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1. The nurse is caring for a patient with a sliding hiatal hernia. In which position should the nurse expect the patient to report that the symptoms are more acute? a. Sitting b. Standing c. Lying down d. Semi-Fowlers

1. ANS: C In a sliding hiatal hernia, the stomach slides up into the thoracic cavity when a patient is supine and then goes back into the abdominal cavity when upright. Sliding hiatal hernia symptoms are worse when lying down. A. B. D. The symptoms of a hiatal hernia are not worse when sitting, standing, or in the semi-Fowlers position.

2. The nurse is reinforcing teaching provided to a patient with a hiatal hernia. Which patient statement indicates a correct understanding of lifestyle modification to reduce symptoms? a. Avoid high-stress situations. b. Perform daily aerobic exercise. c. Avoid nicotine and alcohol use. d. Carefully space activity periods with rest.

2. ANS: C Lifestyle changes for symptomatic hiatal hernia include losing weight, antacids, eating small meals that pass easily through the esophagus, not reclining for 3-4 hours after eating, elevating the head of the bed 6 to 12 inches to prevent reflux, and avoiding bedtime snacks, spicy foods, alcohol, caffeine, and smoking. A. B. D. Stress, exercise, and rest periods are not recommendations for the patient with a hiatal hernia.

_ 3. The nurse teaching a patient with gastroesophageal reflux about the influence of body position on the disease process. Which patient statement indicates that teaching has been effective? a. I elevate the head of the bed 4 to 6 inches. b. I elevate the foot of the bed 12 to 16 inches. c. I sleep on my back without a pillow under my head. d. I sleep on my stomach with my head turned to the left.

3. ANS: A Elevating the head of the bed 4 to 6 inches helps prevent reflux of gastric contents into the esophagus. B. The head of the bed does not need to be elevated 12 to 16 inches. C. D. Sleeping flat or on the stomach could exacerbate symptoms of gastroesophageal reflux.

471. The nurse is reinforcing teaching to a client about an upcoming colonoscopy procedure. The nurse should include in the instructions that the client will be placed in which position for the procedure? 1. Left Sims' position 2. Lithotomy position 3. Knee-chest position 4. Right Sims' position

471. 1 Rationale: The client is placed in the left Sims' position for the procedure. This position takes the best advantage of the client's anatomy for ease in introducing the colonoscope. The other options are incorrect.

472. The nurse is preparing to perform an abdominal examination. The initial step should be which? 1. Palpation 2. Inspection 3. Percussion 4. Auscultation

472. 2 Rationale: The appropriate technique for abdominal examination is inspection, auscultation, percussion, and palpation. Auscultation is performed after inspection and before percussion and palpation to ensure that the motility of the bowel and bowel sounds are not altered. The sequence of maneuvers is inspect, auscultate, percuss, and palpate.

473. The nurse reinforces postoperative liver biopsy procedures to a client. Which should the nurse tell the client? 1. Avoid alcohol for 8 hours. 2. Remain NPO for 24 hours. 3. Lie on the right side for 2 hours. 4. Save all stools to be checked for blood.

473. 3 Rationale: To splint the puncture site, the client is kept on the right side for a minimum of 2 hours. It is not necessary to remain NPO for 24 hours. Permission regarding the consumption of alcohol should be obtained from the health care provider. It is not necessary to save all stools.

474. The nurse is caring for a client with a diagnosis of chronic gastritis. The nurse anticipates that the client is at risk for which vitamin deficiency? 1. Vitamin A 2. Vitamin C 3. Vitamin E 4. Vitamin B12

474. 4 Rationale: Deterioration and atrophy of the lining of the stomach lead to the loss of function of the parietal cells. When the acid secretion decreases, the source of the intrinsic factor is lost, which results in the inability to absorb vitamin B12. This leads to the development of pernicious anemia. Options 1, 2, and 3 are incorrect.

475. The nurse is caring for a client after a Billroth II (gastrojejunostomy) procedure. On review of the postoperative prescriptions, which should the nurse clarify? 1. Leg exercises 2. Early ambulation 3. Irrigating the nasogastric (NG) tube 4. Coughing and deep-breathing exercises

475. 3 Rationale: In a Billroth II resection, the proximal remnant of the stomach is anastomosed to the proximal jejunum. Patency of the NG tube is critical for preventing the retention of gastric secretions. The nurse, however, should never irrigate or reposition the gastric tube after gastric surgery unless specifically prescribed by the health care provider. In this situation, the nurse should clarify the prescription. Options 1, 2, and 4 are appropriate postoperative interventions.

476. The nurse is reinforcing discharge instructions to a client after a gastrectomy. Which measure should the nurse include in client teaching to help prevent dumping syndrome? 1. Ambulate after a meal. 2. Eat high-carbohydrate foods. 3. Limit the fluids taken with meals. 4. Sit in a high Fowler's position during meals.

476. 3 Rationale: The client should be instructed to decrease the amount of fluid taken at meals. The client should also be instructed to avoid high-carbohydrate foods, including fluids such as fruit nectars; assume a low-Fowler's position during meals; lie down for 30 minutes after eating to delay gastric emptying; and take antispasmodics as prescribed.

477. The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which indicates this occurrence? 1. Sweating and pallor 2. Dry skin and stomach pain 3. Bradycardia and indigestion 4. Double vision and chest pain 613

477. 1 Rationale: Early manifestations occur 5 to 30 minutes after eating. Symptoms include vertigo, tachycardia, syncope, sweating, pallor, palpitations, and the desire to lie down.

478. The nurse is reviewing the record of a client with Crohn's disease. Which stool characteristic should the nurse expect to see documented in the record? 1. Diarrhea 2. Constipation 3. Bloody stools 4. Stool constantly oozing from the rectum

478. 1 Rationale: Crohn's disease is characterized by nonbloody diarrhea of usually not more than four or five stools daily. Over time, the diarrhea episodes increase in frequency, duration, and severity. Options 2, 3, and 4 are not characteristics of Crohn's disease.

479. A client with ascites is scheduled for a paracentesis. The nurse is assisting the health care provider in performing the procedure. Which position should the nurse assist the client into for this procedure? 1. Flat 2. Upright 3. Left side-lying 4. Right side-lying

479. 2 Rationale: An upright position allows the intestine to float posteriorly and helps prevent intestinal laceration during catheter insertion. Options 1, 3, and 4 are incorrect positions.

549. A client newly diagnosed with chronic kidney disease has recently begun hemodialysis. Which are signs/symptoms of disequilibrium syndrome? 1. Hypertension, tachycardia, and fever 2. Hypotension, bradycardia, and hypothermia 3. Restlessness, irritability, and generalized weakness 4. Headache, deteriorating level of consciousness, and twitching

549. 4 Rationale: Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and onset of symptoms. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

480. The nurse is reviewing the prescriptions of a client admitted to the hospital with a diagnosis of acute pancreatitis. Which interventions should the nurse expect to note? Select all that apply. 1. Administer antacids, as prescribed. 2. Encourage small, frequent, high-calorie feedings. 3. Encourage coughing and deep breathing. 4. Administer anticholinergics, as prescribed. 5. Maintain the client in a supine and flat position.

480. 1, 3, 4 Rationale: The client with acute pancreatitis is normally placed on an NPO status to rest the pancreas and suppress gastrointestinal (GI) secretions. Because abdominal pain is a prominent symptom of pancreatitis, pain medication will be prescribed. Some clients experience lessened pain by assuming positions that flex the trunk and draw the knees up to the chest. A side-lying position with the head elevated 45 degrees decreases tension on the abdomen and may also help ease the pain. The client is susceptible to respiratory infections because the retroperitoneal fluid raises the diaphragm, which causes the client to take shallow, guarded abdominal breaths. Therefore, measures such as turning, coughing, and deep breathing are instituted. Antacids and anticholinergics may be prescribed to suppress GI secretions.

481. It has been determined that a client with hepatitis has contracted the infection from contaminated food. Which type of hepatitis is this client most likely experiencing? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

481. 1 Rationale: Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are most commonly transmitted via infected blood or body fluids.

482. The nurse is reviewing the health care provider's prescriptions written for a client admitted with acute pancreatitis. Which health care provider prescription should the nurse verify if noted in the client's chart? 1. NPO status 2. An anticholinergic medication 3. Position the client supine and flat 4. Prepare to insert a nasogastric tube

482. 3 Rationale: The pain associated with acute pancreatitis is aggravated when the client lies in a supine and flat position. Therefore, the nurse would verify this prescription. Options 1, 2, and 4 are appropriate interventions for the client with acute pancreatitis.

483. A client with hiatal hernia chronically experiences heartburn after meals. Which should the nurse teach the client to avoid? 1. Lying recumbent after meals 2. Eating small, frequent, bland meals 3. Raising the head of the bed on 6-inch blocks 4. Taking histamine receptor antagonist medication, as prescribed

483. 1 Rationale: Hiatal hernia is caused by a protrusion of a portion of the stomach above the diaphragm, where the esophagus usually is positioned. The client generally experiences pain caused by reflux resulting from ingestion of irritating foods, lying flat following meals or at night, and consuming large or fatty meals. Relief is obtained by eating small, frequent, and bland meals; histamine antagonists and antacids; and elevation of the thorax after meals and during sleep.

484. The nurse is monitoring for stoma prolapse in a client with a colostomy. Which stoma observation should indicate that a prolapse has occurred? 1. Dark and bluish 2. Sunken and hidden 3. Narrowed and flattened 4. Protruding and swollen

484. 4 Rationale: A prolapsed stoma is one in which bowel protrudes through the stoma, with an elongated and swollen appearance. A stoma retraction is characterized by sinking of the stoma. Ischemia of the stoma would be associated with dusky or bluish color. A stoma with a narrowed opening, either at the level of the skin or fascia, is said to be stenosed.

485. An ultrasound of the gallbladder is scheduled for the client with a suspected diagnosis of cholecystitis. Which should the nurse explain to the client about this test? 1. The test is uncomfortable. 2. The test requires that the client be NPO. 3. The test requires the client to lie still for short intervals. 4. The test is preceded by the administration of oral tablets.

485. 3 Rationale: Ultrasound of the gallbladder is a noninvasive procedure and is frequently used for emergency diagnosis of acute cholecystitis. The client may need to lie still during the procedure for short intervals of time while visualization of the gallbladder is done. The client may or may not need to be NPO (per health care provider preference), but may be instructed to avoid carbonated beverages for 48 hours before the test to help decrease intestinal gas. It is a painless test and does not require the administration of oral tablets as preparation.

546. The nurse is caring for the client with epididymitis. Which treatment modalities should be implemented? Select all that apply. 1. Bed rest 2. Sitz bath 3. Antibiotics 4. Heating pad 5. Scrotal elevation

546. 1, 2, 3, 5 Rationale: Common interventions used in the treatment of epididymitis include bed rest, elevation of the scrotum, ice packs, sitz baths, analgesics, and antibiotics. A heating pad should not be used because direct application of heat could increase blood flow to the area and increase the swelling. Test-Takin

547. A client has epididymitis as a complication of a urinary tract infection (UTI). The nurse is giving the client instructions to prevent a recurrence. The nurse determines that the client needs further teaching if the client states the intention to do which? 1. Drink increased amounts of fluids 2. Limit the force of the stream during voiding 3. Continue to take antibiotics until all symptoms are gone 4. Use condoms to eliminate risk from chlamydia and gonorrhea

547. 3 Rationale: The client who experiences epididymitis from UTI should increase intake of fluids to flush the urinary system. Because organisms can be forced into the vas deferens and epididymis from strain or pressure during voiding, the client should limit the force of the stream. Condom use can help prevent urethritis and epididymitis from sexually transmitted infections. Antibiotics are always taken until the full course of therapy is completed.

548. The nurse is collecting data from a client who has had benign prostatic hyperplasia (BPH) in the past. To determine if the client is currently experiencing exacerbation of BPH, the nurse should ask the client about the presence of which early symptom? 1. Nocturia 2. Urinary retention 3. Urge incontinence 4. Decreased force in the stream of urine

548. 4 Rationale: Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client may then develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.

560. The nurse is monitoring an older client suspected of having a urinary tract infection (UTI) for signs of the infection. Which sign/symptom should occur first? 1. Fever 2. Urgency 3. Confusion 4. Frequency

560. 3 Rationale: In an older client, the only symptom of a UTI may be something as vague as increasing mental confusion or frequent unexplained falls. Frequency and urgency may commonly occur in an older client, and fever can be associated with a variety of conditions.

550. A client with chronic kidney disease has been on dialysis for 3 years. The client is receiving the usual combination of medications for the disease, including aluminum hydroxide as a phosphate-binding agent. The client now has mental cloudiness, dementia, and complaints of bone pain. Which does this data indicate? 1. Advancing uremia 2. Phosphate overdose 3. Folic acid deficiency 4. Aluminum intoxication

550. 4 Rationale: Aluminum intoxication may occur when there is accumulation of aluminum, an ingredient in many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain from infiltration of the bone with aluminum. This condition was formerly known as dialysis dementia. It may be treated with aluminum-chelating agents, which make aluminum available to be dialyzed from the body. It can be prevented by avoiding or limit

551. A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse monitors this client for which signs/symptoms of this disorder? 1. Edema and purpura of the left arm 2. Warmth, redness, and pain in the left hand 3. Aching pain, pallor, and edema of the left arm 4. Pallor, diminished pulse, and pain in the left hand

551. 4 Rationale: Arterial steal syndrome results from vascular insufficiency after creation of a fistula. The client exhibits pallor and diminished pulse distal to the fistula and complains of pain distal to the fistula, which is caused by tissue ischemia. Warmth, redness, and pain should more likely characterize a problem with infection. Options 2 and 3 are not characteristics of steal syndrome.

552. The nurse is reviewing the medical record of a client with a diagnosis of pyelonephritis. Which disorder noted on the client's record should the nurse identify as a risk factor for this disorder? 1. Hypoglycemia 2. Diabetes mellitus 3. Coronary artery disease 4. Orthostatic hypotension

552. 2 Rationale: Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of urinary stones, and indwelling or frequent urinary catheterization.

553. The nurse is reviewing the client's record and notes that the health care provider has documented that the client has a renal disorder. Which laboratory results would indicate a decrease in renal function? Select all that apply. 1. Elevated serum creatinine level 2. Elevated thrombocyte cell count 3. Decreased red blood cell (RBC) count 4. Decreased white blood cell (WBC) count 5. Elevated blood urea nitrogen (BUN) level

553. 1, 3, 5 Rationale: BUN testing is a frequently used laboratory test to determine renal function. The BUN and serum creatinine levels start to rise when the glomerular filtration rate falls below 40% to 60%. A decreased RBC count may be noted if erythropoietic function by the kidney is impaired. An increased WBC is most likely to be noted in renal disease. Thrombocyte cell counts do not indicate decreased renal function.

554. A client is scheduled for intravenous pyelography (IVP). Which priority nursing action should the nurse take? 1. Restrict fluids. 2. Administer a sedative. 3. Determine a history of allergies. 4. Administer an oral preparation of radiopaque dye.

554. 3 Rationale: An iodine-based dye may be used during the IVP and can cause allergic reactions such as itching, hives, rash, tight feeling in the throat, shortness of breath, and bronchospasm. Checking for allergies is the priority. Options 1, 2, and 4 are unnecessary.

555. After a renal biopsy, the client complains of pain at the biopsy site, which radiates to the front of the abdomen. Which would this indicate? 1. Bleeding 2. Infection 3. Renal colic 4. Normal, expected pain

555. 1 Rationale: If pain originates at the biopsy site and begins to radiate to the flank area and around the front of the abdomen, bleeding should be suspected. Hypotension, a decreasing hematocrit, and gross or microscopic hematuria should also indicate bleeding. Signs of infection should not appear immediately after a biopsy. Pain of this nature is not normal. There are no data to support the presence of renal colic.

556. The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. The nurse should take which actions? Select all that apply. 1. Contact the health care provider (HCP). 2. Check the level of the drainage bag. 3. Reposition the client to his or her side. 4. Place the client in good body alignment. 5. Check the peritoneal dialysis system for kinks. 6. Increase the flow rate of the peritoneal dialysis solution.

556. 2, 3, 4, 5 Rationale: If outflow drainage is inadequate, the nurse attempts to stimulate outflow by changing the client's position. Turning the client to the other side or making sure that the client is in good body alignment may assist with outflow drainage. The drainage bag needs to be lower than the client's abdomen to enhance gravity drainage. The connecting tubing on the peritoneal dialysis system is also checked for kinks or twisting, and the clamps on the system are checked to ensure that they are open. There is no reason to contact the HCP. Increasing the flow rate is an inappropriate action and is unassociated with the amount of outflow solution.

557. The nurse is collecting data on a newly admitted client with a diagnosis of bladder cancer. Which sign/symptom should be noted first? 1. Dysuria 2. Urgency 3. Frequency 4. Hematuria

557. 4 Rationale: Gross, painless hematuria is most frequently the first manifestation of bladder cancer. As the disease progresses, the client may experience dysuria, frequency, and urgency.

558. A client with benign prostatic hypertrophy (BPH) undergoes a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigations postoperatively. Which are the signs/symptoms of transurethral resection (TUR) syndrome? 1. Tachycardia and diarrhea 2. Bradycardia and confusion 3. Increased urinary output and anemia 4. Decreased urinary output and bladder spasms

558. 2 Rationale: TUR syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure, such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.

559. A client with prostatitis resulting from kidney infection has received instructions on management of the condition at home and prevention of recurrence. Which statement indicates that the client understood the instructions? 1. Stop antibiotic therapy when pain subsides. 2. Exercise as much as possible to stimulate circulation. 3. Use warm sitz baths and analgesics to increase comfort. 4. Keep fluid intake to a minimum to decrease the need to void.

559. 3 Rationale: Treatment of prostatitis includes medication with antibiotics, analgesics, and stool softeners. The client is also taught to rest, increase fluid intake, and use sitz baths for comfort. Antimicrobial therapy is always continued until the prescription is completely finished.

646. Which individual is least at risk for the development of Kaposi's sarcoma? 1. A kidney transplant client 2. A male with a history of same-sex partners 3. A client receiving antineoplastic medications 4. An individual working in an environment where exposure to asbestos exists

646. 4 Rationale: Kaposi's sarcoma is a vascular malignancy that presents as a skin disorder and is a common acquired immunodeficiency syndrome indicator. It is seen frequently in men with a history of same-sex partners. Although the cause of Kaposi's sarcoma is not known, it is considered to be the result of an alteration or failure in the immune system. The renal transplant client and the client receiving antineoplastic medications are at risk for immunosuppression. Exposure to asbestos is not related to the development of Kaposi's sarcoma.

647. The nurse prepares to give a bath and change the bed linens on a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which should the nurse incorporate in the plan during the bathing of this client? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to change the bed linens and gloves only for the bath

647. 2 Rationale: Gowns and gloves are required if the nurse anticipates contact with soiled items, such as wound drainage, or while caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn.

648. A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which is one of the initial characteristic signs/symptoms of systemic lupus erythematous? 1. Weight gain 2. Subnormal temperature 3. Elevated red blood cell count 4. Rash on the face across the nose and on the cheeks

648. 4 Rationale: Skin lesions or a rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.

649. A client with pemphigus is being seen in the clinic regularly. The nurse plans care based on which description of this condition? 1. The presence of tiny red vesicles 2. An autoimmune disease that causes blistering in the epidermis 3. The presence of skin vesicles found along the nerve caused by a virus 4. The presence of red, raised papules and large plaques covered by silvery scales

649. 2 Rationale: Pemphigus is an autoimmune disease that causes blistering in the epidermis. The client has large flaccid blisters (bullae). Because the blisters are in the epidermis, they have a thin covering of skin and break easily, leaving large denuded areas of skin. On initial examination, clients may have crusting areas instead of intact blisters. Option 1 describes eczema, option 3 describes herpes zoster, and option 4 describes psoriasis.

650. Which interventions would apply in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply. 1. Use nonlatex gloves. 2. Use medications from glass ampules. 3. Place the client in a private room only. 4. Do not puncture rubber stoppers with needles. 5. Keep a latex-safe supply cart available in the client's area. 6. Use a blood pressure cuff from an electronic device only to measure the blood pressure.

650. 1, 2, 4, 5 Rationale: If a client is allergic to latex and is at high risk for an allergic response, the nurse would use nonlatex gloves and latex-safe supplies and would keep a latex-safe supply cart available in the client's area. Any supplies or materials that contain latex would be avoided. These include blood pressure cuffs and medication bottles with rubber stoppers that require puncture with a needle. It is not necessary to place the client in a private room.

651. The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse should incorporate which as a priority in the plan of care? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function

651. 1 Rationale: The client with immune deficiency has inadequate or absent immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Op

652. A client calls the office of his primary care health care provider and tells the nurse that he was just stung by a bumblebee while gardening. The client is afraid of a severe reaction because his neighbor experienced such a reaction just 1 week ago. Which is the appropriate nursing action? 1. Advise the client to soak the site in hydrogen peroxide. 2. Ask the client if he ever sustained a bee sting in the past. 3. Tell the client to call an ambulance for transport to the emergency room. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.

652. 2 Rationale: In some types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. Therefore, the appropriate action would be to ask the client if he ever received a bee sting in the past. Option 1 is not appropriate advice. Option 3 is unnecessary. The client should not be told "not to worry."

653. The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that immunization provides which? 1. Protection from all diseases 2. Innate immunity from disease 3. Natural immunity from disease 4. Acquired immunity from disease

653. 4 Rationale: Acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. Natural (innate) immunity is present at birth. No immunization protects the client from all diseases.

654. The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care considering which factor regarding this diagnosis? 1. A local rash occurs as a result of allergy. 2. It is a disease caused by overexposure to sunlight. 3. A continuous release of histamine in the body causes the disease. 4. It is an inflammatory disease of collagen contained in connective tissue.

654. 4 Rationale: SLE is an inflammatory disease of collagen contained in connective tissue. Options 1, 2, and 3 are not associated with this disease. Test-Taking Strategy: Focus on the subject, the characteristics of SLE. Eliminate option 1 because SLE is a systemic disorder, not a local one. Next, eliminate option 3 because of its similarity to option 1. From the remaining options, select option 4 because of its systemic characteristic.

655. The camp nurse prepares to instruct a group of children about Lyme disease. Which information should the nurse include in the instructions? 1. Lyme disease is caused by a tick carried by deer. 2. Lyme disease is caused by contamination from cat feces. 3. Lyme disease can be contagious by skin contact with an infected individual. 4. Lyme disease can be caused by the inhalation of spores from bird droppings.

655. 1 Rationale: Lyme disease is a multisystem infection that results from a bite by a tick carried by several species of deer. Persons bitten by Ixodes ticks can be infected with the spirochete Borrelia burgdorferi. Lyme disease cannot be transmitted from one person to another. Toxoplasmosis is caused from the ingestion of cysts from contaminated cat feces. Histoplasmosis is caused by the inhalation of spores from bat or bird droppings.

656. The client is diagnosed with stage I of Lyme disease. The nurse should check the client for which characteristic of this stage? 1. Arthralgias 2. Flu-like symptoms 3. Enlarged and inflamed joints 4. Signs of neurological disorders

656. 2 Rationale: The hallmark of stage I is the development of a skin rash within 2 to 30 days of infection, generally at the site of the tick bite. The rash develops into a concentric ring, giving it a bull's-eye appearance. The lesion enlarges up to 50 to 60 cm, and smaller lesions develop farther away from the original tick bite. In stage I, most infected persons develop flu-like symptoms that last 7 to 10 days; these symptoms may reoccur later. Arthralgias and joint enlargements are most likely to occur in stage III. Neurological deficits occur in stage II.

657. A female client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which nursing action is appropriate? 1. Refer the client for a blood test immediately. 2. Inform the client that there is not a test available for Lyme disease. 3. Tell the client that testing is not necessary unless arthralgia develops. 4. Instruct the client to return in 4 to 6 weeks to be tested, because testing before this time is not reliable.

657. 4 Rationale: A blood test is available to detect Lyme disease; however, the test is not reliable if performed before 4 to 6 weeks following the tick bite. Antibody formation takes place in the following manner: immunoglobulin M is detected 3 to 4 weeks after Lyme disease onset, peaks at 6 to 8 weeks, and then gradually disappears; immunoglobulin G is detected 2 to 3 months after infection and may remain elevated for years. Options 1, 2, and 3 are incorrect.

658. The nurse, a Cub Scout leader, is preparing a group of Cub Scouts for an overnight camping trip and instructs them about the methods to prevent Lyme disease. Which statement by one of the Cub Scouts indicates a need for further teaching? 1. "I need to bring a hat to wear during the trip." 2. "I should wear long-sleeved tops and long pants." 3. "I should not use insect repellent because it will attract the ticks." 4. "I need to wear closed shoes and socks that can be pulled up over my pants."

658. 3 Rationale: In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found. Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, one should avoid heavily wooded areas or areas with thick underbrush. Socks can be pulled up and over the pant legs to prevent ticks from entering under clothing.

659. The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse under-stands that this has been confirmed by which? 1. Swelling in the genital area 2. Swelling in the lower extremities 3. Punch biopsy of the cutaneous lesions 4. Appearance of reddish-blue lesions on the skin

659. 3 Rationale: Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis through the upper body and then to the face and oral mucosa. They can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions.

660. The client is brought to the emergency department and is experiencing an anaphylactic reaction from eating shellfish. The nurse should implement which immediate action? 1. Maintaining a patent airway 2. Administering a corticosteroid 3. Administering epinephrine (Adrenalin) 4. Instructing the client on the importance of obtaining a Medic-Alert bracelet

660. 1 Rationale: If the client experiences an anaphylactic reaction, the immediate action would be to maintain a patent airway. The client then would receive epinephrine. Corticosteroids may also be prescribed. The client will need to be instructed about obtaining and wearing a Medic-Alert bracelet, but this is not the immediate action.