Exam 1 NCLEX

A 48-year-old patient with sudden onset of respiratory distress is scheduled for a stat ventilation-perfusion scan. What explanations should the nurse provide to the patient about the procedure? 1 Radioisotope is injected and inhaled to examine the lungs. 2 You will be sedated during the test to prevent you from moving. 3 We need to be sure there is no metal in your body before this test. 4 You will feel a sensation of chest pressure as the dye circulates through your body.

1 Radioisotope is injected and inhaled to examine the lungs. A ventilation perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal.

To maintain patient safety, the nurse would question the health care provider about the prescription for prednisone if the patient also had which condition? 1 Systemic fungal infection 2 Diabetes mellitus 3 Congestive heart failure 4 Renal insufficiency

1 Systemic fungal infection Systemic fungal infection would be a contraindication to the use of prednisone because the drug can interfere with the body's ability to fight infection. Although blood sugars may increase and fluid retention may occur, diabetes, congestive heart failure, and renal insufficiency are not absolute contraindications to the use of prednisone, although it should be used with caution.

The male client diagnosed with multiple sclerosis states he has been investigating alternative therapies to treat his disease. Which intervention is most appropriate by the nurse? 1. Encourage the therapy if it is not contraindicated by the medical regimen. 2. Tell the client only the health-care provider should discuss this with him. 3. Ask how his significant other feels about this deviation from the medical regimen. 4. Suggest the client research an investigational therapy instead.

1.The nurse should listen without being judgmental about any alternative therapy the client is considering. Alternative therapies, such as massage and relaxation, are frequently beneficial and enhance the medical regimen.

The nurse writes the client problem of "altered sexual functioning" for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented? 1. Encourage the couple to explore alternative ways of maintaining intimacy. 2. Make an appointment with a psychotherapist to counsel the couple. 3. Explain daily exercise will help increase libido and sexual arousal. 4. Discuss the importance of keeping physically calm during sexual intercourse.

1.This will assist the client and significant other to maintain a close relation-ship without putting undue pressure on the client. 2. This is a real physical problem, not a psychological one. 3. The problem is impotence, not libido 4. The problem is not psychosocial. It is aphysical problem, and staying calm willnot hel

The nurse and a licensed practical nurse (LPN) are caring for a group of clients.Which nursing task should not be assigned to the LPN? 1. Administer a skeletal muscle relaxant to a client diagnosed with low back pain. 2. Discuss bowel regimen medications with the HCP for the client on strict bed rest. 3. Draw morning blood work on the client diagnosed with bacterial meningitis. 4. Teach self-catheterization to the client diagnosed with multiple sclerosis.

4.The nurse should not assign assessing,teaching, or evaluation to the LPN. Evaluating the client's ability to per-form self-catheterization should not beassigned to the LPN

The nurse should teach the client with erectile dysfunction to alter his lifestyle to: A. Avoid alcohol B. Follow a low-salt diet C. Decrease smoking D. Increase attempts at sexual intercourse

A Avoidance of alcohol can improve the outcome of therapy. Alcohol and smoking can affect a man's ability to have and maintain an erection.

Which male client should the nurse consider at risk for complications when taking sildenafil (Viagra), a sexual stimulate? A. A 56-year-old client with unstable angina B. An 87-year-old client with glaucoma C. A 44-year-old client with type 2 diabetes D. A 32-year-old client with an L1 spinal cord injury (SCI)

A Viagra should be used cautiously in clients with coronary heart disease because during sexual activity the client could have a myocardial infarction from the extra demands on the heart. Specifically, clients taking nitroglycerin or any nitrate medication should not take Viagra because the vasodilatation effect of Viagra may cause hypotension. A client with unstable angina would be taking a nitrate medication.

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age? a) 26 b) 35 c) 18 d) 32

A) 26 The CDC (2007) recommends annual screening for Chlamydia in all sexually active women younger than 26 years of age and in women with new or multiple sexual partners.

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A) human papillomavirus (HPV) Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

The nurse is caring for a client diagnosed with ED. The client has diabetes and hypertension and is recovering from having several toes on his left foot amputated due to diabetic complications. He asks you what his treatment options might be for ED. Which is least likely to be an effective treatment option for this client? A. Mechanical devices B. Selective phosphodiesterase type 5 inhibitors C. Revascularization surgery D. Injectable medications

C Revascularization surgery is usually not successful for a client where underlying vascular issues cannot be corrected.

A nurse is providing care to a client with chlamydia. The nurse anticipates that the client will also receive treatment for which of the following? a) Mycoplasma b) Trichomoniasis c) Human papillomavirus d) Gonorrhea

D) Gonorrhea There is a high incidence of corinfection with chlamydia and gonorrhea. Therefore, the client would also receive treatment for gonorrhea. Typically chlamydial infections do not occur in conjunction with mycoplasma, trichomoniasis, or human papillomavirus.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient? a) Alteration in comfort related to impaired skin integrity b) Fear related to complications c) Noncompliance with treatment regimen related to age d) Knowledge deficit related to modes of transmission

D) Knowledge deficit related to modes of transmission. Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about the modes of transmission for syphilis.

A client is prescribed rifampin (Rifadin), 600 mg P.O. daily. Which statement about rifampin is true? a) It's usually given alone. b) Its exact mechanism of action is unknown. c) It's tuberculocidal, destroying the offending bacteria. d) It acts primarily against resting bacteria.

c

The physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which of the following? a) Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years b) Isolation until 24 hours after antitubercular therapy begins c) Nothing, until signs of active disease arise d) Daily doses of isoniazid, 300 mg for 6 months to 1 year

d) Daily doses of isoniazid, 300 mg for 6 months to 1 year

Standard precautions should be used when providing care for A) All patients regardless of diagnosis. B) Pediatric and gerontologic patients. C) Patients who are immunocompromised. D) Patients with a history of infectious diseases.

A) All patients regardless of diagnosis. Standard precautions are designed for all care of all patients in hospitals and health care facilities.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? a) Gonorrhea b) Candidiasis c) Chancroid d) Trichomoniasis

A) Gonorrhea In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What is the typical span of time between infection and developing symptoms with syphilis? a) 14 days b) 21 days c) 35 days d) 28 days

B) 21 Days In syphilis, the time between infection and the first occurrence of symptoms is about 21 days

A client is diagnosed with chlamydia and is distraught. "How can I have this problem? I don't have any symptoms!" she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as a) 100% b) 75% c) 50% d) 25%

B) 75% As many as 75% of all infected women and 25% of all infected men are asymptomatic.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? a) Podophyllum resin b) Tetracycline c) Ceftriaxone d) Acyclovir

B) Tetracycline Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient? a) The virus causes "cold sores" of the lips. b) Treatment is focused on relieving symptoms. c) The virus may be cured with antibiotics. d) The virus when active may not be contracted during intercourse.

B) Treatment is focused on relieving symptoms HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes "cold sores," and varicella zoster causes shingles.

A 30-year-old female patient has sought care because of the recent appearance of itchy lesions on her vulva, some of which have recently burst. The patient's description of her problem would lead you to first suspect A) HIV. B) Gonorrhea. C) Chlamydia. D) Genital herpes.

D) Gential herpes A primary episode of genital herpes is often marked by multiple small, vesicular lesions on the genitals. This symptomatology is not commonly associated with gonorrhea, chlamydia, or HIV.

After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client states which of the following? a) "I will clean my kitchen counter with hot water." b) "Alcohol is good to clean any skin areas that are dry or chafed." c) "I should avoid eating cooked fruits and vegetables." d) "I should avoid being around other people who have an infection."

D) I should avoid being around other people who have an infection. Strategies to prevent infection include avoiding being around others who have an infection and avoiding crowds. The client should avoid consumption of raw fruits and vegetables and use creams and emollients to prevent or manage dry, chafed, or cracked skin. A disinfectant, not just hot water, should be used to clean kitchen and bathroom surfaces.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease.

D) Importance of informing his partners of the disease. Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception?"

3.These are clinical manifestation of MS and can go un diagnosed for years be-cause of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS. 1. MS does not affect the menstrual cycle. 2. A rash across the bridge of the nose suggests systemic lupus erythematosus 4. Taking birth control medications should not produce these symptoms or the pattern of occurrence.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which of the following would the nurse expect to include as the most common STI in the United States? a) Chlamydia b) Syphilis c) Genital herpes d) Gonorrhea

A) Chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea has presented at the clinic. The student knows that the care plan for this patient should be include what in the treatment of gonorrhea? a) Concurrent treatment for chlamydia b) Avoidance of the use of tampons c) Vaginal smears every 6 months d) Radiation therapy to destroy cancerous cells

A) Concurrent treatment for chlamydia Because of the high incidence of coinfection with chlamydia and gonorrhea, treatment for gonorrhea should also include treatment for chlamydia. One cause of cervicitis is chlamydia. A management strategy used in the treatment of chlamydia is a cytologic examination of cervical smear. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). Gonorhhea is considered a sexually transmitted infection (STI), not a carcinoma.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? a) Human papilloma virus b) Haemophilus ducreyi bacillus c) Herpes virus d) Treponema pallidum

A) Human papilloma virus Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect to find which of the following once the microorganism disseminates throughout the body? a) Painful joints b) Intermenstrual bleeding c) Sore throat d) Painful urination

A) Painful joints The client with an anal gonorrheal infection experiences symptoms of gonorrhea where the microorganism has invaded the rectum. After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism's invasion of those structures, depending on the nature of the sexual contact.

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? a) Risk for infection related to altered immune cell function b) Impaired skin integrity related to persistent deep skin abscesses c) Anxiety related to an inherited disorder d) Grieving related to the poor prognosis of the condition

A) Risk for infections related to altered immune cell function Although anxiety and impaired skin integrity may be appropriate, the priority nursing diagnosis for any immunodeficiency is the risk for infection. Although primary immunodeficiencies can be serious, they are rarely fatal. Therefore, the nursing diagnosis of grieving would be inappropriate.

The nurse is caring for a postoperative client with an inflatable penile implant. Which statements from the client indicate the need for further instruction? (Select all that apply) A. "Next week is out anniversary - we can be intimate for the first time in years" B. "I think this is going to work very well for us" C. "I think this will take some practice and patience once we get back to sexual activity again" D. "I guess we can practice with this as much as we want" E. "What if we can't get the hang of this? What should we do?"

A,E In teaching the client and his partner about penile implants of the inflatable variety, let them know that practice is important - both to learn how to use the implant and to maintain its position and help tissue grow around it to hold it in place.

The nurse is caring for a client who is newly diagnosed with ED. The client asks why his diabetes caused this to happen. The nurse bases the response on which rationale? A. ED is a normal part of aging that happens to all men at some point B. Vascular disease often associated with diabetes contributes to ED C. The medications he is on for diabetes are iatrogenic causes of ED D. The psychological stress of having a chronic disease brought on the ED

B Damage to arteries and vascular disease, which occurs in diabetes, are a common cause of ED.

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a) 60 to 70 years b) 15 to 24 years c) 25 to 29 years d) 30 to 45 years

B) 15 to 24 years Gonorrhea is the second most frequently reported communicable disease in the United States. Its highest incidence occurs in the 15- to 24-year-old age group.

A 45-year-old waitress with a history of IV drug use also is HIV-positive. She has been following her antiretroviral medication regimen faithfully and is doing well. She's attending college to get a social work degree and is focused on a bright future. In her regular CD counts, what factor will indicate she has progressed from HIV to AIDS? a) CD count > 200/mm b) CD count > 100/mm c) CD count < 200/mm d) CD count < 100/mm

C) CD count <200/mm A CD (T-cell) count of less than 500/mm indicates immune suppression; a CD (T-cell) count of 200/mm or less is an indicator of AIDS.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

4) The nurse is caring for a client who is hospitalized due to an exacerbation of systemic lupus erythematosus (SLE). The nurse is reviewing the client's lab work and finds the white blood cell count (WBC) is shifted to the left. Based on this information, which is a priority nursing diagnosis for this client? A) Ineffective Protection B) Ineffective Health Maintenance C) Ineffective Individual Coping D) Risk for Impaired Skin Integrity

Answer: A Explanation: A) All identified diagnoses are appropriate for a client with SLE. However, the shift to the left in the WBC count indicates an increased risk for infection. A shift to the left in a WBC differential is indicative of a large number of immature cells, suggesting infection, and is therefore the priority for the client with the diagnosis Ineffective Protection. Page Ref: 516 Cognitive Level: Analyzing Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with systemic lupus erythematosus.

7) The nurse is caring for a client who has been diagnosed with discoid lupus erythematosus. The nurse is collaborating with the client to set goals for the nursing plan of care. What is an appropriate goal for this client? A) Work through the stages of death and dying. B) Comply 100% of the time with a sun protection plan. C) Gain weight to within 10 pounds of normal for height. D) Report pain no higher than four on a scale of 1-10.

Answer: B Explanation: A) Discoid lupus erythematosus is an autoimmune disorder of the skin, so the client must protect against the sun to avoid skin cancers and other complications. It is not fatal, is not related to weight, and is rarely painful unless complications arise. Page Ref: 515 Cognitive Level: Applying Client Need: Health Promotion and Maintenance Nursing Process: Implementation Learning Outcome: 7. Evaluate expected outcomes for an individual with systemic lupus erythematosus.

The client is taking sildenafil orally for erectile dysfunction. What instruction should the nurse give the client? A. Sildenafil may be taken more than one time per day B. The HCP should be notified promptly if the client experiences sudden or diminished vision C. Sildenafil offers protection again some STDs D. Sildenafil does not require sexual stimulation to work

B The client should notify his HCP promptly if he experiences sudden or decreased vision loss in one or both eyes.

The nurse is caring for a male client, with a history of coronary artery disease and hypertension, who smoked one pack per day of cigarettes for 30 years before quitting 2 years ago. Which is the most likely etiology of the client's newly diagnosed ED? A. Nurogenic B. Hormonal C. Latrogenic D. Vascular

D Vascular causes of ED include atherosclerosis, hypertension, heart disease, and diabetes mellitus.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Palmar rash b) Development of gummas c) Development of central nervous system lesions d) Genital chancres

D) Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4. Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

The client diagnosed with angina is prescribed nitroglycerin (Nitrobid) and tells the nurse, "I don't understand why I can't take my Viagra. I need to take it so that I can make love to my wife." Which statement is the nurse's best response? A. "If you take the medications together, you may get very low blood pressure." B. "You are worried your wife will be concerned if you cannot make love." C. "If you wait at least 8 hours after taking you nitroglycerin (NTG), you can take your Viagra." D. "You should get clarification with your HCP about your taking Viagra."

A Life-threatening hypotension can result with concurrent use of nitroglycerin and sildenafil (Viagra).

Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States? a) Gonorrhea b) Chlamydia c) Herpes simplex 1 d) HPV

B) Chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States.

8) The nurse is planning care for an adolescent client who has systemic lupus erythematosus (SLE). The nurse knows that the treatment plan implemented by the healthcare team is appropriate for the situation when the client: A) Refuses to attend school. B) Does not want to attend any social functions. C) Discusses skin changes with the healthcare personnel. D) Discusses skin changes with a good friend.

Answer: D Explanation: A) Peer interaction is important to teens. Being able to discuss the physical changes related to SLE with a friend indicates acceptance of the change in body image. Refusing to go to school or attend social functions indicates nonacceptance of the changes to body image. Discussing changes only with healthcare personnel does not indicate the teen has adjusted to the body image changes. Page Ref: 515 Cognitive Level: Analyzing Client Need: Psychosocial Integrity Nursing Process: Implementation Learning Outcome: 7. Evaluate expected outcomes for an individual with systemic lupus erythematosus.

A patient comes to the free clinic complaining of urethral discharge. On assessment, the nurse notes that the patient is feverish. During the assessment, the patient admits to having unprotected sex. The nurse suspects the patient may have a diagnosis of what? a) HIV b) Chlamydia c) Syphilis d) Gonorrhea

D) Gonorrhea The signs and symptoms of gonorrhea include fever; urethral, vaginal, and rectal discharge; and in untreated cases, arthritis.

2. A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which nursing diagnosis would be most appropriate? 1. Activity intolerance related to fatigue and pain. 2. Self-care deficit related to increasing joint pain. 3. Ineffective coping related to chronic pain. 4. Disturbed body image related to fatigue and joint pain.

1. Based on the client's complaints, the most appropriate nursing diagnosis would be Activity intolerance related to fatigue and pain. Nursing interventions would focus on helping the client conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit related to the activity intolerance and increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may develop ineffective coping or body image disturbance as the disorder becomes chronic with increasing pain and fatigue.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. Methotrexate is considered teratogenic.

1. A nurse is reviewing the plan of care for a client who has systemic lupus erythematosus (SLE). The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following laboratory findings should the nurse anticipate? (Select all that apply.) A. Positive ANA titer B. Increased hemoglobin C. 2+ urine protein D. Increased serum C3 and C4 E. Elevated BUN

1. A. CORRECT: A positive antinuclear antibody (ANA) titer is an expected finding in a client who has SLE. The ANA test identifies the presence of antibodies produced against the client's own DNA. B. Pancytopenia, rather than an elevated hemoglobin, is an expected finding in a client who has SLE. C. CORRECT: Increased urine protein is an expected finding due to kidney injury as a result of SLE. D. The client who has SLE is expected to have a decreased level of serum C3 and C4. E. CORRECT: Elevated BUN is an expected finding due to kidney injury in a client who has SLE. NCLEX® Connection: Reduction of Risk Potential, Laboratory Values

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit? 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to 15 minutes per application is the maximum time for cold applications."

3. Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching? 1. Pushing with palms when rising from a chair. 2. Holding packages close to the body. 3. Sliding objects. 4. Carrying a laundry basket with clinched fingers and fists.

4. Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

5. A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A. Swelling of joints of the fingers B. Pallor of toes with cold exposure C. Feet that become reddened with ambulation D. Client report of intense feeling of heat in the fingers

5. A. Swelling, pain, and joint tenderness are findings in a client who has SLE and is not specific to an episode of Raynaud's phenomenon. B. CORRECT: Pallor of the extremities occurs in Raynaud's phenomenon in a client who has SLE and has been exposed to cold or stress. C. The extremities becoming red, white, and blue when exposed to cold or stress is characteristic of an episode of Raynaud's phenomenon in a client who has SLE. D. A client report of intense pain in the hands and feet is characteristic of an episode of Raynaud's phenomenon in a client who has SLE. NCLEX® Connection: Physiological Adaptation, Pathophysiology

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Being asymptomatic b) All options are correct c) Being sexually inactive d) Knowing the signs and symptoms of STIs

A) Being asymptomatic Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease.

When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education? A) "I will need to isolate any tissues I use so as not to infect my family." B) "I will notify all of my sexual partners so they can get tested for HIV." C) "Unprotected sexual contact is the most common mode of transmission." D) "I do not need to worry about spreading this virus to others by sweating at the gym."

A) I will need to isolate any tissues I use so as not to infect my family. HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? a) "Inform all potential sexual partners about the infection, even if it is inactive.". b) "Use a condom during sexual activity if the infection becomes active again." c) "If the infection has healed, you probably don't have to use a condom." d) "Refrain from all sexual activity until you don't have another outbreak for a year."

A) Inform all potential sexual partners about the infection, even if its inactive. The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left exposed.

9) The nurse is providing care for a newly married woman with systemic lupus erythematosus (SLE). Which client statement indicates plan of care understanding? A) "I will take birth control pills while I am taking cytotoxic medications." B) "I do not need to contact the doctor if I develop a fever or rash." C) "I plan to go to the movies this weekend so that I get out of the house." D) "I can take ibuprofen as indicated for pain."

Answer: A Explanation: A) Treatment for SLE can include cytotoxic drugs. The client is taught to avoid pregnancy by using contraceptives, as these drugs can cause birth defects. The client is taught to avoid crowds, as they are potential sources of infection. Client with SLE should contact their primary care providers should signs of infection occur, as the immune system is compromised. Aspirin and ibuprofen can cause bleeding and should be taken with extreme care. Page Ref: 514 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 7. Evaluate expected outcomes for an individual with systemic lupus erythematosus.

11) A nurse caring for a client with SLE on immunosuppressive therapy understands that careful teaching is required to make sure both clients and family members understand appropriate precautions against the threat of infection. Teaching points should include: Select all that apply. A) Avoid large crowds and situations that increase exposure to infection. B) Report difficulty breathing or cough to the physician if taking cyclophosphamide. C) Use ibuprofen instead of acetaminophen if fever develops. D) Women may develop heavy menstrual bleeding during therapy.

Answer: A, B Explanation: A) The nurse should teach the client and family regarding avoiding large crowds and situations that increase exposure to infection and to report difficulty breathing or cough. The client should report a fever if it develops, and ibuprofen should not be used, as this may increase the risk for bleeding. Women may have an absence of menstruation, not heavy bleeding, during therapy. Page Ref: 514 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with systemic lupus erythematosus.

5) A client with SLE is being treated with immunosuppressant drugs and corticosteroids. Which precautions should the nurse provide this client? Select all that apply. A) Avoid large crowds. B) Don't get a flu shot. C) Use contraception to prevent pregnancy D) Refrain from taking aspirin or ibuprofen. E) Report signs of infection to the physician.

Answer: A, C, D, E Explanation: A) Crowds may increase exposure to infection. Annual influenza vaccination is recommended but clients with significant immunosuppression should not receive live vaccines. Immunosuppressive drugs may increase the risk of birth defects. Aspirin or ibuprofen may increase the risk of bleeding. Chills, fever, sore throat, fatigue, or malaise should be reported. Page Ref: 516 Cognitive Level: Analyzing Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with systemic lupus erythematosus.

The nurse is teaching a client about treatment options for ED. Which explanation regarding pharmacological treatment is the most appropriate? A. They allow a man to relax enough to reduce the psychological stress of ED in order to achieve an erection B. They help a man achieve an erection during sexual stimulation by enhancing the effects of nitrous oxide to relax the smooth muscle of the penis and increase blood flow C. They dilate blood vessels all over the body except in the penis, to allow the man to achieve an erection D. They constrict blood flow to other parts of the body in order to shunt it to the penis during sexual stimulation

B Selective phosphodiesterase type 5 inhibitors enhance erections in the presence of sexual stimulation. They increase the effects of nitrous oxide to relax smooth muscle in the penis and increase blood flow during sexual stimulation.

The nurse teaches the client with erectile dysfunction about the use of alprostadil via subcutaneous penile injection. Which statement indicates the client needs further teaching? A. "I need to keep the needle sterile before I inject my penis" B. "The erection won't last long after alprostadil is injected" C. "The injection will produce an erection within 30 minutes" D. "I should report if I am feeling dizzy after an injection"

B The nurse should correct the statement about an erection not lasting long. Alprostadil (Caverject) injection therapy has the potential of producing a prolonged erection.

A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend? A) Use of gloves during patient contact B) Frequent and thorough hand washing C) Prophylactic, broad-spectrum antibiotics D) Fitting and appropriate use of N95 masks

B) Frequent and thorough hand washing Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? a) "I will have to take the medication for up to a year." b) "This disease may come back later if I am under stress." c) "I will stay in isolation for at least 6 weeks." d) "I will always have a positive test for tuberculosis."

c) "I will stay in isolation for at least 6 weeks."

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed? a) Do nothing because the client's sexual habits place him at risk for contracting other STDs. b) Educate the client about why it's important to inform sexual contacts so they can receive treatment. c) Inform the health department that this client contracted an STD. d) Inform the client's sexual contacts of their possible exposure to chlamydia.

B) Educate the client about why it's important to inform sexual contacts so they can receive treatment. The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? a) Painful red papules on the shaft of the penis b) Foul-smelling discharge from the penis c) Rashes on the palms of the hands and soles of the feet d) Cauliflower-like warts on the penis

B) Foul smelling discharge from the penis Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) "This combination of medications will eradicate the infection faster than a single antibiotic." b) "Many people infected with gonorrhea are infected with chlamydia as well." c) "The combination of these two antibiotics reduces the risk of reinfection." d) "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment."

B) Many people infected with gonorrhea are infected with chlamydia as well Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

A 22-year-old male is being treated at a college health care clinic for gonorrhea. Which of the following teaching points should the nurse include in patient teaching? A) "While being treated for the infection, you will not be able to pass this infection on to your sexual partner." B) "While you're taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol." C) "It's important to complete your full course of antibiotics in order to ensure that you become resistant to reinfection." D) "The symptoms of gonorrhea will resolve on their own, but it is important for you to abstain from sexual activity while this is occurring."

B) While you're taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol Treatment for gonorrhea necessitates abstinence from sexual activity (to prevent infection of partners) and alcohol (to avoid urethral irritation). The disease is not self limiting nor does successful treatment confer future resistance.

The client, who had been prescribed sildenafil 2 weeks ago for erectile dysfunction, calls the clinic to report that nothing happens, despite taking sildenafil orally and waiting for his erection to develop, Which fact should the nurse consider before responding to the client? A. In clinical trials, the sildenafil was effective only 20% of the time B. Sildenafil is not effective if taken orally and should be taken rectally C. In the absence of sexula stimuli, sidenafil will not cause an erection D. Sildenafil is ineffective if taken with foods high in saturated fats

C Sildenafil (Viagra) enhances the normal erectile response to sexual stimuli by promoting relaxation of arterial and trabecular smooth muscle. The resultant arterial dilation causes engorgement of sinusoidal spaces in the corpus cavernsum. In the absence of sexual stimuli, however, nothing will happen.

The nurse is explaining to a student nurse that lifestyle choices often can be both a risk factor for and a cause of ED. The nurse knows that the student understands the explanation when stating which lifestyle choices as causes of ED? A. Stress, anxiety, low self-esteem B. Injury to the penis, COPD, diabetes mellitus C. Smoking, alcohol use, being overweight, not exercising D. Low level of testosterone, hypothyroidism

C Smoking, alcohol use, being overweight and not exercising are examples of lifestyle choices.

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise? a) Reduce food intake. b) Encourage large, high-fat meals. c) Avoid residue, lactose, fat, and caffeine. d) Increase the intake of iron and zinc.

C) Avoid residue, lactose, fat, and caffeine Diarrhea may subside when the client avoids residue, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? a) "You should take the drug with an antacid." b) "It doesn't matter if you take this drug with or without food." c) "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." d) "When you take this drug, eat a high-fat meal immediately afterwards."

C) Be sure to take this drug about 1/2 hour before or 2 hours after you eat Didanosine should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

A nurse is teaching a community health class of women and explains that a sexually transmitted infection (STI) is associated with an increased risk of infertility in women. Which of the following STIs would the nurse identify? a) Herpes simplex b) Syphilis c) Chlamydia d) Gonorrhea

C) Chlamydia Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.

A client with genital herpes asks the nurse about what to expect with the infection. Which of the following responses would be most appropriate? a) Once you take the medication, the infection will be gone for good. b) You might have to try several different medications before finding one that works. c) Even though you don't have symptoms, you could still spread the infection. d) You can expect other outbreaks, each of which will be longer than the first.

C) Even though you don't have symptoms, you could still spread the infection Genital herpes can be transmitted during asymptomatic periods of viral shedding. Herpes recurs because after the initial infection, the virus remains dormant in the ganglia of the nerves that supply the area. Symptoms usually are more severe with the initial outbreak. Subsequent episodes usually are shorter and less intense. When the virus is active, shedding viral particles are infectious. Herpes infection is a highly contagious STI that is controllable but not curable. Herpes virus responds well to the antiviral drugs acyclovir, valacyclovir, and famciclovir.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Development of gummas b) Palmar rash c) Genital chancres d) Development of central nervous system lesions

C) Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

The nurse is gathering data from a male client who is suspected of having gonorrhea. Which of the following would the nurse most likely find? a) Testicular pain b) Purulent rectal discharge c) Pain on urination d) Skin rash

C) Pain on urination In men, symptoms usually appear 2 to 6 days after infection. Urethritis with a purulent discharge and pain on urination are the most common signs and symptoms. A small proportion of men are asymptomatic. An anal infection is accompanied by painful bowel elimination and purulent rectal discharge. Skin rash is associated with disseminated gonorrhea. Testicular pain would be associated with Chlamydia.

A mother brings her young child to the clinic for an evaluation of an infection. The mother states, "He's been taking antibiotics now for more than 2 months and still doesn't seem any better. It's like he's always sick." During the history and physical examination, which of the following would alert the nurse to suspect a primary immunodeficiency? a) Superficial wound on the child's left leg b) History of fungal diaper rash c) Ten ear infections in the past year d) Weight within age-appropriate parameters

C) Ten ear infections in the past year The mother has already reported one of the warning signs associated with primary immunodeficiencies--the use of antibiotics for 2 or more months with little effect. Another warning sign is eight or more new ear infections within 1 year. Therefore, the report of 10 ear infections in the past year would increase the nurse's suspicion. Recurrent, deep skin, or organ abscesses, failure of an infant to gain weight or grow normally, and persistent thrush (yeast infection) in the mouth or elsewhere on the skin after age 1 year would be additional warning signs. A superficial wound on the leg, age-appropriate weight, and a history of a fungal diaper rash would not be considered warning signs.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient? a) "It's important to start treatment soon, so you will be prescribed pills today." b) "I'd like to give you an HPV vaccination if that's okay with you." c) "There is a chance that these will clear up on their own without any treatment." d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease."

C) There is a chance that these will clear up on their own without any tx Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

Screening for chlamydia is recommended for young women because A) Chlamydia is frequently comorbid with HIV. B) Chlamydial infections may progress to sepsis. C) Untreated chlamydial infections can lead to infertility. D) Chlamydial infections are treatable only in the early stages of infection.

C) Untreated chlamydial infections can lead to infertility. Because of the potential for infertility, screening for chlamydia is recommended for women under 25. Sepsis is not a primary risk of chlamydia and is not noted to be strongly correlated with HIV infection. The disease is treatable at all stages of infection.

The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to A) Gardasil. B) Antibiotic therapy. C) Wart removal options. D) Treatment with antiviral drugs.

C) Wart removal options The HPV vaccine (Gardasil) is ineffective in cases of existing HPV, whereas neither antiviral nor antibiotic drugs are effective treatments. Patient teaching should focus on the various options for physically removing the warts.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Syphillis b) Gonorrhea c) Chlamydia d) Genital herpes

D) Genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes? a) Emergence of hard, painless nodules on the shaft of the penis b) Presence of purulent, whitish discharge from the penis c) Production of cloudy, foul-smelling urine d) Itching, pain, and the emergence of pustules on the penis

D) Itching, pain, and the emergence of pustules on the penis The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine are not suggestive of the disease.

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate? a) "All you need is a dose of penicillin and the infection will be gone." b) "There is a new vaccine available that prevents the infection from returning." c) "Once you have the infection, you develop an immunity to it." d) "There is no cure, but drug therapy helps to reduce symptoms and recurrences."

D) There is no cure, but drug therapy helps to reduce symptoms and recurrences Genital herpes is a life-long viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.

A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following? a) "The discharge is yellowish but thin." b) "I noticed a strange fishy odor during my period." c) "The discharge looks almost like cottage cheese." d) "I've been experiencing some really intense itching."

I noticed a strange fishy odor during my period Bacterial vaginosis is characterized by a fishlike odor that is particularly noticeable after sexual intercourse or during menstruation. Most clients do not experience local discomfort or pain; more than one half of clients do not notice any symptoms. Intense itching is often associated with candidiasis or trichomoniasis. A cottage-cheese like discharge is associated with candidiasis. A thin, yellow discharge is most commonly noted with trichomoniasis.

The nurse is caring for the patient with a productive cough. The nurse collects a sputum specimen for an acid-fast bacillus (AFB) smear. What collection time by the nurse is most appropriate? 1 6 AM 2 12 noon 3 6 PM 4 9 PM

The correct answer is 6 AM because if the patient has a productive cough, early morning is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. Twelve noon, 6 PM, and 9 PM are incorrect, because all of these times are afternoon or evening hours and the amount of secretions for the specimen may not be optimal.

The nurse cares for a patient with tuberculosis who is taking isoniazid and rifampin. About which data found in the patient's health history is the nurse most concerned? 1 Hepatitis B 2 Asthma attacks 3 Rheumatic fever 4 Allergy to penicillin

1 Hepatitis B Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. They are contraindicated in the patient with a history of liver disease, including any form of hepatitis. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin.

The nurse cares for an immunocompetent patient. Which clinical manifestation is most indicative of pulmonary tuberculosis? 1 Mucopurulent sputum 2 Diarrhea and fatigue 3 Lymph node enlargement 4 Hematuria and dehydration

1 Mucopurulent sputum A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary tuberculosis (TB). Diarrhea, hematuria, and dehydration are manifestations not directly associated with pulmonary TB. Fatigue and lymph node enlargement may be seen with TB but are not as indicative as is the production of mucopurulent sputum.

A patient began taking antitubercular drugs a week ago. The nurse reviews the patient's medical record and learns that the patient has a 10-year history of consuming one standard drink of alcohol three times a week. The patient states, "In the last week, my urine turned orange and I am very worried about it." How should the nurse respond? 1 Inform the patient that it is one of the side effects of the antitubercular drug rifampin. 2 Recognize that the tuberculosis may have spread to the liver, and further medical consultation is required. 3 Recognize that the liver may be damaged due to alcohol, and so a liver function test should be performed. 4 Instruct the patient to stop taking antitubercular drugs immediately and consult the primary health care provider.

1. A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. It may also cause hepatitis. Liver damage can lead to jaundice, which usually presents as yellowish discoloration of urine and sclera. However it is highly unlikely that tuberculosis has spread to the liver. The alcohol intake of the patient is within normal limits, and so it is not correct to say that alcohol may have damaged the liver. It is also inappropriate to advise the patient to stop taking antitubercular drugs.

When can airborne infection isolation for a patient with pulmonary tuberculosis (TB) be discontinued? 1 Once isoniazid drug therapy has been initiated 2 After three consecutive acid-fast bacillus (AFB) smears are negative 3 After effective instruction on the use of a high-efficiency particulate air (HEPA) mask 4 When two consecutive negative x-ray results are confirmed

2 After three consecutive acid-fast bacillus (AFB) smears are negative Airborne infection isolation is indicated for the patient with pulmonary or laryngeal TB until the patient is noninfectious (defined as effective drug therapy, clinical improvement, and three negative AFB smears). Therapy must be deemed effective. Teaching the patient to properly use the HEPA mask isn't a criterion for terminating isolation. Chest x-rays are not criteria to terminate isolation.

The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make? 1. "Why are you crying?The medication will help the disease." 2. "You seem upset. I will sit down and we can talk for awhile." 3. "Multiple sclerosis is a disease that has good times and bad times." 4. "I will have the chaplain come and stay with you for a while."

2.This is stating a fact and offering self. Both are therapeutic techniques for conversations. 1. "Why" is requesting an explanation, and the client does not owe the nurse an explanation. 3. The client did not ask about the nature of MS. The client needs to be able to verbalize feelings. 4. This is "passing the buck." Therapeutic communication is an integral part of nursing.

The patient with human immunodeficiency virus (HIV) has been diagnosed with Candida albicans, an opportunistic infection. The nurse knows the patient needs more teaching when the patient says, 1 "I will be given amphotericin B to treat the fungus." 2 "I got this fungus because I am immunocompromised." 3 "I need to be isolated from my family and friends so they won't get it." 4 "The effectiveness of my therapy can be monitored with fungal serology titers."

3 "I need to be isolated from my family and friends so they won't get it." The patient with an opportunistic fungal infection does not need to be isolated because C. albicans is not transmitted from person to person. This immunocompromised patient will be likely to have a serious infection so it will be treated with intravenous amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers.

The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving related to progressive loss." Which intervention should be implemented? 1. Consult the physical therapist for assistive devices for mobility. 2. Determine if the client has a legal power of attorney. 3. Ask if the client would like to talk to the hospital chaplain. 4. Discuss the client's wishes regarding end-of-life care.

4.The client should make personal choices about end-of-life issues while it is possible to do so. This client is progressing toward immobility and all the complications related to it. 1. The problem is grieving R/T loss of functioning. Assistive devices will not prevent loss of functioning and do not address grieving. 2. A legal power of attorney is for personal property and control of financial issues,which is not the focus of the nurse's care. A legal power of attorney for health care maybe appropriate. 3. The nurse should and must discuss end-of-life issues with the client and does not need to contact the hospital chaplain.

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority? a) Acute pain related to the development of the genital lesions b) Deficient knowledge related to the disease and its transmission c) Ineffective coping related to the increased stress associated with the infection d) Hyperthermia related to body's response to an infectious process

A) Acute pain related to the development of the genital lesions Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week.

A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for which of the following characteristic findings of syphilis in the primary clinical stage? A) Chancre B) Alopecia C) Condylomata lata D) Regional adenopathy

A) Chancre Chancres appear in the primary stage of the bacterial invasion of Treponema pallidum, the causative organism of syphilis. The other findings do not appear until the secondary stage of syphilis, occurring a few weeks after the chancres appear.

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported? a) Syphilis b) Condylomata acuminata c) Genital herpes d) Hepatitis B

A) Syphilis The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, veneral warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.

The nurse is discharging a male client with a semirigid penile implant. Which statements by the client indicate the instruction has been successful? (Select all that apply) A. "I think this will take some time to get used to with my partner." B. "If we have problems adjusting to this, I have the number of the therapist you gave me." C. "I guess I'll need to buy some different trousers so my implant won't be so noticeable." D. "I can't wait to try this out tomorrow with my partner." E. "I bet my partner will have a great time - I'll be able to go for hours!"

A,B,C With a simirigid implant, the type of clothing worn can be used to conceal it and decrease self-consciousness. it will take a period of adjustment for the man and his partner to get used to the implant.

Teaching for patients with a sexually transmitted disease (STD) would include (select all that apply) A) Treatment of sexual partner is important. B) Douching may help provide relief of itching. C) Cotton undergarments are preferred over synthetic materials. D) Sexual abstinence is indicated during the communicable phase of the disease. E) Condoms should be used during as well as after treatment during sexual activity.

A,C,D,E Douching may spread the infection or alter the local immune responses and is therefore contraindicated in patients with STDs. All other choices are appropriate patient teaching.

The nurse is caring for a client newly diagnosed with ED. Which items are appropriate for the nurse to include in the assessment process? (Select all that apply) A. Client's current sexual practices B. Client's socioeconomic status C. Client's risk factors for ED D. Client's religious affilation E. Client's history of sexual dysfunction

A,C,E In order to assist a client in coping with ED, the nurse should assess risk factors for ED, sexual dysfunction, and the client's current sexual practices.

1) The client enters the outpatient clinic and states to the triage nurse, "I think I have the flu. I'm so tired, I have no appetite, and everything hurts." The triage nurse assesses the client and finds a butterfly rash over the bridge of nose and on the cheeks. Which diagnosis does the nurse expect? A) Systemic lupus erythematosus B) Fibromyalgia C) Lyme disease D) Gout

Answer: A Explanation: A) The rash over the nose and cheeks is sometimes called a butterfly rash and is classic for the diagnosis of systemic lupus erythematosus (SLE), although not every client diagnosed with this disorder will have this rash. While fibromyalgia, Lyme's disease, and gout share some symptoms of SLE, they do not cause a rash over the nose and cheeks. Page Ref: 510 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of systemic lupus erythematosus.

A male client reports having impotence. The nurse examines the client's medication regimen and determines that a contributing factor to impotence could be: A. Aspirin B. Antihypertensives C. Nonsteroidal anti-inflammatory drugs D. Anticoagulants

B Antihypertensives, especially beta-blockers such as propranolol, can cause impotence. When a male client has impotence, the nurse should always examine his medication regimen as a potential contributing factor.

A 65-year-old male client with erectile dysfunction asks the nurse, "Is all this just in my head? Am I crazy?" The best response by the nurse is based on the knowledge that: A. ED is believed to be psychogenic in most cases B. More than 50% of the cases are attributed to organic causes C. Evaluation of nocturnal erection does not help differentiate psychogenic or organic causes D. ED is an uncommon problem among men older than age 65

B ED is multifactorial in origin, and more than 50% of the cases can be attributed to organic causes, which include alteration in vascular supply, hormonal changes, neurologic dysfunction, medications, and associated systemic diseases, such as diabetes mellitus or alcoholism.

The nurse is caring for a male client being discharged from the hospital with a nitroglycerin prescription for chest pain. The client states that he takes Viagra for ED, but he knows this is no longer safe. Which treatment option for ED would be appropriate for the nurse to include in the discharge instructions? A. Topical cream B. Mechanical device C. Acupuncture D. Biofeedback device

B If a client is unable to take selective phosphodiesterase type 5 inhibitors, unwilling to try injectable medications, and not a candidate for surgery, a mechanical device such as a vacuum constriction device (VCD) may be prescribed.

The nurse is caring for a client who presents with an exacerbation of hypertension. While obtaining the nursing admission history, the nurse learns that he recently stopped taking his blood pressure medication. When asked why, he is initially reluctant to answer but eventually states that it made him 'have problems in the bedroom.' What is the cause of this client's erectile dysfunction? A. Lifestyle choices B. Latrogenic C. Hormonal D. Psychological

B Latrogenic causes of ED are side effects of medication and surgical procedures.

Which information would be most appropriate for a nurse to provide to a client who has never used a condom? a) A condom can be used, even if it is old, so long as the pack is unopened. b) A new condom should be used for each sex act. c) Cheap condoms of any brand can be used based on monetary constraints. d) A fresh condom should be unrolled over a limp penis before it becomes erect.

B) A new condom should be used for each sex act Information that is important to provide when explaining the use of a condom include the following: use condoms manufactured and tested in the United States, discard old or deteriorated condoms, unroll a fresh condom over the erect penis, remove the condom before the penis becomes limp, and use a new condom for each sex act.

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B) Ceftriaxone The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with cefixime (Suprax).

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? 1 Negative sputum cultures 2 Clear breath sounds bilaterally 3 Decrease in the number of coughing episodes 4 Conversion of the Mantoux test from positive to negative

1 Negative sputum cultures A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds and a decrease in coughing are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures. Once a person has been exposed to the tuberculosis-causing organism, the Mantoux test will always elicit a positive result.

The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess?Select all that apply. 1. Muscle flaccidity. 2. Lethargy. 3. Dysmetria. 4. Fatigue. 5. Dysphagia.

1.Muscle flaccidity is a hallmark symptom of MS. 3.Dysmetria is the inability to control muscular action characterized by overestimating or under estimating range of movement. 4.Fatigue is a symptom of MS. 5.Dysphagia, or difficulty swallowing, is associated with MS. 2. Lethargy is the state of prolonged sleepiness or serious drowsiness and is not associated with MS.

The client newly diagnosed with multiple sclerosis (MS) states, "I don't understand how I got multiple sclerosis. Is it genetic?" On which statement should the nurse base the response? 1. Genetics may play a role in susceptibility to MS, but the disease may be caused by a virus. 2. There is no evidence suggesting there is any chromosomal involvement in developing MS. 3. Multiple sclerosis is caused by a recessive gene, so both parents had to have the gene for the client to get MS. 4. Multiple sclerosis is caused by an autosomal dominant gene on the Y chromosome,so only fathers can pass it on.

1.The exact cause of MS is not known,but there is a theory stating a slow virus is partially responsible. A failure of apart of the immune system may also beat fault. A genetic predisposition involving chromosomes 2, 3, 7, 11, 17, 19, and X may be involved. 2. There is some evidence supporting a genetic component involved in developing MS. 3. A specific gene has not been identified to know if the gene is recessive or dominant. 4. The X chromosome, not the Y chromosome,may be involved.

2. A nurse is teaching a client who has SLE about self-care. Which of the following statements by the client indicates an understanding of the teaching? A. "I should limit my time to 10 minutes in the tanning bed." B. "I will apply powder to any skin rash." C."I should use a mild hair shampoo." D."I will inspect my skin once a month for rashes."

2. A. A client who has SLE should avoid the use of tanning beds, as well as prolonged sun exposure. B. A client who has SLE should apply steroid-based creams to skin rashes, not a powder. C. CORRECT: A client who has SLE should use a mild hair shampoo that does not irritate the scalp. D. A client who has SLE should inspect her skin daily for any open areas or rashes. NCLEX® Connection: Physiological Adaptation, Illness Management

The nurse is providing discharge instructions to a client and his partner regarding a new penile implant. Which teaching point is not appropriate for the nurse to include in the teaching session A. An implant is softer than a natural penis and may not provide usual partner satisfaction B. Men are usually satisfied with their implant C. It is important to practice with the pump D. Sexual activity can be resumed in six to eight weeks

A Teaching is an essential part of the nurse's role in the discharge process. The nurse would not include the statement that the implant is softer than the natural penis.

The client diagnosed with multiple sclerosis is scheduled for a magnetic resonanceimaging (MRI) scan of the head. Which information should the nurse teach the client about the test? 1. The client will have wires attached to the scalp and lights will flash off and on. 2. The machine will be loud and the client must not move the head during the test. 3. The client will drink a contrast medium 30 minutes to one (1) hour before the test. 4. The test will be repeated at intervals during a five (5)- to six (6)-hour period.

2.MRI scans require the client to lie stilland not move the body; the clientshould be warned about the loud noise 1. This describes an evoked potential electroencephalogram (EEG). 3. The client does not drink any contrast medium. If contrast is used, it will be given IVP for a CT scan. 4. The test is performed at one time

3. A nurse is discussing gout with a client who is concerned about developing the disorder. Which of the following findings should the nurse identify as risk factors for this disease? (Select all that apply.) A. Diuretic use B. Obesity C. Deep sleep deprivation D. Depression E. Cardiovascular disease

3. A. CORRECT: The use of diuretics is a risk factor for gout. B. CORRECT: Obesity is a risk factor for gout. C. Deep sleep deprivation is a manifestation of fibromyalgia and is not a risk factor for gout. D. Depression is a manifestation of SLE and is not a risk factor for gout. E. CORRECT: Cardiovascular disease is a risk factor for gout. NCLEX® Connection: Physiological Adaptation, Pathophysiology

The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance? 1. The client refuses to have a gastrostomy feeding. 2. The client wants to discuss if she should tell her fiancé. 3. The client tells the nurse life is not worth living anymore .4. The client needs the flu and pneumonia vaccines.

3.A potential suicide statement is priority for the nurse when caring for the client with MS.

The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 2. Hold the medication until after all cultures have been obtained. 3. Monitor the client's serum blood glucose levels frequently .4. Provide supplemental dietary sodium with the client's meals.

3.Steroids interfere with glucose metabolism by blocking the action of insulin;therefore, the blood glucose levels should be monitored. 1. Steroid medications increase gastric acid;therefore, a proton pump inhibitor is an appropriate medication for the client. 2. Cultures are ordered prior to administer-ing antibiotics, not steroids. 4. Steroid medications cause the client to retain sodium; therefore, a low-sodiumdiet should be encouraged

A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential because: Recommendations for the initial treatment of tuberculosis 1 It minimizes the required dosage of each of the medications. 2 It helps reduce the unpleasant side effects of the medications. 3 It shortens amount of time that the treatment regimen will be needed. 4 It discourages the development of resistant strains of the TB organism

4 It discourages the development of resistant strains of the TB organism Recommendations for the initial treatment of tuberculosis (TB) include a four-drug regimen until drug susceptibility tests are available. After susceptibility is established, the regimen can be altered, but patients should still receive at least two drugs to prevent emergence of drug-resistance organisms. Dosage, side effects, and duration of the regimen are not reasons for combination drug therapy in a patient with TB.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate? 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings.

4. A nurse is assessing a client who has SLE. Which of the following findings should the nurse expect? A. Weight loss B. Petechiae on thighs C. Systolic murmur D. Alopecia

4. A. Weight gain can occur in a client who has SLE due to being treated with corticosteroids. This is an adverse effect of this medication. B. A butterfly rash on the face is a finding in a client who has lupus. C. A cardiac friction rub is an expected finding of SLE. D. CORRECT: Alopecia (hair loss) is an expected finding in a client who has SLE. NCLEX® Connection: Physiological Adaptation, Pathophysiology

The nurse is assessing a 48-year-old client diagnosed with multiple sclerosis. Which clinical manifestation warrants immediate intervention? 1. The client has scanning speech and diplopia. 2. The client has dysarthria and scotomas. 3. The client has muscle weakness and spasticity. 4. The client has a congested cough and dysphagia.

4.Dysphagia is a common problem of clients diagnosed with multiple sclerosis,and this places the client at risk for aspiration pneumonia. Some clients diagnosed with multiple sclerosis eventually become immobile and are at risk for pneumonia. 1. These are clinical manifestations of multiple sclerosis and are expected. 2. These are expected clinical manifestations of multiple sclerosis. 3. These are expected clinical manifestations of multiple sclerosis.

6) A nurse is caring for a client with systemic lupus erythematosus (SLE). The client begins to cry and tells the nurse that she is afraid that her skin will be disfigured with lesions. Which intervention does the nurse plan to teach this client to minimize skin infections associated with SLE? Select all that apply. A) Use sunscreen with an SPF of 15 or greater. B) Remain indoors on sunny days. C) Avoid swimming in a pool or the ocean. D) Avoid sun exposure between 10:00 a.m. and 3:00 p.m. E) Decrease sun exposure between 3:00 p.m. and 5:00 p.m.

Answer: A, D Explanation: A) The nurse teaches the client to live a normal life with a few extra precautions. There is a relationship between sun exposure and infection, so the client is taught to use sunscreen with an SPF of at least 15 and to avoid the sun between 10:00 a.m. and 3:00 p.m. The client may swim but should reapply sunscreen after swimming. The client does not need to stay indoors on sunny days or to decrease sun exposure between 3:00 p.m. and 5:00 p.m. Page Ref: 513 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 6. Plan evidence-based care for an individual with systemic lupus erythematosus and his or her family in collaboration with other members of the healthcare team.

10) A nurse is caring for a client with systemic lupus erythematous (SLE) who is taking hydroxychloroquine (Plaquenil). The nurse understands that the primary concern with this drug is: A) Pulmonary fibrosis. B) Cushingoid effects. C) Retinal toxicity. D) Renal toxicity.

Answer: C Explanation: A) Hydroxychloroquine (Plaquenil) is an antimalarial drug used in SLE to reduce the frequency of acute episodes of SLE. The primary concern with Plaquenil is retinal toxicity and possible irreversible blindness. Cushingoid effects are a concern with corticosteroid therapy. Pulmonary fibrosis is a potential adverse effect of cyclophosphamide, not Plaquenil. Renal toxicity is not the primary concern with Plaquenil. Page Ref: 514 Cognitive Level: Analyzing Client Need: Physiological Integrity Nursing Process: Planning Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with systemic lupus erythematosus.

2) A female client asks the nurse if there are any conditions that can exacerbate systemic lupus erythematosus (SLE). Which is the best nurse response? A) "Conditions that cause hypotension can often exacerbate SLE." B) "GI upset is often associated with SLE exacerbation." C) "Pregnancy is often associated with an SLE exacerbation." D) "Fever is a known trigger for an SLE exacerbation."

Answer: C Explanation: A) Pregnancy can be associated with an exacerbation of SLE due to the rise of estrogen levels. Hypotension, fever, and GI upset are not factors that risk exacerbation of SLE. Page Ref: 510 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 2. Identify risk factors and prevention methods associated with systemic lupus erythematosus.

3) The nurse is providing health education to a diverse group at a neighborhood community center. Why does the nurse plan to include signs and symptoms of systemic lupus erythematosus (SLE)? A) The neighborhood is composed of many young female children. B) The audience has asked the nurse to include the information. C) The audience is mainly composed of Caucasian women. D) The audience is mainly females of Asian-American descent.

Answer: D Explanation: A) Among women who are of child-bearing age, SLE is seen in more African-Americans, Hispanics, and Asian-Americans than Caucasians. There is no evidence that the audience asked for the information. Page Ref: 510 Cognitive Level: Applying Client Need: Physiological Integrity Nursing Process: Implementation Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with systemic lupus erythematosus.

The nurse is caring for a client who was diagnosed with ED several months ago. Knowing that he has poor visual acuity and experiences a tremor in his left hand, which treatment choice for ED is likely not to meet his needs? A. Mechanical devices B. Penile implant C. Selective phosphodiesterase type 5 inhibitors D. Injectable medications

D Injectable medications are often not an acceptable treatment for clients. Many clients report dissatisfaction with them because of difficulty in self-injecting, pain, lack of spontaneity, and cost.

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)? a) Hive-like rash for the past 2 days b) Clear vaginal discharge c) Weight gain of 5 lbs in one year d) Five different sexual partners

D) Five different sexual partners The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one's risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest a STI.

A woman whose husband was recently diagnosed with active pulmonary tuberculosis (TB) is a tuberculin skin test converter. Management of her care would include: a) scheduling her for annual tuberculin skin testing. b) placing her in quarantine until sputum cultures are negative. c) gathering a list of persons with whom she has had recent contact. d) advising her to begin prophylactic therapy with isoniazid (INH).

d) advising her to begin prophylactic therapy with isoniazid (INH).

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's teenage daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? a) 3 to 5 days b) 1 to 3 weeks c) 2 to 4 months d) 6 to 12 months

d.