Med Surg Test 1 Practice Test

For a male client who has acquired immunodeficiency syndrome with chronic diarrhea, anorexia, a history of oral candidiasis, and weight loss, which dietary instruction would be included in the teaching plan? A. "Follow a low-protein, high-carbohydrate diet." B. "Eat three large meals per day." C. "Include unpasteurized dairy products in the diet." D. "Follow a high-protein, high-calorie diet."

"Follow a high-protein, high-calorie diet." Rationale: Dietary instructions should include the need for a high-protein, high-calorie diet. The patient should be taught to eat small, frequent meals and include low-microbial foods, such as pasteurized dairy products, washed and peeled fruits and vegetables, and well-cooked meats.

Mr. Mc Princeton who is diagnosed with rheumatoid arthritis (RA) complains about joints that always hurt, saying, "I just feel like staying in bed all day." Which discharge instruction would be aimed at maintaining as such function as possible? A. "Refrain from exercise because it only aggravates the disease process." B. "Apply elastic bandages to all joints to increase the pain threshold." C. "Maintain a supine position most of the day to prevent the stress of weight bearing." D. "Promote aquatic (water) exercises to enhance joint mobility."

"Promote aquatic (water) exercises to enhance joint mobility." Rationale: Water exercises are excellent because water promotes buoyancy, which eases joint movement. Persons with RA should maintain an active exercise program to strengthen and preserve muscle movement. Heat or cold applications, which promote circulation and reduce swelling, may help relieve pain, but elastic bandage wraps most likely would not be helpful.

April is diagnosed with systemic lupus erythematosus. Which instruction would be included in the teaching plan for the client? A. "Wear large-brimmed hats when exposed to the sun." B. "Use tanning beds instead of sunbathing outside." C. "Remove all rugs, curtains, and dust-collecting items in home." D. "Carry injectable epinephrine at all times in case of exacerbation."

"Wear large-brimmed hats when exposed to the sun." Rationale: The client diagnosed with systemic lupus erythematosus needs to modify his lifestyle. This includes avoiding sun and ultraviolet light exposure, especially between the hours of 10 a.m. and 4 p.m. The client also should wear tightly woven clothing. Regardless of of the source, exposure to ultraviolet light, even by means of tanning beds, should be strictly avoided. Removing all dust-collecting items in the home is appropriate for client diagnosed with asthma. Carrying injectable epinephrine is appropriate for a client who is allergic to insect stings or certain foods.

The nurse working in an HIV testing and treatment clinic plans teaching about antiretroviral therapy for: A. a patient who tested positive for HIV 3 years ago and has developed tuberculosis. B. male health care worker who is HIV negative but has unprotected sex with men. C. patient who was infected with HIV 10 years ago and has a CD4+ T-cell count of 650/μL. D. patient with persistent generalized lymphadenopathy who was exposed to HIV 2 years previously.

A patient who tested positive for HIV 3 years ago and has developed tuberculosis Rationale: Antiretroviral therapy initiation is recommended for the following patients infected with HIV: history of AIDS-defining illness (such as tuberculosis), CD4+ T-cell count <200 cells/uL or between 200 and 350 cells/uL, pregnant women, persons with HIV-associated nephropathy, and persons co-infected with hepatitis B.

The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is: A. antibiotics should have been used to prevent pneumonia. B. all of the supplied antibiotics should be taken even when symptoms have resolved. C. enough antibiotics for 2 days' treatment should be reserved in case symptoms recur. D. patients should request antibiotics for upper respiratory infections to prevent development of streptococcal-related diseases.

All of the supplied antibiotics should be taken even when symptoms have resolved. Rationale: To prevent the emergence of antibiotic-resistant organisms, patients need to take the entire prescription even if symptoms have resolved. Antibiotics should not be used routinely to prevent bacterial pneumonia.

A client with acquired immunodeficiency syndrome has a respiratory infection from Pneumocystis jiroveci and a nursing diagnosis of Impaired Gas Exchange written in the plan of care. Which of the following indicates that the expected outcome of care has not yet been achieved? A. Client has clear breath sounds B. Client now limits his fluid intake C. Client expectorates secretions easily D. Client is free of complaints of shortness of breath

Client now limits his fluid intake Rationale: The status of the client with a diagnosis of Impaired gas exchange would be evaluated against the standard outcome criteria for this nursing diagnosis. These would include the client stating that breathing is easier and is coughing up secretions effectively, and has clear breath sounds. The client should not limit fluid intake because fluids are needed to decrease the viscosity of secretions for expectoration.

The nurse is caring for a patient who is receiving antiretroviral therapy (ART) for treatment of AIDS. Which assessment best indicates that the patient's condition is improving? A. Decreased viral load B. Increased drug resistance C. Decreased CD4+ T-cell count D. Increased aminotransferase levels

Decreased Viral Load Rationale: Goals of antiretroviral therapy (ART) in the treatment of a patient with HIV are to decrease the viral load and maintain or increase CD4+ T-cell counts. Combination drugs are prescribed to prevent or decrease drug resistance. Some of these drugs may impair liver function; increased aminotransferase levels indicate impaired liver function.

During the past 6 months, a client diagnosed with acquired immunodeficiency syndrome has had chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor and dry mucous membranes. Which nursing diagnosis focuses attention on the client's most immediate problem? A. Diarrhea related to the disease process and acute infection B. Disturbed thought processes related to central nervous system effects of disease C. Imbalanced nutrition: less than body requirements related to nausea and vomiting D. Deficient fluid volume related to diarrhea and abnormal fluid loss

Deficient fluid volume related to diarrhea and abnormal fluid loss Rationale: Based on the client's assessment findings, the most immediate problem is dehydration because of chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to improving the client's fluid status. Although imbalanced nutrition, disturbed thought processes, and diarrhea are involved, they assume a lower priority at this time.

As a knowledgeable nurse, you know that the primary goals of antiretroviral therapy (ART) include all, EXCEPT: A. Reduce HIV-associated morbidity and prolong the duration and quality of survival B. Restore and preserve immunologic function C. Maximally and durably suppress plasma HIV viral load D. Elimination of HIV entirely from the body

Elimination of HIV entirely from the body Rationale: Eradication of HIV infection cannot be achieved with available antiretroviral (ARV) regimens even when new, potent drugs are added to a regimen that is already suppressing plasma viral load below the limits of detection of commercially available assays.

For Mikael who is diagnosed of having allergic rhinitis, which nursing intervention is the most appropriate? A. Encouraging the client to use nasal saline sprays B. Discouraging nose blowing before administering nasal medication C. Advising use of bronchodilator regularly, even if having no symptoms D. Instructing the client to carry epinephrine with him at all times

Encouraging the client to use nasal saline sprays Rationale: For the client with allergic rhinitis, saline nasal sprays may be helpful in soothing mucous membranes, softening crusted secretions, and removing irritants. To achieve maximum relief, the client should blow the nose before administering any medication into the nasal cavity. The client diagnosed with asthma, not allergic rhinitis, may use bronchodilators. Carrying epinephrine would be appropriate for the client with an allergy to insect stings or certains foods such as shellfish.

Which intervention should Nurse John Joe discuss with Elena who has an allergic disorder and is requesting information for allergy symptom control? (Select all that apply.) A. Instructing the client to refrain from using air conditioning or humidifiers in the house B. Instructing the client to use curtains instead of pull shades over windows C. Instructing the client to cover the mattress with a hypoallergenic cover D. Instructing the client to wear a mask when cleaning E. Instructing the client to avoid using sprays, powders, and perfumes F. Instructing the client to change detergents frequently

Instructing the client to cover the mattress with a hypoallergenic cover Instructing the client to wear a mask when cleaning Instructing the client to avoid using sprays, powders, and perfumes Rationale: Using hypoallergenic covers and cosmetics will help reduce the chance of n allergic attack, wearing mask while cleaning will help decrease the amount of dust entering the lungs, and avoiding sprays, powders, and perfumes will help decrease the chance of an allergic attack. The client should use air conditioning and humidifiers. Drapes, curtains, blinds, and carpets should be removed. The client should not change detergents or soaps.

Which clinical manifestation would cause the nurse to suspect that the client is diagnosed with systemic lupus erythematosus? A. Joint edema and tenderness B. Red, burning, tearing eyes C. Chest tightness with wheezing on expiration D. Fever and night sweats

Joint edema and tenderness Rationale: Clinical features of systemic lupus erythematosus involve multiple body systems. When the musculoskeletal system is involved, the client exhibits joint tenderness, edema, and morning stiffness. Eyes that are red, burning, and tearing are commonly associated with allergic rhinitis (i.e., hay fever). Chest tightness and wheezing on expiration are associated with allergic asthma. Fever and night sweats are manifestations of acquired immunodeficiency syndrome

A 35-year-old female patient on your hospital unit is awaiting a liver transplant. All the following statements about organ donations are true except: A. More than 85% of adult Americans approve of organ donation. B. Organ recipients are matched to donors by age and sex. C. More than 17,000 people were awaiting liver transplants in 2004. D. Less than 6,000 liver transplants were performed in 2003.

Organ recipients are matched to donors by age and sex. Rationale: Organ recipients and donors are matched for tissue types and organs needed, but not by age and sex. It is true that more than 85% of adult Americans approve of organ donation. In 2003, 25,640 persons received organ transplants; liver transplants accounted for 5,671 of these. In 2004, more than 17,000 people were awaiting liver transplants.

Which intervention should the nurse implement when caring for a client diagnosed with Pneumocystis carinii pneumonia related to acquired immunodeficiency syndrome who is crying over the loss of friends and family members because they will not talk to him anymore? A. Advising the client not to worry, and telling him everything will be alright B. Asking the health care provider for a psychiatric consult to assess the client's mental functioning C. Sitting down and listening to the client's concerns and frustrations D. Telling the client that the friends probably were not true friends anyway

Sitting down and listening to the client's concerns and frustrations Rationale: Crying is evidence that the client is beginning to express concerns to the nurse. In response, active, nonjudgmental listening would most appropriate because is aids in the development of a trusting relationship. Advising the client not to worry or saying that everything will be alright provides false reassurance, which does not help the client cope. Further assessment is needed to determine whether a psychiatric consult should be considered. Telling the client that the friends were not true friends discounts the client's feeling and hinders the development of a therapeutic relationship.

Nurse Ruffa is providing dietary instructions to the client with systemic lupus erythematosus. Which of the following dietary items would the nurse instruct the client to avoid? A. Cantaloupe B. Steak C. Broccoli D. Turkey

Steak Rationale: The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake.

The decision to begin antiretroviral therapy is based on: A. The CD4 cell count B. The plasma viral load C. The intensity of the patient's clinical symptoms D. All of the above

The CD4 cell count The plasma viral load The intensity of the patient's clinical symptoms Rationale: A person's CD4 count is an important factor in the decision to start ART. A low or falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART. Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and co infections.

A child with leukemia will be undergoing an allogeneic bone marrow transplant. When teaching the parents about the procedure, which information should the healthcare provider include? Check all that apply A. Your child's stem cells are removed before the chemotherapy and radiation B. The stem cells for this transplant might come from a baby's umbilical cord blood C. Your child's immune system will improve as soon as the transplant is complete D. Your child may need periodic blood transfusions after the procedure E. It is possible that the donor cells will attack your child's cells

The stem cells for this transplant might come from a baby's umbilical cord blood Your child may need periodic blood transfusions after the procedure It is possible that the donor cells will attack your child's cells Rationale: "Allo" means "other" so the bone marrow is coming from a donor. Graft-versus-host disease may occur in allogenic transplants. The newly transplanted cells might attack the recipient's body because the donor cells regard the patient's cells to be foreign. One type of allogenic transplant is a stem cell transplant from umbilical cord blood collected at the time of delivery. Umbilical cord blood is rich in immature hematopoietic cells. The transplanted cells will take some time to begin making new cells, so the patient will be at risk for infection and bleeding. The patient may also require transfusions of red blood cells to maintain oxygen carrying capacity of the blood.

Which is the most common HIV-related neurological complication? A. Tuberculosis B. Kaposi's sarcoma C. Toxoplasmosis D. Lymphoma

Toxoplasmosis Rationale: Toxoplasmosis is the most common central nervous system infection in patients with the acquired immunodeficiency syndrome (AIDS) who are not receiving appropriate prophylaxis. This infection has a worldwide distribution and is caused by the intracellular protozoan parasite, Toxoplasma gondii.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. Serum sodium level of 135 mEq/L b. Serum potassium level of 4.9 mEq/L c. Temperature of 99.2° F (37.3° C) d. Urine output of 20 ml/hour

Urine output of 20 ml/hour Rationale: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

A patient with a sore throat and rhinitis has an elevated level of IgG in the blood. The nurse explains that the patient's symptoms are most likely caused by: A. an allergy. B. exposure to toxic fume. C. an initial viral infection. D. a re-infection by bacteria.

a re-infection by bacteria.

The home care nurse is making follow-up visits to a client following renal transplant. The nurse assesses the client for which signs of acute graft rejection? A. hypotension, graft tenderness, and anemia B. hypertension, oliguria, thirst, and hypothermia C. fever, hypertension, graft tenderness, and malaise D. fever, vomiting, hypotension, and copious amounts of dilute urine

fever, hypertension, graft tenderness, and malaise Rationale: Acute rejection usually occurs within the first 3 months after transplant, although it can occur for up to 2 years posttransplant. The client exhibits fever, hypertension, malaise, and graft tenderness. Treatment is immediately begun with corticosteroids and possibly also with monoclonal antibodies and antilymphocyte agents.

A diagnosis of AIDS can be made for a patient with HIV with: A. a CD4+ T-cell count <500/µL. B. a WBC count <3000/µL (3 × 109/L). C. development of oral candidiasis (thrush). D. onset of Pneumocystis jiroveci pneumonia

onset of Pneumocystis jiroveci pneumonia Rationale: The Centers for Disease Control (CDC) has established criteria for a patient to be diagnosed with AIDS. AIDS is diagnosed when an HIV-positive individual develops at least one of several criteria: examples are CD4+ T-cell count less than 200 cells/uL and fungal infection such as Pneumocystis jiroveci pneumonia (PCP). Candidiasis infection must be of the bronchi, trachea, lungs, or esophagus (not only the mouth).

A client is diagnosed with oral candidiasis. Nurse Tina knows that this condition in the immunosuppressed can be treated with: A. Trimethoprim + sulfamethoxazole B. Fluconazole C. Acyclovir D. Zidovudine

Fluconazole Rationale: Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin "swish and swallow"). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments.

Human Papilloma Virus in AIDS patients is manifested as: A. Cough, evening fever, night sweats, weight loss and anemia B. Persistent fever, tachypnea, hypoxia, cyanosis and tachycardia. C. Genital warts, flat warts, skin warts, neoplasm of cervix, vagina and penis D. Watery diarrhea, abdominal pain, nausea and vomiting

Genital warts, flat warts, skin warts, neoplasm of cervix, Rationale: Dermatologic human papillomavirus (HPV) infection in HIV patients manifests as both anogenital and nongenital skin disease. Cutaneous HPV-related disease in nongenital skin is also increased in HIV-positive patients, in the form of benign common warts, epidermodysplasia verruciformis-like skin lesions, and nonmelanoma skin cancers.

Nurse Vince sustained a dirty needle stick injury. Which diagnostic test would be ordered on a client? A. Enzyme-linked immunosorbent assay (ELISA) B. SUDS screening test C. Antibody titers D. Skin biopsy for Kaposi's sarcoma

SUDS screening Test Rationale: SUDS screening test results are available in 30 to 60 minutes. The test is performed on a client to determine if the health care worker with a dirty needle stick injury should begin antiretroviral treatment. ELISA test results indicate exposure to or infection with human immunodeficiency virus (HIV), but the test does not diagnose acquired immunodeficiency syndrome (AIDS). Antibody titers would not be appropriate to determine whether the health care worker has been exposed to HIV or hepatitis. Kaposi's sarcoma is usually associated with AIDS but not immediately after a needle stick.