Remediation

When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant other for discharge, which explanation by the nurse accurately describes proper condom use?

"Always position the condom with a space at the tip of an erect penis."

A 28-year-old patient comes to the clinic requesting HIV testing. He is a gay man with two significant others in his lifetime. His partner recently received a diagnosis of HIV infection. The patient asks the nurse how long it will take before the infection could sho up in him. What would be the nurse's best response?

"Antibodies may be detected in the blood within 72 hours of exposure"

A client diagnosed with human immune deficiency virus is prescribed zidovudine (Retrovir), efavirenz (Sustiva), lamivudine (Epivir), and enfuvirtide (Fuzeon). The client asks the nurse what will happen if the prescriptions are not refilled on time, or if a few doses of one of the medications are missed. What is the nurse's best response?

"Blood concentrations will be decreased, which will lead to increased viral replication."

A young gay patient being treated for his third sexually transmitted disease does not see why he should use condoms, because "they don't work." Which is the most appropriate response?

"Condoms may not provide 100% protection, but when used correctly and consistently with every act of sexual intercourse they reduce your risk of getting infected with HIV or other sexually transmitted diseases."

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diabetic diet. Which statement made by the client indicates the need for further teaching?

"I need to buy a special dietetic foods"

The nurse is conducting a health assessment interview with a client diagnosed with a human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address?

"I remember to take my antiretroviral drugs almost every day."

The nurse has reinforced instructions about measuring blood glucose levels to a client newly diagnosed with diabetes mellitus. The nurse determines that the client understands the procedure when making which most accurate statement?

"I should check my blood glucose level before eating each meal, regardless of how much I eat."

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia. Which statement by the client indicates a correct understanding of Humulin N insulin and exercise?

"I should not exercise in the late afternoon."

The nurse determines that the client diagnosed with neutropenia needs further teaching if which statement is made by the client?

"I will include plenty of fresh fruits in my diet."

When the nurse is reinforcing instructions to a client who has been newly diagnosed with type 1 diabetes mellitus, which statement by the client would indicate that teaching has been effective?

"I will notify my health care provider if my blood glucose level is consistently greater than 250 mg/dL."

A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate?

"I'm interested in knowing how you feel about yourself."

The nurse is providing discharge teaching for a client following a liver transplant. Which statement by the client indicates that that additional teaching is needed?

"If I develop an infection, I should stop taking the steroid preparation."

An older adult client tells the nurse that her granddaughter has chickenpox. The client is afraid to visit because she is afraid of getting shingles from her granddaughter. What is the nurse's best response?

"If you already had chickenpox, you can safely visit your granddaughter."

A young man at the HIV clinic tells the nurse how relieved he is that he does not have HIV because he now has no symptoms at all when just a few weeks ago he felt awful. What is the most appropriate nursing response?

"In the latent stage, the physical symptoms are reduced, but the HIV is still present in the lymph nodes"

A client recovering from hepatitis A asks whether he should take the vaccine to avoid contracting the disease again. What does the nurse say?

"No, having the infection has done the same thing a vaccination would."

The nurse is teaching a client with a leg injury and warmth around the injured area. Which statement by the client indicates a good understanding?

"The warmth indicates increased blood flow."

A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must do to self-manage pain?

"When you push the button, you will get the medicine."

The anxious male patient is fearful that he has been exposed to a person with an HIV infection. He states he does not want to go to a laboratory for the ELISA tests because he does not want to be identified. What would be the nurse's most helpful response?

"You can be tested anonymously for ELISA. If you are seronegative, your concerns are over."

The nurse evaluates that the older client has need for further teaching on how to promote sleep when the client makes which statements? Select all that apply

-"I drink hot chocolate before bedtime." -"I plan out my goals for work for the next day."

The nurse is reinforcing teaching with a client who is having difficulty sleeping. Which bedtime snacks will help the client achieve a restful night's sleep? select all that apply

-A glass of warm milk -A cup of caffeine-free chamomile tea -A small banana

Which factors are possible transmission routes for human immune deficiency virus (HIV)? select all that apply

-Breastfeeding -Anal intercourse -Oral sex

The nurse would instruct a patient who is hypocalcemic from hypoparathyroidism about a diet that should include? select all that apply

-Canned fish with bones -Tofu -Vitamin D supplements

The nurse educator is asking the nursing student to recall the signs/symptoms of hypothyroidism. The nurse educator determines that the student understands this disorder if which are included in the student's response? select all that apply

-Constipation -Weight gain -Paresthesia -Menstrual Disturbances -Edema around the eyes and face

The practical nurse is addressing a clients need for sleep. What interventions will the nurse include in the care of this client? select all that apply

-Discourage staff from walking into client's room -Plan vital signs monitoring for when client is likely to be awake -Dim the room lights while client is sleeping

Which of the following are methods in which children with AIDS could have contracted their disease? select ll that apply

-During intrauterine life with an HIV-positive mother -During the birth process of an HIV-positive mother -From receiving a transfusion contaminated with the HIV virus -From breastfeeding by an HIV-positive mother

The home health nurse designing a teaching plan for a person with HIV disease that would support weight gain would include information pertaining to? (select all that apply)

-Eating high-protein/high-calorie diet -Drinking nutritional supplements (Boost, Sustacal, etc.) -Eating several small meals during the day -Providing referrals to dietitians -Resistance weight training

What pharmacologic therapies are effective in managing postoperative pain and reducing the risk of chronic pain after surgery?

-Epidural analgesia -Systemic opioid-based pain regimen -Acupuncture -Trancutaneous electrical nerve stimulation

The patient is concerned that he may be infected with HIV. Which signs or symptoms are most commonly associated with an HIV infection? (select all that apply)

-Fever -Rash -Lymphadenopathy

The nurse is caring for a client after a thyroidectomy and monitoring for signs of thyroid storm. The nurse determines that which sign/symptom is indicative that a thyroid storm may be occurring?

-Heart rate of 132 beats per minute -Profuse diarrhea -Abdominal pain

In planning nutrition for the client with hypoparathyroidism, which diet would be appropriate?

-High in calcium -Low phosphorous

The nurse is preparing to reinforce instructions to a client with Addison's disease regarding diet therapy. The nurse understands that which diet should be prescribed for this client?

-High sodium -High-carbohydrate diet

Which signs/symptoms should indicate to the nurse that the client is experiencing and anaphylactic reaction? select all that apply

-Hives -Stridor -Dyspnea -Urticaria -Wheezing

A client with diabetes mellitus decides to exercise an extra 30 minutes. The client is now experiencing hypoglycemia. Hypoglycemia is supported by which noted data? select all that apply

-Hunger -Cool, clammy skin

The nurse should administer an analgesic to an unconscious patient after observing which signs? select all that apply

-Increased heart rate from 82 to 94 -Increased muscle tension -Perspiration on upper lip -Facial grimacing

Patients diagnosed with HIV infection may risk having a malignancy. Identify the types of cancer that may occur in 40% of patients with HIV infection? select all that apply

-Kaposi Sarcoma -Anal cancer -Cervical cancer -Lymphoma

Which of the following are diseases which result from one's own immune system attacking the body? select all that apply

-Lupus erythematosus -Glomerulonephritis -Rheumatoid arthritis -Thrombocytopenic purpura

A health care provider diagnosed a client to have sleep apnea. What will the nurse expect to find during assessment in this patient? select all that apply

-Morning headache -Loud snoring during sleep -Daytime sleepiness -Increased blood pressure problems

A client asks the nurse how she will know if her husband who snores is at risk of "not breathing during sleep." The nurse is correct to include which of the following as risk factors for obstructive sleep apnea? select all that apply

-Obesity -Elongated uvula -Receding chin -Nasal allergies

The nurse is preparing to complete the plan of care of a patient diagnosed with obstructive sleep apnea. Which of the following measures will the nurse include? Select all that apply

-Obesity -Elongated uvula -Receding chin -Nasal allergies

Which are major complications of HIV infection? select all that apply

-Opportunistic infection -malnutrition -Weight loss -Hemorrhage -Edema

Which of the following provide the body with innate immunity? select all that apply

-Skin and mucous membranes -Tears and saliva -Natural intestinal and vaginal flora -Stomach acid

Which nonpharmacologic therapies are effective in managing pain?

-Sucrose for newborn infants -Massage for mechanical neck disorders -Cognitive behavior therapy

The nurse is explaining about antigens and antibodies when the client asks where antibodies come from. The nurse should include which areas as the most appropriate response? select all that apply

-Tears -Spleen -Saliva -Blood serum -Lymph nodes

Which intervention should be implemented in the care of a client at high risk for an allergic response to a latex allergy? select all that apply

-Use nonlatex gloves -Use medications from glass ampules -Do not puncture rubber stoppers with needles -Keep a latex-safe supply cart available in the client's area.

Which of the following are early signs and symptoms of an HIV infection? select all that apply

-Weight loss -sore throat -Dyspnea

The nurse is assisting with the administration of immunizations at a health care clinic. The nurse should understand that immunization provides which protection?

Acquired immunity from disease

What should the nurse emphasize when counseling an anxious HIV-positive mother about the care of her HIV-positive infant?

Although infants of HIV-infected mothers may test positive for HIV antibodies, not all infants are infected with the virus

What is true concerning passive-acquired immunity?

Antibodies are acquired from outside the host and instilled in the host

When assessing a client who is taking long-term ibuprofen (Motrin) for pain, the nurse finds numerous areas of bruising. What is the nurse's first action?

Assess for gastric discomfort

A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patient's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle?

Attachement

What is the term fro transplantation of tissue between members of the same species?

Autograft

A client diagnosed with human immune deficiency virus is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions does the nurse recommend to the client?

Bathe daily using an antimicrobial soap

The nurse is caring for a client who was medicated for pain 1 hour ago. The client states that the medication is not working and the pain is still present. What is the first action that the nurse will take?

Believe the client's report of pain

The nurse outlines for a patient who has asthma attacks from pollen that the process form exposure to symptoms follows a systematic sequence. What is the last physiologic responses of an allergic asthma attack?

Bronchospasm

The nurse enters the room of a client with type 1 diabetes mellitus and finds the client difficult to arouse. The client's skin is warm and flushed, and the pule and respiratory rate are elevated from the client's baseline. Which action should the nurse implement?

Check the client's capillary blood glucose

When preparing a patient for sleep, timing the lights and decreasing the noise levels are examples of nursing interventions. What are these interventions designed to do?

Decrease environmental stimuli

Which client complaint should alert the nurse to a possible hypoglycemic reaction?

Diplopia

During assessment of a client with a 15-year history of diabetes, the nurse notes that the client has decreased tactile sensation in both feet. Which action does the nurse take first?

Examine the client's feet for signs of injury

What is the most common form of transmission of the HIV virus?

Exposure to contaminated blood products

The home care nurse finds a client who has diabetes awake and alert, but shaky, diaphoretic, and weak. The nurse gives the client 1/2 cup of orange juice. The client's clinical manifestations have not changed 5 minutes later. Which is the nurse's best next action?

Give the client another 1/2 cup of orange juice

What should the nurse look for when reviewing a patient's chart to determine whether she has progressed from HIV disease to AIDS?

HIV-positive test result, CD4+ count below 200, history of opportunistic disease

The nurse is teaching a client with diabetes about exercise. Which statement by the client indicates a need for further teaching?

If my blood glucose is over 200, I should not exercise

What assessment should a nurse make to evaluate the presence of pain in a patient who is cognitively impaired?

Increasing confusion

A patient is admitted with a secondary immunodeficiency from chemotherapy. The nursing plan of care should include provisions for?

Infection control

The client is to receive Humulin NPH 56 units subcutaneously every morning hour before breakfast. Which dosage and syringe is correct for the nurse to administer the medication?

Insulin 100 unit syringe drawn up with Humulin NPH at the 56 unit mark

The nurse is reinforcing dietary instructions to a client newly diagnosed with diabetes mellitus. The nurse accurately instructs the client with which statement?

It is best to eat meals at approximately the same time each day.

A patient who has had a right below the knee amputation continues to complain of unpleasant sensation in the right foot. What can the nurse explain about this "phantom pain"?

It is related to the severed nerves that are still sending messages to the brain

The nurse is assessing pain reported by a latino male patient. What is important for the nurse take into consideration when observing objective data?

Latino men feel it is unmanly to admit to pain

The nurse is reinforcing instructions to a client with diabetes mellitus about blood glucose monitoring for signs of hypoglycemia. The nurse should teach the client that which result is a sign of hypoglycemia?

Less than 50 mg/dL

What action should the nurse implement when assisting a postoperative patient with pain control and comfort?

Lift the patient up in bed

A nurse is caring for a client who has been diagnosed with insomnia. What nursing intervention would help the nurse relieve the client's condition?

Maintain a calm and quiet environment free from noise

The nurse is reinforcing instructions to a client with diabetes mellitus who is recovering from diabetic keto acidosis (DKA) regarding measures to prevent a recurrence. Which instruction is important for the nurse to emphasize?

Monitor blood glucose levels frequently

Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?

Monitor the client's blood pressure

A nurse is caring for a patient who requires long-term management for severe pain. What should be the drug of choice for the patient?

Morphine

The nurse is monitoring a client following a thyroidectomy for signs/symptoms of hypocalcemia. Which signs/symptoms noted in the client indicates the presence of hypocalcemia?

Muscle spasms and bradycardia

What should the nurse do because of the increasing strength of the dose in the injections for immunotherapy?

Observe the patient for at least 20 minutes after administration

Which symptom would be classified as a mild transfusion reaction?

Orthopnea

Which type of immunity does the hepatitis B immune globulin provide for the nurse?

Passive

The nurse notes that a client with type 1 diabetes mellitus has lipodystrophy on both upper thighs. Which further information should the nurse obtain from the client during data collection?

Plan for injection rotation

The nurse manager in an acute care facility has received client evaluations in which the clients have complained about excessive noise that interfered with their rest. The nurse manager and nursing staff plan to do the following. Which activity will most assist clients in obtaining rest?

Post signs for quiet and turn down hall lights during formal quiet times

An anxious patient enters the emergency room with angioedema of the lips and tongue, dyspnea, urticaria, and wheezing after having eaten a peanut butter sandwich. What should be the nurse's first intervention?

Provide oxygen per non-rebreathing mask

Alcohol may initiate sleep but then disrupts sleep by depriving the person of ________ sleep

REM

A patient has pain in the left arm secondary to coronary insufficiency. This is an example of what type of pain?

Referred pain

A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?

Rotate the insulin injection sites systematically

The hospitalized post surgical patient is reluctant to take the opioid pain medication because of drowsiness. Which response is most informative for the nurse to make?

Sleep and pain relief promote healing

The nurse arrives at the bedside of a patient who has had a unit of packed cells infusing in his right arm for 35 minutes. He is complaining of chills, itching, and shortness of breath. What should be the nurse's initial action?

Stop the transfusion and continue with saline

Three hours after surgery, the nurse notes that the breath of the client with type 1 diabetes has a "fruity" odor. Which is the nurse's best first action?

Test the serum for ketone bodies

A patient is in the primary infection stage of HIV. What is true of this patient's current health status?

The patient is infected with HIV but lacks HIV-specific antibodies

The nurse understands that the cytotoxic T lymphocytes increase in number in HIV infection. What is their involvement in HIV infection?

These cells kill T-helper cells which are infected with HIV

Why should interventions such as promotion of nutrition, exercise, and stress reduction be undertaken by the nurse for patients who have HIV infection?

They will improve immune function

The nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists in developing a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan?

Toothbrushing will not be permitted for at least 2 weeks following surgery

A diabetic client has numbness and reduced sensation. Which intervention does the nurse teach this client to prevent injury?

Use a bath thermometer to test the water temperature

The nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which item in the diet?

Vegetables

The nurse is caring for a client with pheochromocytoma. The client is schedules for an adrenalectomy. During the preoperative period, the priority nursing action should be to monitor which criterion?

Vital signs

The nurse is assisting with preparing a teaching plan for the client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?

Wash feet daily with a mild soap

A client has a reduction in immune function. What is the nurse's priority action for this client?

Wash hands before entering the room

The nurse explains that transcutaneous electrical nerve stimulation (TENS) provides a continuous mild electrical current to the skin. How does the TENS unit act to reduce pain?

block pain impulse

The nurse reassures a patient that most acute pain is intense and of short duration. How long does can acute pain usually last?

less than 6 month

The client is diagnosed with an immune deficiency. The nurse focuses on which nursing responsibility as the highest priority when providing care to the client?

protecting the client from infection

While teaching community groups about AIDS, what should the nurse indicate as the most common method of transmission of the HIV?

sexual contact with an HIV-infected partner