV to others within a few days after becoming infected, even before it is detected on a screening test. The ability to transmit HIV continues for life. HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting. The virus is not spread by tears, saliva, urine, emesis (vomiting), sputum, feces, sweat, respiratory droplets, or enteric routes.
After administering a few milliliters of contrast media to a patient undergoing a cerebral CT scan with contrast, the health care provider assesses the patient and immediately stops the infusion. Which clinical manifestations would lead the health care provider to discontinue the contrast dye? Select all that apply. 1 Sneezing 2 Dyspnea 3 Hypotension 4 Nasal discharge 5 Rapid, weak pulse
Correct answers (2, 3, 5) Dyspnea Hypotension Rapid, weak pulse Rationale: Anaphylaxis is a significant adverse reaction that is life threatening, in this case in response to the iodinated dye that was used as a contrast. Because anaphylaxis is manifested by respiratory distress, a rapid, weak pulse, hypotension, and shock, counteractive measures must be implemented immediately. Nasal discharge and sneezing are not associated with contrast dye-related complications; these are minor manifestations of atopic reactions.
Which statements would the nurse include when teaching an awareness program on acquired immunodeficiency syndrome's (AIDS') routes of transmission? Select all that apply. 1 Individuals can become infected by donating a pint of whole blood. 2 Having intercourse with only one stable partner can still infect a person. 3 Even if a condom is used each time there is sexual intercourse, a person can be infected. 4 A person can be infected while hugging or shaking hands with a person infected with HIV. 5 If sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies, an individual can still become infected.
Correct answers (2, 3, 5) Having intercourse with only one stable partner can still infect a person. Even if a condom is used each time there is sexual intercourse, a person can be infected. If sexual contact is limited to those without human immunodeficiency virus (HIV) antibodies, an individual can still become infected. Rationale: The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus. Equipment used in blood donation is disposable, and the donor does not come into contact with anyone else's blood. Hence, transmission cannot occur by donating blood. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters in any setting.
