Unit 3 - Custom Quiz

A nurse is reviewing the records of four clients who have prescriptions for cytokines. Which client's record indicates a need for correction? 1

Client A Cytokines are soluble factors secreted by white blood cells and a variety of other cells in the body; cytokines act as messengers between the cell types. Epoetin alfa is an erythropoietin that is effective in treating anemia secondary to chronic cancer. Therefore client A's medication chart indicates a need for correction. Betaseron is a β-Interferon used to treat multiple sclerosis. Etanercept is used to treat rheumatoid arthritis. Aldesleukin is an interleukin-2 used to treat metastatic melanoma.

The healthcare team is caring for a client who has undergone surgery for lung cancer. The client needs respiratory therapy. Which task can be safely delegated to a respiratory therapist paired with a registered nurse?

Assessing respiration Respiratory therapy is needed in clients who undergo surgery for lung cancer. Assessing respiration can be safely delegated to the respiratory therapist. Placing a Foley catheter, an IV catheter, or administering patient-controlled analgesia is within the scope of a registered nurse's practice.

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse?

"Antibiotics are recommended for infants younger than 6 months with acute otitis media." All cases of acute otitis media (AOM) in infants younger than 6 months should be treated with antibiotics because of their immature immune systems and the potential for infection with bacteria. Current literature indicates that waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. However, the watchful waiting approach is not recommended for children younger than 2 years of age who have persistent acute symptoms of fever and severe ear pain. Antiviral or antiinflammatory medications would not be recommended in an acute case of otitis media.

A client is diagnosed with an eczematous eruption with well-defined and geometric margins on the scalp. Which condition does the nurse anticipate in the client?

Contact dermatitis The diagnostic feature of contact dermatitis is the presence of localized eczematous eruptions with well-defined and geometric margins. The diagnostic feature of drug eruption is the presence of bright-red erythematous macules and papules in large areas. In atopic dermatitis, the client has lichenification with scaling and excoriation, which causes extreme itching. In nonspecific eczematous dermatitis, lesions evolve from vesicles to weeping papules and plaques.

A senior nurse educates a nursing student about measures to reduce vaccine-related pain in children. Which statement by a nursing student indicates a need for further teaching?

Correct 4 "I should give antipyretics to the child. According to a research study conducted in Russia, providing analgesics or antipyretics interferes with the immune response produced by the vaccine. Studies also show that providing antipyretics does not help to reduce pain and fever caused by vaccination. The use of microneedles reduces pain because this tool is minimally invasive. The application of topical anesthetics to the area before vaccination numbs the area and prevents the perception of pain. Providing tactile stimulation after vaccination helps to reduce pain.

Which drug is most appropriate for relieving a painful muscle spasm in the back of a client with osteoarthritis (OA)?

Cyclobenzaprine hydrochloride Cyclobenzaprine hydrochloride is a muscle relaxant administered to relieve painful muscle spasms, especially those resulting from OA of the vertebral column. While tramadol is a weak opioid drug that may also be given to relieve pain in clients with OA, it is not as effective against painful muscle spasms. Hyaluronate is a specific injection for knee and hip pain associated with OA. The diclofenac epolamine patch is used in clients with signs and symptoms of knee OA.

The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality specific to osteoarthritis?

Heberden nodes Heberden nodules are the bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis. Ulnar drift, swan-neck deformity, and boutonnière deformity occur with rheumatoid arthritis.

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply.

Hips Knees Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

The registered nurse instructs the nursing student about caring for a hospitalized client with a human immunodeficiency (HIV) infection. Which action made by the nursing student indicates effective learning?

Keeping a dedicated disposable glove box in the client's room A client with an HIV infection is at a high risk of contracting infections. Therefore the nurse should keep a dedicated disposable glove box in the client's room and avoid using supplies from a common area. The nurse should refrain from keeping potted plants and flowers in the client's room because they act as source of potentially infectious bacteria and fungi. A client with an HIV infection should be discouraged from consuming raw fruits and vegetables and should be given well-cooked food to reduce risk of food borne pathogens. In order to reduce the risk of infections, the nurse should change gauze-containing wound dressings every day.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend?

Myringotomy Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

The registered nurse (RN) assigns an unlicensed assistive personnel (UAP) to obtain and record the body temperature of a client with a fever. After completing the task, the delegator evaluates the work and gets clear feedback from the delegatee related to the task. Which delegation right is followed in this situation? 1

Correct 2 Right supervision Right supervision is followed by the delegator in this situation. After completing the task, the delegatee gives the feedback related to the task. Right person is the right followed when the specific task is given and the delegate has the knowledge to complete the task safely. Right circumstance is the right followed when the delegatee has the appropriate supervision to complete the task. Right communication is followed when the delegator and the delegatee understand the common working language.

Which type of hypersensitivity reaction is present in a client with a body temperature of 102 °F, severe joint pain, rashes on the extremities, and enlarged lymph nodes from serum sickness?

Immune complex-mediated reaction Serum sickness is a type III immune complex-mediated reaction. A delayed reaction is a type IV hypersensitivity reaction that may include poison ivy skin rashes, graft rejection, and sarcoidosis. A cytotoxic reaction is a type II hypersensitivity reaction that includes autoimmune hemolytic anemia, Goodpasture syndrome, and myasthenia gravis. An immediate reaction is a type I hypersensitive reaction that includes allergic asthma, hay fever, and anaphylaxis.

A client comes to the clinic for a physical and asks to be tested for acquired immune deficiency syndrome (AIDS). Which test should the nurse explain will be used for the initial screening for human immunodeficiency virus (HIV)? 1

4 Enzyme-linked immunosorbent assay (ELISA) The ELISA is the first screening test done to detect serum antibodies that bind to HIV antigens on test plates. The CD4 T cell count is not a screening test; it is done to monitor the progression of HIV infection and response to treatment. The Western blot test is not done first; the Western blot is done to validate repeatedly reactive ELISA results. The polymerase chain reaction test is not an initial screening test; it is done when there are consistently inconclusive test results with previous screening tests.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen for discomfort associated with osteoarthritis and notifies the healthcare provider. Which drug does the nurse expect will most likely be prescribed instead of the ibuprofen?

Acetaminophen Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not affect platelet function. Naproxen, aspirin, and ketorolac are nonselective nonsteroidal antiinflammatory drugs ( NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.`

While teaching a parents' group about acute otitis media, the nurse includes the fact that among infants and children acute otitis media is an infection commonly caused by what?

Bacteria Otitis media, one of the most prevalent illnesses in toddlers, is caused by a bacterial infection. The causative agent is not a fungus, virus, or rickettsial organism.

Steroid therapy is prescribed for a client with an exacerbation of ulcerative colitis. The nurse evaluates that teaching is effective when the client identifies which times for the medication schedule?

In the early morning with food Taking the drug in the early morning mimics usual adrenal secretions; food helps reduce gastric irritation. Diurnal rhythms may be altered, and steroids are ulcerogenic; they should be taken with more than just a snack. Steroids cause gastric irritation and should be taken with food. Although food helps decrease gastric irritation, dividing the dose and taking it throughout the day may alter regular diurnal rhythms; it should be taken in the early morning with food.

A client with an acute episode of ulcerative colitis is admitted to the hospital. When reviewing the client's laboratory results, the nurse identifies that the client's blood chloride level is decreased. What is the most efficient way this can be corrected?

Intravenous therapy Intravenous therapy ensures a rapid, well-controlled technique for electrolyte (chloride) replacement. There is no assurance that adequate chloride will be ingested and absorbed. Oral electrolyte solution is not a rapid or well-controlled method for correcting electrolyte deficiencies. TPN is not necessary at this time, although it may be used eventually.

A nurse is caring for a client with an impaired immune system. Which blood protein associated with the immune system is important for the nurse to consider? 1

Correct 2 Globulin The gamma-globulin fraction in the plasma is the fraction that includes the antibodies. Albumin helps regulate fluid shifts by maintaining plasma oncotic pressure. Thrombin is involved with clotting. Hemoglobin carries oxygen.

A nurse is assessing a 10-year-old child admitted to the pediatric unit with acute poststreptococcal glomerulonephritis (APSGN). What specific signs and symptoms does the nurse expect? Select all that apply.

Anorexia Preorbital edema Increased creatinine leve Anorexia occurs as a result of malaise caused by the disease process. An early sign of APSGN is an edematous face, especially around the eyes, caused by the retention of sodium and fluid. Increased creatinine and blood urea nitrogen levels reflect the presence of nitrogenous bodies, especially urea in the blood (azotemia) caused by impaired glomerular filtration. Glycosuria is not associated with APSGN. Hypertension, not hypotension, occurs because of impaired kidney function.

A nurse manager in a surgical unit finds that many clients are developing urinary tract infections post-operatively and wants to discuss the measures to prevent it with the team. Which action of the nurse manager reflects good communication practice?

Correct 1 Calling the team for a brief meeting Communication is a very important aspect of any leader. Solving a client care-related issue such as increasing incidences of urinary tract infections may require discussion with team and input from the team members to arrive at any decision. Therefore a face-to-face meeting with the team would be the best communication practice. Texting or sending emails to the team members would not facilitate feedback. Addressing all the nursing staff of the facility would not be needed, as the issue is limited to the surgical unit.

The mother of a 5-year-old girl child reports to a nurse that her daughter has a genital discharge and recurrent urinary tract infections. What should the nurse suspect from the mother's statement?

Correct 1 The child may be a victim of sexual abuse. Genital discharge and recurrent urinary tract infections are signs of sexual abuse. Bruises, burns, fractures, or dislocation may indicate physical abuse. Malnutrition and poor hygiene may indicate physical neglect. Enuresis and sleep disorders may indicate emotional neglect.

A registered nurse is teaching a nursing student about the various mechanisms that antiviral drugs use to control human immune deficiency (HIV) infections. Which statement made by the nursing student needs correction?

Correct 2 "Saquinavir blocks the fusion between HIV and the host cell. Saquinavir is a protease inhibitor that works by blocking the HIV enzyme protease; it is not a fusion inhibitor. Saquinavir prevents the viral protein strand from being lysed into active smaller fragments. Entry inhibitors such as maraviroc block CCR 5 receptors on CD4+ T-cells. Zidovudine is a nucleoside reverse transcriptase inhibitor that acts as a counterfeit base for the HIV enzyme reverse transcriptase. Protease inhibitors such as nelfinavir prevent the breakup of viral protein strand into smaller active viral particles.

A client is hospitalized with pneumococcal pneumonia. Which drug will the nurse most likely administer?

Correct 2 Ceftriaxone Streptococcus pneumoniae causes pneumococcal pneumonia. The drug preferred for the disease caused by this bacterium is ceftriaxone. Streptococcus pneumoniae is resistant to penicillin G. Vancomycin is preferred for the treatment of the infections caused by Staphylococcus aureus. Meropenem is used for treating the infections caused by Klebsiella pneumoniae.

A toddler with a puncture wound to the sole is brought to the emergency department. Because of a language barrier the caregiver cannot provide a clear history of previous tetanus immunizations. Tetanus immunoglobulin (TIG) is prescribed by the healthcare provider. The nurse explains to the caregiver that this medication is given because it has what action?

Correct 2 Confers short-term passive defense against tetanus Tetanus immunoglobulin contains antibodies, not the live or attenuated virus; it confers short-term passive immunity that is temporary. Tetanus toxoid, not TIG, stimulates the production of antibodies.

In addition to hepatitis B, pneumococcal, H. influenza type B, and varicella vaccines, what should the nurse expect a 20-month-old child who has been receiving immunizations on schedule to have had?

Correct 2 Four DTaPs, three IPVs, and one MMR By 18 months of age a child should have received four diphtheria, tetanus, and pertussis (DTaP) vaccinations; three inactivated polio vaccinations (IPVs); and one measles, mumps, rubella (MMR) vaccination, as well as hepatitis B, pneumococcal, Haemophilus influenzae type B, and varicella vaccines.

A woman who is Rh negative has a spontaneous abortion at the end of the second trimester, and the primary healthcare provider prescribes Rho(D) immune globulin. The client asks the nurse, "Why do I need this drug?" What should the nurse consider before answering the client's question?

Correct 2 It will prevent the woman from producing antibodies Rho(D) immune globulin attacks fetal red cells that have gained access to the maternal bloodstream at the time of birth; it prevents antibody formation. Antibody formation is undesirable; it sensitizes the woman and contributes to fetal red cell destruction in future pregnancies. There is no production of immune bodies. Rho(D) immune globulin prevents the woman's immune system from responding to the fetal Rh-positive blood.

A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease? 1

Correct 4 Involvement starting distally with rectal bleeding that spreads continuously up the colon Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Crohn disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Crohn. In ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Abscesses and fistulas occur more frequently in Crohn disease.

A client is diagnosed with a human immune deficiency-2 (HIV-2) infection and is on rilpivirine therapy. What drug does the nurse anticipate that the primary healthcare provider will prescribe to the client?

Emtricitabine Emtricitabine is a nucleoside reverse transcriptase inhibitor that mimics DNA nucleoside bases and tricks the HIV reverse transcriptase enzyme into using it. Therefore emtricitabine would be prescribed. Etravirine, efavirenz, and delavirdine are non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs stop viral cell DNA and RNA replication by directly binding to the HIV-1 enzyme reverse transcriptase. NNRTIs such as rilpivirine are not effective in suppressing HIV-2 replication.

After performing an otoscopic examination on a client who reports a decrease in hearing acuity, the primary healthcare provider diagnoses the condition as otitis media. Which assessment finding supports the diagnosis?

Redness of the eardrum Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity but not the manifestation of otitis media. Excessive soft cerumen in the external canal impacts the hearing acuity but not the manifestation of otitis media.

Which intervention would be most beneficial in preventing a catheter-associated urinary tract infection in a postoperative client?

Removing the catheter within 24 hours Clients who undergo surgery are at a greater risk of acquiring catheter-associated urinary tract infections. Infections can be prevented by removing the catheter within 24 hours, if the client does not need it. Therefore removing the catheter within 24 hours would be the best intervention. While pouring warm water over the perineum helps voiding in the postoperative client and also reduces the chances of infection, this action would not be as beneficial as the former intervention. The catheter should be maintained in its place to avoid leakage and infection. Cleaning the catheter insertion site will definitely reduce the risk of infection, but this action cannot prevent infections if the catheter is inserted for a long time.

A client with a history of ulcerative colitis is admitted to the hospital because of severe rectal bleeding. The client engages in angry outbursts and places excessive demands on the staff. One day an unlicensed healthcare worker tells the nurse, "I've had it. I am not putting up with that behavior. I'm not going in there again." What is the best response by the nurse?

The client's frightened and taking it out on the staff. Let's think of approaches we can take." The correct response interprets the client's behavior without belittling the unlicensed healthcare worker's feelings; it encourages the unlicensed healthcare worker to get involved with plans for future care. Telling the unlicensed healthcare worker to be patient recognizes the client's feelings, but it does not address the unlicensed healthcare worker's feelings or help the unlicensed healthcare worker cope with the client's behavior. The nurse should not assume the unlicensed healthcare worker has nothing to contribute and that only the nurse can deal with the problem. Saying "Just ignore it" does not help the unlicensed healthcare worker understand the client's behavior, nor does it demonstrate an understanding of the client's feelings.

The nurse performs a skin test on a client who has a mosquito bite. The client shows wheal and flare reaction post-skin test. Which type of hypersensitivity reaction most likely has occurred?

Type I Type I is an IgE-mediated hypersensitivity reaction that causes wheal and flare response. This reaction is characterized by a pale wheal containing edematous fluid surrounded by a red flare from the hyperemia. Type II is a cytotoxic hypersensitivity reaction that involves IgG and IgM antibodies but does not show any wheal and flare response. Type III hypersensitivity reaction is an immune complex-mediated reaction that involves erythema and edema in 3 to 8 hours. Type IV is a delayed hypersensitivity reaction that involves erythema and edema in 24 to 48 hours.