Final Exam Prep U

The ECG of a new patient shows a P wave slightly different than normal. The nurse is considering the possibility of premature atrial contractions (PAC). The nurse will ask about which factors when taking this client's history? A. All options are correct. B. caffeine C. nicotine D. hyperthyroidism or other metabolic disorders

A. All options are correct. There are a number of causes of premature atrial contractions (PAC), which is why it is so important to know and review a patient's complete history when examining for arrhythmias.

Which medication is the drug of choice for sinus bradycardia? A. Atropine B. Lidocaine C. Pronestyl D. Cardizem

A. Atropine Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.

A nurse is caring for a client with end-stage cardiomyopathy and the client's spouse asks the nurse to clarify one of the last treatment options available that the health care provider mentioned. What is considered to be one of the last treatments for end-stage cardiomyopathy? A. heart transplantation B. xenograft tissue valve C. annuloplasty D. valvuloplasty

A. heart transplantation When heart failure progresses and medical treatment is no longer effective, surgical intervention, including heart transplantation, is considered. The other three choices have to do with failing valves and valve repairs.

The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia? A. atropine B. lidocaine C. diltiazem D. adenosine

A. atropine The treatment of symptomatic bradycardia includes transcutaneous pacing and atropine. Lidocaine may be used in the treatment of ventricular fibrillation. Diltiazem and adenosine are medications used to treat clients with atrial fibrillation.

A patient is admitted with suspected cardiomyopathy. What diagnostic test will the nurse need to teach the client about for identification of this disease? A. serial enzyme studies B. cardiac catheterization C. echocardiogram D. phonocardiogram

C. echocardiogram The echocardiogram is one of the most helpful diagnostic tools for cardiomyopathy because the structure and function of the ventricles can be observed easily. Cardiac catheterization will focus on coronary vessels. The serial enzymes are done to detect heart muscle damage. The phonocardiogram is helpful for valve function.

In myasthenia gravis (MG), there is a decrease in the number of receptor sites of which neurotransmitter? A. Acetylcholine B. Epinephrine C. Norepinephrine D. Dopamine

A. Acetylcholine In MG, there is a reduction in the number of acetylcholine receptor sites because antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the neuromuscular junction. There are no decreased receptor sites of epinephrine, norepinephrine, or dopamine implicated in MG.

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? A. "Treatment aims at keeping you independent as long as possible." B. "Treatment really doesn't matter; the disease is going to progress anyway." C. "Treatment for Parkinson's is only palliative; it keeps you comfortable." D. "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease."

A. "Treatment aims at keeping you independent as long as possible." Treatment aims at prolonging independence. Treatment does matter, it is not palliative, and it is not aimed at keeping you emotionally healthy.

The development of a positive HIV antibody test following initial infection generally occurs in which timeframe? A. 4 weeks B. 6 weeks C. 8 weeks D. 10 weeks

A. 4 weeks Development of a positive HIV antibody test generally occurs within 4 weeks and with few exceptions by 6 months.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? A. AIDS B. DAF C. CVID D. SCID

A. AIDS AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe hypogammaglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

During a health history, a client explains that he was just diagnosed with Parkinson's disease and wants to know what to expect. What should the nurse include during client teaching? A. Abnormal body movements such as tremors may occur at rest along with asymmetry of movement. B. Eventually there will be paralysis of the extremities on one side of the body. C. Whole-body convulsive movements will occur as the disease progresses. D. Over time, the client's eyesight will diminish, especially at night.

A. Abnormal body movements such as tremors may occur at rest along with asymmetry of movement. Parkinson's disease is characterized by involuntary tremors at rest and asymmetrical movement. Neither paralysis nor convulsions occur with this disease. It also does not affect vision.

During assessment of a client admitted for cardiomyopathy, the nurse notes the following symptoms: dyspnea on exertion, fatigue, fluid retention, and nausea. The initial appropriate nursing diagnosis is which of the following? A. Decreased cardiac output B. Autonomic dysreflexia C. Disturbed sensory perception D. Ineffective airway clearance

A. Decreased cardiac output A primary nursing diagnosis for cardiomyopathy is decreased cardiac output related to structural disorders caused by cardiomyopathy or to dysrhythmia from the disease process and medical treatments. Dyspnea on exertion, fatigue, and fluid retention are related to poor cardiac output. Nausea is related to poor perfusion of the gastrointestinal system. Autonomic dysreflexia is related to a spinal cord injury. Ineffective airway clearance relates to the inability to clear secretions from the airway, which is not an initial problem with cardiomyopathy. Disturbed sensory perception is related to specific senses and not to initial cardiomyopathy.

A patient has been diagnosed with congestive heart failure (CHF). The health care provider has ordered a medication to enhance contractility. The nurse would expect which medication to be prescribed for the patient? A. Digoxin B. Clopidogrel C. Enoxaparin D. Heparin

A. Digoxin Contractility is enhanced by circulating catecholamines, sympathetic neuronal activity, and certain medications, such as Lanoxin. Increased contractility results in increased stroke volume. The other medications are classified as platelet-inhibiting medications.

A client experiencing flu-like symptoms over the last several weeks is concerned about being symptomatic for the HIV virus. After determining risk factors for contraction of the HIV virus, the nurse knows which tests may be ordered for this client? Select all that apply. A. HIV-1 p24 antigen test B. HIV-1 differentiation assay C. HIV-1/HIV-2 immunoassay D. HIV-1 nucleic acid amplification test E. HIV/1-HIV-2 antigen/antibody combination immunoassay

A. HIV-1 p24 antigen test D. HIV-1 nucleic acid amplification test There are five screening blood tests for HIV. The tests that are used to directly check for the virus include the HIV-1 p24 antigen test and the HIV-1 nucleic acid amplification test. The HIV-1 differentiation assay differentiates HIV-1 from HIV-2. The HIV-1/HIV-2 immunoassay tests for both HIV-1 and HIV-2 antibodies. The HIV/1-HIV-2 antigen/antibody combination immunoassay tests for both virus (antigen) and antibodies for both HIV-1 and HIV-2.

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation? A. In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. B. Sinus bradycardia means your heart is not beating fast enough to keep you alive. C. Sinus bradycardia is nothing to worry about. D. In many clients a heart rate slower than 70 beats per minute is considered to slow to maintain an adequate cardiac output.

A. In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. A heart rate slower than 60 beats per minute is pathologic in clients with heart disorders, increased intracranial pressure, hypothyroidism, or digitalis toxicity. The danger in sinus bradycardia is that the slow rate may be insufficient to maintain cardiac output. Option B is incorrect as it is an incomplete answer to the client's question. Option C minimizes the client's concern so it is incorrect. Option D is incorrect as it gives the client incorrect information.

A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? A. Insulin B. Parathormone C. Melatonin D. Calcitonin

A. Insulin Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.

A nurse assesses a patient for a possible abdominal aortic aneurysm (AAA). Which of the following signs would the nurse recognize as positive indicators? Select all that apply. A. Low back pain B. Lower abdominal pain C. Hypertension D. An abdominal pulsatile mass E. A systolic bruit F. Radiating chest pain

A. Low back pain B. Lower abdominal pain D. An abdominal pulsatile mass E. A systolic bruit Chest pain and hypertension, although they may be present, are not indicators of AAA even if present. All other choices are positive.

The nurse places a client in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection? A. Mode of transmission B. Agent C. Susceptible host D. Portal of entry

A. Mode of transmission Isolation techniques attempt to break the chain of infection by interfering with the transmission mode. These techniques do not directly affect the agent, host, or portal of entry.

Hypocalcemia is associated with which of the following manifestations? A. Muscle twitching B. Bowel hypomotility C. Fatigue D. Polyuria

A. Muscle twitching Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are not associated with hypocalcemia.

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: A. a positive edrophonium (Tensilon) test. B. Kernig's sign. C. a positive sweat chloride test. D. Brudzinski's sign.

A. a positive edrophonium (Tensilon) test. A positive edrophonium test confirms the diagnosis of myasthenia gravis. After edrophonium administration, most clients with myasthenia gravis show markedly improved muscle tone. Kernig's sign and Brudzinski's sign indicate meningitis. The sweat chloride test is used to confirm cystic fibrosis.

A nursing student observes the home care nurse provide education to a client with congestive heart failure (CHF). The nurse teaches the client how to read food labels and calculate sodium content. The nursing student recognizes that the home care nurse is aware of which basic principle of patient education? A. Patient instruction related to self-care activities promotes patient independence B. Patients are required to learn about their therapeutic nutritional regimen C. The home care nurse has a physician order to teach a 2-g sodium diet D. The home care nurse is providing hospital discharge instructions

A. Patient instruction related to self-care activities promotes patient independence Teaching is a function of nursing to assist patients to alter lifestyle patterns that increase health risk. By teaching the client how to calculate sodium content of foods the nurse is facilitating independence in nutrition disease management. Patients have the right to decide whether or not to learn. Teaching is an independent function of nursing and does not require a physician's order. Teaching related to food labels in the patient home is an appropriate environment for this client. The nurse can use actual foods from the patient's kitchen.

The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? A. Severe pain B. Hematemesis C. Rectal bleeding D. Hypertensive crisis

A. Severe pain Pressure from an enlarging or dissecting abdominal aortic aneurysm is likely to be exhibited as severe pain. A decrease in blood pressure will result as the client goes into shock from hemorrhaging. Blood in emesis or rectal bleeding is not associated with rupture of AAA.

When developing a preventative plan of care for a patient at risk for developing chronic obstructive pulmonary disease (COPD), which of the following should be incorporated? A. Smoking cessation B. Weight reduction C. Cholesterol management D. Cancer prevention

A. Smoking cessation The most important risk factor for the development of COPD is cigarette smoking. The effects of cigarette smoke are complex and lead to the development of COPD in approximately 15% to 20% of smokers. Tobacco smoke irritates the airways and, in susceptible individuals, results in mucus hypersecretion and airway inflammation.

The nurse is teaching the client with HIV about therapy. Which elements are essential for the nurse to include in the teaching plan? Select all that apply. A. The CD4 count is the major indicator of immune function and guides therapy. B. Antiretroviral therapy targets different stages of the HIV life cycle. C. The goal of antiretroviral therapy is to prevent opportunistic infections. D. Medication therapy is rarely effective. E. Clients rarely respond to medication therapy.

A. The CD4 count is the major indicator of immune function and guides therapy. B. Antiretroviral therapy targets different stages of the HIV life cycle.

A client has tested positive for tuberculosis (TB). While providing client teaching, which information should the nurse prioritize? A. The importance of adhering closely to the prescribed medication regimen B. The fact that the disease is a lifelong, chronic condition that will affect activities of daily living (ADLs) C. The fact that TB is self-limiting but can take up to 2 years to resolve D. The need to work closely with the occupational and physical therapists

A. The importance of adhering closely to the prescribed medication regimen Successful treatment of TB is highly dependent on careful adherence to the medication regimen. The disease is not self-limiting; occupational and physical therapy are not necessarily indicated. TB is curable.

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? A. The muscles will become fatigued and the patient will not be able to chew food or swallow pills. B. There should not be a problem, since the medication was only delayed by about 2 hours. C. The patient will go into cardiac arrest. D. The patient will require a double dose prior to lunch.

A. The muscles will become fatigued and the patient will not be able to chew food or swallow pills. Maintenance of stable blood levels of anticholinesterase medications, such as pyridostigmine, is imperative to stabilize muscle strength. Therefore, the anticholinesterase medications must be administered on time. Any delay in administration of medications may exacerbate muscle weakness and make it impossible for the patient to take medications orally.

A nurse is preparing a presentation about human immunodeficiency virus (HIV) for a local community group. What would the nurse include in the presentation about HIV transmission? Select all that apply. A. The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. B. HIV transmission from mother-to child occurs primarily during pregnancy while the fetus is in utero. C. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. D. HIV can be found in seminal fluid, vaginal secretions, and breast milk. E. Sharing of infected equipment used to inject drugs increases the risk for infection.

A. The risk of acquiring HIV through the transfusion of blood products is almost nonexistent. C. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. D. HIV can be found in seminal fluid, vaginal secretions, and breast milk. E. Sharing of infected equipment used to inject drugs increases the risk for infection. HIV-1 is transmitted in body fluids that contain free virions and infected CD+4 T cells. These fluids include blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk. The amount of HIV and infected cells in the body fluid is associated with the probability that the exposure will result in infection. Blood and blood products can transmit HIV to recipients; however, the risk associated with transfusions have been virtually eliminated as the result of intensive donor screening. Mother-to-child transmission may occur in utero, at the time of delivery, or through breastfeeding. Most perinatal infections are thought to occur during delivery. Sharing infected equipment during drug injections increases a person's risk for acquiring HIV.

The nurse is teaching a client with cardiomyopathy. Which statement is a valid teaching point? A. The treatments include medications, medical devices, surgery, or transplantation. B. The disease was inherited, so there are no reversal treatments. C. Clients with cardiomyopathy often need to live in a skilled nursing care facility. D. Clients with cardiomyopathy have a goal to improve lung function.

A. The treatments include medications, medical devices, surgery, or transplantation. Treatments for clients with cardiomyopathy include medications, medical devices such as pacemakers, internal defibrillators, surgery or transplantation. The disease is not curable or reversible. Clients with cardiomyopathy do not need to live in a skilled facility. The main goal for clients with cardiomyopathy is to improve heart function.

When interpreting the results of a Mantoux test, the nurse explains to the client that a reaction occurs when the intradermal injection site shows A. redness and induration. B. drainage. C. tissue sloughing. D. bruising.

A. redness and induration. The injection site is inspected for redness and palpated for hardening. Drainage at the injection site does not indicate a reaction to the tubercle bacillus. Sloughing of tissue at the injection site does not indicate a reaction to the tubercle bacillus. Bruising of tissue at the site may occur from the injection but does not indicate a reaction to the tubercle bacillus.

A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of arrhythmia would the cardiologist likely diagnose? A. sinus tachycardia B. sinus bradycardia C. supraventricular tachycardia D. supraventricular bradycardia

A. sinus tachycardia Sinus tachycardia is an arrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100 to 150 beats/minute).

A patient with HIV has been on antiretroviral therapy (ART) for 6 months. The patient comes to the clinic with home medications and the nurse observes that there are too many pills in the container. What does the nurse know about the factors associated with nonadherence to ART? (Select all that apply.) A. Lives alone B. Active substance abuse C. Taking other medication D. Depression E. Lack of social support

B. Active substance abuse D. Depression E. Lack of social support Factors associated with nonadherence include active substance abuse, depression, and lack of social support.

A nurse works in an employee health department of a hospital. She was asked to treat a staff nurse who was exposed to blood from a patient with an HIV infection. The nurse practitioner instituted a PEP protocol that includes which of the following actions? Select all that apply. A. Start prophylaxis medications between 3 to 6 hours after exposure. B. Continue HIV medications for 4 weeks postexposure. C. Practice safe sex for 2 weeks (time for HIV medications to reach a satisfactory blood level). D. Initiate postexposure testing after 4 weeks. E. Finish postexposure testing at 6 months.

B. Continue HIV medications for 4 weeks postexposure. D. Initiate postexposure testing after 4 weeks. E. Finish postexposure testing at 6 months. Refer to Box 37-4 in the text

The nurse observes a nursing assistant leave the room of client diagnosed with Clostridium difficile infection without washing hands. Which is the priority action by the nurse? A. Report the nursing assistant to the nurse manager. B. Have the nursing assistant wash hands with soap and water. C. Provide written documentation about the incident. D. Teach the nursing assistant about the chain of infection.

B. Have the nursing assistant wash hands with soap and water. Although all actions listed are appropriate, the priority nursing action is to ensure that the nursing assistant washes their hands with soap and water. Allowing nursing assistants to continue with their job without washing their hands could lead to the nursing assistant infecting other clients with whom they come in contact. The potential for health care-associated acquisition is increased because the spore is relatively resistant to disinfectants and can be spread via the hands of healthcare providers.

The nurse is caring for a patient with Parkinson's disease and is preparing to administer medication. What does the nurse administer to the patient that is considered the most effective drug currently given for the tremor of Parkinson's? A. Requip B. Levodopa C. Symmetrel D. Permax

B. Levodopa Levodopa is the most effective agent and the mainstay of treatment for Parkinson's disease.

Cryptococcus meningitis is suspected in a client with HIV. Which manifestations would be consistent with cryptococcus meningitis? Select all that apply. A. Psychomotor slowing B. Stiff neck C. Seizures D. Vacant stare E. Hyperreflexia

B. Stiff neck C. Seizures Manifestations of cryptococcal meningitis include fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures. Psychomotor slowing, a vacant stare, and hyperreflexia suggest HIV encephalopathy.

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? A. The aneurysm has become obstructed. B. The aneurysm may be preparing to rupture. C. The client is experiencing inflammation of the aneurysm. D. The client is experiencing normal sensations associated with this condition.

B. The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized to the middle or lower abdomen to the left of the midline. Low-back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing AAA include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is quickly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

The health care provider prescribes esmolol for a client with supraventricular tachycardia. During esmolol therapy, what should the nurse monitor? A. body temperature. B. heart rate and blood pressure. C. ocular pressure. D. cerebral perfusion pressure.

B. heart rate and blood pressure. Because class II antiarrhythmics such as esmolol inhibit sinus node stimulation, they may produce bradycardia. Hypotension with peripheral vascular insufficiency also may occur, especially with esmolol. Class II antiarrhythmics don't alter body temperature, ocular pressure, or cerebral perfusion pressure.

During flu season, a nurse is teaching clients about the chain of infection. What components are considered "links" in this chain? Select all that apply. A. virulence B. infectious agent C. portal of entry D. susceptible host E. fomites

B. infectious agent C. portal of entry D. susceptible host The six components involved in the transmission of microorganisms are described as the chain of infection. All components in the chain of infection must be present to transmit an infectious disease from one human or animal to a susceptible host: an infectious agent, an appropriate reservoir, exit route, means of transmission, portal of entry, and susceptible host.

A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: A. dry, waxy swelling and abnormal mucin deposits in the skin. B. protruding eyes and a fixed stare. C. a wide, staggering gait. D. more than 10 beats/minute difference between the apical and radial pulse rates.

B. protruding eyes and a fixed stare. Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.

A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following? A. Serotonin B. Acetylcholine C. Dopamine D. Norepinephrine

C. Dopamine Parkinson's disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglion region. The loss of dopamine stores results in more excitatory neurotransmitters (acetylcholine) than inhibitory transmitters (dopamine). Serotonin and norepinephrine are not involved.

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment? A. A blood pressure cuff B. A cell phone to call 911 C. An automatic external defibrillator D. A stethoscope

C. An automatic external defibrillator Most malls in the United States now have automatic external defibrillators in common areas. These defibrillators can easily be applied and obtain electrical confirmation of no ventricular contraction or R wave. The machine allows an electrical stimulation when the discharge button is depressed. A blood pressure cuff and stethoscope will not provide the equipment needed to save the client's life. The 911 can be called by a bystander, but the priority is to obtain the life-saving equipment. If defibrillation is performed within the first 3 minutes of cardiac arrest, the potential for survival is nearly 70%.

The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter? A. Sinusoidal B. Triangular C. Sawtooth D. Square

C. Sawtooth

A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client? A. IV lidocaine B. Chemical cardioversion C. Immediate CPR D. Electric cardioversion

C. Immediate CPR Immediate CPR is used during pulseless ventricular tachycardia and ventricular fibrillation.

A patient presents to a clinic on May 1 and tells the nurse practitioner that he had a 1-month sexual relationship with a friend who did not disclose that he was HIV positive. The relationship ended last week. The nurse tells the patient that after infection with HIV, the immune system responds by making antibodies against the virus; therefore the patient should expect this to happen by: A. May 8 B. May 20 C. June 5 D. July 1

C. June 5 An antibody response to an HIV infection usually occurs 4 to 6 weeks after exposure.

Which medication is the most effective agent in the treatment of Parkinson disease? A. Benztropine B. Amantadine C. Levodopa D. Bromocriptine mesylate

C. Levodopa Levodopa is the most effective agent and is the mainstay of treatment for Parkinson disease (PD). Benztropine, amantadine, and bromocriptine mesylate are utilized in the treatment of PD but are not the most effective.

A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of which health problem? A. Adenoiditis B. Chronic tonsillitis C. Obstructive sleep apnea D. Laryngeal cancer

C. Obstructive sleep apnea Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This client's symptoms are not suggestive of laryngeal cancer.

Which nursing action is essential before an EIA test is performed? A. Performing Western blotting B. Performing a polymerase chain reaction test C. Obtaining a general consent for medical care from the client D. Obtaining a written consent from the client

C. Obtaining a general consent for medical care from the client Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Western blotting is performed if the results of an EIA test are positive. A polymerase chain reaction test, which measures viral loads, is used if a positive diagnosis is confirmed.

The nurse is evaluating a client's neck for thyroid enlargement. Which action by the nurse is appropriate during the evaluation? A. Inspect changes in pigmentation in the neck. B. Perform repeated palpation of the thyroid gland. C. Palpate the thyroid gland gently. D. Examine the skin of the neck for excessive oiliness.

C. Palpate the thyroid gland gently. The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which may have serious implications. Pigment changes in the neck and excessive oiliness of the skin are not related to assessment for thyroid enlargement.

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? A. Multiple sclerosis B. Myasthenia gravis C. Parkinson's disease D. Huntington's disease

C. Parkinson's disease Early signs include stiffness, referred to as rigidity, and tremors of one or both hands, described as pill-rolling (a rhythmic motion of the thumb against the fingers). The hand tremor is obvious at rest and typically decreases when movement is voluntary, such as picking up an object. Bradykinesia, slowness in performing spontaneous movements, develops. Clients have a masklike expression, stooped posture, hypophonia (low volume of speech), and difficulty swallowing saliva. Weight loss occurs. A shuffling gait is apparent, and the client has difficulty turning or redirecting forward motion. Arms are rigid while walking. These symptoms are not indicative of MS, Myasthenia gravis, or Huntington's.

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? A. Emphysema B. Asthma C. Polycythemia D. Bronchitis

C. Polycythemia Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer? A. "Not everyone is susceptible to STDs, but they still get them." B. "STDs can be gotten from bed linens and toilet seats, so you don't really need a reservoir." C. "You can be missing any part of the chain of infection except the infectious agent." D. "All parts of the chain of infection have to be present for the disease to be passed to another human."

D. "All parts of the chain of infection have to be present for the disease to be passed to another human." All components in the chain of infection must be present for an infectious disease to be transmitted from one human or animal to a susceptible host. This makes options A, B, and C incorrect.

A client in stage 1 of HIV feels well and questions having the virus. Which response by the nurse is appropriate? A. "Not everyone who is HIV positive has a severe case of the disease." B. "Your immune system has increased other cells to successfully combat the virus." C. "It's possible that the original testing was incorrect and retesting is needed." D. "There is an equal amount of virus and the cells to combat the virus in your body."

D. "There is an equal amount of virus and the cells to combat the virus in your body." During Stage 1, the amount of virus in the body after the initial immune response subsides results in a viral set point which reflects an equilibrium between HIV levels and the immune response. Untreated, this set point can last for years and is inversely correlated with disease prognosis. In this prolonged, chronic stage (Stage 1), clients feel well and have few, if any, symptoms, which is why this stage had been referred to as asymptomatic. There is a specific course for HIV and the client may eventually go through all of the stages. The client's immune system has not increased other cells to combat the virus. It is unlikely that the original testing was inaccurate.

A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best? A. "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." B. "Warfarin controls heart rate in the client with atrial fibrillation." C. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." D. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation."

D. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation." Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. Warfarin is ordered in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically ordered to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.

A home care nurse makes a visit to a client with Parkinson's disease who is being cared for by his spouse. During the visit, the spouse says, "I'm just so tired. I have to do just about everything for him." Which response by the nurse would be most appropriate? A. "You're doing a great job. Just keep it up." B. "It must be difficult for you to see your husband like this." C. "Are you upset about how your husband is doing?" D. "You sound a bit overwhelmed. Tell me more about what's happening."

D. "You sound a bit overwhelmed. Tell me more about what's happening." The spouse appears to be under considerable stress from living with and caring for the husband. Therefore, the nurse's response about being overwhelmed addresses the spouse's concerns and feelings. Telling the nurse about what is happening provides the spouse with an opportunity to verbalize her concerns and provides the nurse with additional information from which to identify areas where additional assistance may be needed. Telling the spouse that she is doing a great job ignores the spouse's feelings. Although the statement about it being difficult for the spouse may be true, it does not address the underlying issues related to the spouse's original statement. Asking the spouse if she is upset about her husband's condition may be appropriate, but it is a closed-ended question that would not allow the spouse to verbalize what she is feeling.

A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? A. Methimazole (Tapazole) B. Thyroid USP desiccated (Thyroid USP Enseals) C. Liothyronine (Cytomel) D. Levothyroxine (Synthroid)

D. Levothyroxine (Synthroid) Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.

A nurse implements aseptic technique as a means to break the chain of infection at which element? A. Reservoir B. Portal of exit C. Means of transmission D. Portal of entry

D. Portal of entry The use of aseptic technique interrupts the chain of infection at the portal of entry. Employee health, environmental sanitation, and disinfection and sterilization interfere with the reservoir element. Hand hygiene, control of secretions, and excretions and proper trash and waste disposal interfere with the portal of exit. Isolation, proper food handling, airflow control, standard precautions, sterilization, and hand hygiene interfere with the means of transmission.

A client diagnosed with human immunodeficiency virus (HIV) asks how the health care provider determines what their viral load is. What is the nurse's best response? A. The health care provider can have a sedimentary rate run. B. The health care provider can have a basic metabolic panel run. C. The health care provider can have an ELISA test run. D. The health care provider can have a polymerase chain reaction test run.

D. The health care provider can have a polymerase chain reaction test run. The p24 antigen test and polymerase chain reaction test measure viral loads. They are used to guide drug therapy and follow the progression of the disease. Options A, B, and C are incorrect, as these tests do not determine the client's viral load.