Adult Health Exam 7

A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse?

"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."

The nurse is obtaining a history from a patient with severe psoriasis. What question would be the most important to ask this patient to determine a genetic predisposition?

"Does anyone in your family have more than one autoimmune disease?"

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

"I will avoid prolonged sitting or walking."

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

Surgical debridement

A nurse provides care for a client who has a rheumatic disorder. The nurse's comprehensive assessment includes the client's mood, behavior, LOC, and neurologic status. What is this client's most likely diagnosis?

Systemic lupus erythematosus (SLE)

An older adult with rheumatoid arthritis says exercise was not effective. Which response will the nurse make to learn the reason for the failure of this treatment approach?

"What types of exercise were you doing?"

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

"You will receive IV antibiotics for 3 to 6 weeks."

Antiretroviral medications should be offered to clients with T-cell counts less than

350 cells/mm3.

The inflammatory response is an important nonspecific component of the immune system that is elicited in response to tissue injury or pathogens. A nurse is aware that dysfunctional inflammatory responses are responsible for numerous pathophysiological conditions. Which of the following patients most clearly exemplifies this?

A 71-year-old woman who uses a quad cane because of mobility limitations brought on by rheumatoid arthritis

An emergency department (ED) nurse has provided care for many patients who have primary and secondary diagnoses of immune dysfunction. Which of the following patients likely has the highest risk of a disruption to normal immune functioning?

A man who has recently completed medical treatment for prostate cancer

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Alkaline phosphatase

Which response is a humoral immune response?

Anaphylaxis

A client with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in clients with AIDS, by increasing body fat stores?

Megestrol

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following?

Antibodies to HIV are not present in his blood.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?

Assess diet and activity at home

A client undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The client becomes anxious because the area begins to swell. What advice should the nurse give to calm the client?

Assure the client that this is a normal reaction.

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

Attachment

A client who has AIDS reports having diarrhea after every meal, and wants to know what can be done to stop this symptom. What should the nurse advise?

Avoid fibrous foods, lactose, fat, and caffeine.

A client has undergone treatment for septic shock and received high doses of numerous antibiotics during treatment. When planning the client's subsequent care, the nurse should be aware of what potential effect on the client's immune function?

Bone marrow suppression

Which condition is associated with impaired immunity relating to the aging client?

Breakdown and thinning of the skin

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?

Decrease in estrogen

A client is admitted with an acute attack of gout. What interventions are essential for this client? Select all that apply.

Dietary consult Probenecid Corticosteroid therapy Pain medication Serum uric acid concentration

A client who is being treated for complications related to acquired immunodeficiency disorder syndrome (AIDS) is receiving interferon parenterally as adjunctive therapy. Why does the nurse understand this route is being used?

Digestive enzymes destroy its protein structure.

A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about?

Duloxetine

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic?

HIV-1 is more prevalent than HIV-2 subtypes

Which of the following was formerly called a bunion?

Hallux valgus

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis?

Rheumatoid arthritis

A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with which health problem?

Rheumatoid arthritis (RA)

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Risk for falls

A 40-year-old client was diagnosed with Raynaud phenomenon several years earlier and has sought care because of a progressive worsening of their symptoms. The client also states that many of their skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem?

Scleroderma

A nurse is providing ongoing care for a client who is positive for human immunodeficiency virus (HIV), and assessment reveals a client with a newly delayed and shortened speech pattern. The client, who previously had no neurological or motor deficits, has forgotten that they are in the hospital and has trouble getting out of bed. Which problem is the client most likely experiencing related to these signs and symptoms?

Subcortical neurodegenerative disease

The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse?

The client has converted from HIV infection to AIDS.

A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize?

The client will express satisfaction with the ability to perform ADLs.

A client is treated in the clinic for a sexually transmitted infection, and the nurse suspects that the client is at risk for HIV. The physician determines that the client should be tested for the virus. What responsibility does the nurse have?

The nurse ensures a written consent is obtained prior to testing.

Which statement accurately reflects current stem cell research?

The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells.

What test will the nurse assess to determine the client's response to antiretroviral therapy?

Viral load

Which drug is not used in the treatment of rheumatoid arthritis?

allopurinol

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?

eating organ meats and sardines

A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

hammer toe

A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?

hydroxychloroquine

A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to:

infection because the spleen removes bacteria from the blood.

What types of cells are the primary targets of the healthy immune system? Select all that apply.

infectious cells foreign cells cancerous cells

The nurse is educating a client just diagnosed with human immunodeficiency virus (HIV) about the use of condoms to prevent sexual transmission. Which statement made by the client indicates the education provided is understood? Select all that apply.

"If I use condoms consistently, they are very effective in preventing transmission." "Latex condom use is recommended during vaginal or anal intercourse."

A client with an autoimmune disorder asks, "Why is autoimmune disease more prevalent in the women in my family?" Which response will the nurse make to this client?

"It's believed to be caused by the differences in the sex hormones."

The nurse is assessing a client with rheumatoid arthritis. The nurse knows that prolonged inflammation can cause compression of nerves. Which symptoms would accompany this level of involvement?

Paresthesias of both hands

A has been diagnosed HIV positive. What will determine the initiation of antiretroviral drug therapy? Select all that apply.

CD (T-cell) count less than 350/mm

A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?

Calcitonin

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?

Calcitonin (Miacalcin)

A client with a documented history of allergies presents to the clinic. The client reports being frustrated by chronic nasal congestion, anosmia (inability to smell), and inability to concentrate. The nurse should identify which nursing diagnosis?

Ineffective individual coping with chronicity of condition

A nurse is planning the care of a client who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. Which is a priority issue for this client?

Ineffective role performance related to pain

A client with rheumatoid arthritis (RA) is being evaluated for medication therapy. Which testing will the nurse anticipate the client will need before medications are started? Select all that apply.

Liver function tests Tuberculin skin test Testing for hepatitis B Testing for hepatitis C

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

Surgical debridement

A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include:

neutrophils and monocytes.

Which tests tell the physician what the viral load is in a client with HIV/AIDS? Select all that apply.

polymerase chain reaction p24 antigen test

The nurse receives a phone call at the clinic from the family of a client with AIDS. They state that the client started "acting funny" and reported headache, tiredness, and a stiff neck. Checking the temperature resulted in a fever of 103.2°F. What should the nurse inform the family member?

"The client may have cryptococcal meningitis and will need to be evaluated by the health care provider."

An individual's exposure to an airborne pathogen has prompted an immune response that includes both cellular and humoral components. Which of the following activities is most closely associated with the humoral immune response?

B lymphocytes produce antibodies that are specific to the pathogen.

A client diagnosed with cystic fibrosis has received a double lung transplant and is now experiencing signs of rejection. What is the immune response that predominates in this situation?

Cellular

When an infection is bloodborne, the manifestations include which symptom?

Chills

A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of?

Chronic diarrhea

A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.)

Corticosteroid injections Surgical excision Aspiration of the cyst

A nurse is performing the admission assessment of a client who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply.

Current medication regimen Identification of client's support system Immune system function History of sexual practices

This type of T lymphocyte is responsible for altering the cell membrane and initiating cellular lysis. Choose the T lymphocyte.

Cytotoxic T cell

A client's current immune response involves the direct destruction of foreign microorganisms. This aspect of the immune response may be performed by which cells?

Cytotoxic T cells

An experiment is designed to determine specific cell types involved in cell-mediated immune response. The experimenter is interested in finding cells that attack the antigen directly by altering the cell membrane and causing cell lysis. Which cells should be isolated?

Cytotoxic T cells

A nurse has admitted a client who has been diagnosed with urosepsis. Which immune response predominates in sepsis?

Humoral

What immunoglobulin is present in small amounts and is thought to be related to allergic responses?

IgE Five different types of immunoglobulins have been identified: IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM), and it contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is IgG. IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are encountered in exposed areas of the body.

At 39 weeks' gestation, a pregnant client visits the physician for a scheduled prenatal checkup. The physician determines that the fetus has developed an infection in utero and sends the client for an emergency cesarean delivery. The client is very concerned about the health of her unborn child. Based on knowledge of the immune system, the delivery room nurse explains about which immunoglobulin that will be increased in the fetus at the time of birth and will be actively fighting the infection?

IgG

Which immunoglobulin assumes a major role in bloodborne and tissue infections?

IgG

A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, she has an inability to fight infection due to the fact her bone marrow is unable to produce a sufficient amount of what?

Lymphocytes

A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions?

Maintenance of adequate levels of activated vitamin D

Which of the following are routes of administration for Calcitonin? Select all that apply.

Nasal spray Subcutaneous Intramuscular injection

Upon reviewing the results of a complete blood count on a patient who is diagnosed with an acute infection what will the nurse expect to see elevated?

Neutrophil count

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which medication classification is known to inhibit prostaglandin synthesis or release?

Nonsteroidal anti-inflammatory drugs in large doses

An older adult has developed a sacral pressure ulcer. What should the nurse assess in order to ensure adequate wound healing and prevent poor outcomes for this client? Select all that apply.

Nutritional status Caloric intake Quality of food ingested

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client?

Open nerve release

The nurse is assisting with the physical examination of a client with a musculoskeletal disorder and observes the client's hands, which have the appearance shown in the accompanying image. With what condition is the client's appearance most consistent?

Osteoarthritis

An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem?

Osteomyelitis

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?

Paget disease

Which characteristic has NOT been implicated as a factor for noncompliance with antiretroviral treatment?

Past substance abuse

The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes.

Perform neurovascular checks of lower extremities every 8 hours. Administer IV antibiotic based on culture and sensitivity report. Administer ibuprofen 400 mg orally three times daily, as needed for pain. Make referral to dietitian to discuss nutrition for healing and blood glucose control. Provide education on self-blood glucose monitoring and insulin administration.

A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a storm door. The fall resulted in a 6 cm laceration of the right antecubital. The nurse caring for this patient knows that the site of the injury will have an invasion of what?

Phagocytic cells

A patient is admitted with an infected leg, and the nurse notes an increase in his white blood cell (WBC) count. The nurse is aware that, during the immune response, pathogens are engulfed by WBCs that ingest foreign particles. What is this process known as?

Phagocytosis

A client is diagnosed with psoriatic arthritis. In which areas will the nurse expect the client to experience pain? Select all that apply.

Plantar fascia Achilles tendon Tibial tuberosities

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication?

Take the medication with food to avoid stomach upset.

The nurse is working with an Unlicensed Assistive Personnel (UAP) to care for a client. In which situation will the nurse intervene to discuss standard precautions with the UAP? Select all that apply.

The UAP applies a second pair of nonsterile gloves over soiled gloves while assisting with a bloody procedure.

A client arrives at the clinic and reports a very sore throat as well as a fever. A rapid strep test returns a positive result and the client is given a prescription for an antibiotic. How did the streptococcal organism gain access to the client to cause this infection?

Through the mucous membranes of the throat

A 38-year-old client has begun to suffer from rheumatoid arthritis and is being assessed for disorders of the immune system. The client works as an aide at a facility that cares for children infected with AIDS. Which is the most important factor related to the client's assessment?

Use of other drugs

A client's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the client's immune response. This is known as what physiologic state?

Viral set point; The remaining amount of virus in the body after primary infection is referred to as the viral set point, which results in a steady state of infection that lasts for years. This is not known as the static or latent stage. The window period is the time a person infected with HIV tests negative even though they are infected.

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger enables cells to resist viral replication and slow viral replication?

interferons

Immunocompetence is the ability of the immune system to cooperatively protect a person from external invaders and the body's own altered cells. Immunocompetence is maintained by white blood cells and:

lymphoid tissue.

Immunoglobulins (also known as antibodies) promote the destruction of invading cells in various ways, using different mechanisms. Which mechanism is used by immunoglobulins to destroy pathogenic antigens?

neutralization agglutination precipitation

The body has several mechanisms to fight disease, one of which is sending chemical messengers. The messengers released by lymphocytes, monocytes, and macrophages have differing roles in the immune response. Which messenger helps in cellular repair in small doses yet destroys healthy tissue in excessive doses?

tumor necrosis factor