Immune and Hematological Disorders

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis Explanation: Hypertension, osteoporosis, muscle wasting, and truncal obesity are all adverse effects of long-term corticosteroid therapy; however, osteoporosis commonly causes compression fractures of the spine. Hypertension, muscle wasting, and truncal obesity aren't likely to cause severe back pain.

A 23-year-old female client diagnosed with HIV is receiving lamivudine. Which assessment finding would require the nurse to notify the healthcare provider?

Positive urine pregnancy test Explanation: Pregnant clients should not take lamivudine. A client positive for HIV would have a low CD4 count and a positive HIV assay, and the WBC count of 6,000 mm3 is within normal limits.

Which is an appropriate outcome for a client with rheumatoid arthritis?

The client will manage joint pain and fatigue to perform activities of daily living. Explanation: An appropriate outcome for the client with rheumatoid arthritis is that he will adopt self-care behaviors to manage joint pain, stiffness, and fatigue and be able to perform activities of daily living. Range-of-motion (ROM) exercises can help maintain mobility, but it may not be realistic to expect the client to maintain full ROM. Depending on the disease progression, there may be further development of pain and joint deformity, even with appropriate therapy. It is important for the client to understand the importance of taking the prescribed drug therapy even if symptoms have abated.

A client newly diagnosed with multiple sclerosis worries that his employer will fire him now that he has a condition that might interfere with his work. How should the nurse respond?

"Groups like the National Multiple Sclerosis Society (Multiple Sclerosis Society of Canada) can assist with this issue." Explanation: The nurse should refer the client to organizations with appropriate resources, such as the Multiple Sclerosis Society of Canada. She shouldn't assure the client that his physician will help him deal with work-related limitations; the physician isn't adequately qualified to advise the client about his relationship with his employer. By telling the client he doesn't have to tell his employer that he has a chronic illness, the nurse is making a legal determination without benefit of legal consultation; she could be performing duties beyond her scope of practice. The Canadians with Disabilities Act provides valuable protections, but unless the nurse has definite knowledge of the legal issues involved, she should refer the client to specialized organizations that have resources to guide him in this area of need.

A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain?

Hearing Explanation: Prolonged use of aspirin and other salicylates sometimes causes bilateral hearing loss of 30 to 40 decibels. Usually, this adverse effect resolves within 2 weeks after the therapy is discontinued. Aspirin doesn't lead to weight gain, gait problems, or changes in muscle mass.

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

Platelet count, prothrombin time, and partial thromboplastin time Explanation: The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, fibrinogen level, and D-dimer, as well as client history and other assessment factors. Red blood cell count and hemoglobin are not utilized in this diagnosis.

A RN preceptor is assisting a new graduate to access a port-a-cath with a Huber needle. Which action by the new graduate would require intervention by the RN preceptor?

Rotation of the needle immediately after access. Explanation: Accessing a port-a-cath is a sterile procedure which requires a mask and sterile gloves. The needle should be placed at a 90 degree angle and should NOT be rotated as this may damage the port.

When assessing a client with an acute infection, the nurse would expect which laboratory results?

White blood cell count 14,000 cells/mcL (14 X10/L) Explanation: An elevated white blood cell count would support the diagnosis of an acute infection. The serum calcium, thyroxine, and platelet count do not support this finding.

A client is taking large doses of aspirin daily to treat rheumatoid arthritis. The nurse should instruct the client to tell the health care provider (HCP) when having:

tinnitus. Explanation: Tinnitus or ringing in the ears is a sign of aspirin toxicity and should be reported. Clients should be instructed to take aspirin as prescribed and to avoid overdosage. Gastrointestinal symptoms associated with aspirin include nausea, heartburn, and epigastric discomfort caused by gastric irritation. Abdominal cramps, rash, and hypotension are not related to aspirin therapy.

The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client says:

"Ecchymoses are large, purple skin bruises." Explanation: Large, purplish skin lesions caused by hemorrhage are called ecchymoses. Small, flat, red pinpoint lesions are petechiae. Numerous petechiae result in a reddish, bruised appearance called purpura. An abrasion is a wound caused by scraping.

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dl and has vertigo when getting out of bed. The nurse suspects abnormal orthostatic changes. What vital sign values most support the nurse's analysis?

Blood pressure of 80/40 mm Hg and pulse of 130 beats per minute. Explanation: The client had blood loss during the splenectomy and developed subsequent anemia. With a subnormal Hb level and vertigo when getting out of bed, the nurse is accurate in suspecting orthostasis. Orthostatic changes develop from hypovolemia and cause a drop in blood pressure (evidenced by a blood pressure of 80/40 mm Hg) and a compensatory rise in the heart rate (evidenced by a pulse of 130 beats per minute) when the client rises from a lying position.

The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?

Contact the health care provider at first signs of an infection. Explanation: Mofetil is an organ rejection medication that diminishes the body's ability to identify and eliminate pathogens (immunosuppressant). Identifying symptoms of infection at an early state is helpful in treating the infection. This medication is administered on an empty stomach. Typically, capsules would not be opened dispensing medication at one time. Antacids may decrease the absorption of the medication.

The nurse is assessing a client with chronic hepatitis B who is receiving lamivudine. What information is most important to communicate to the health care provider (HCP)?

The client's daily record indicates a 3-kg weight gain over 2 days. Explanation: The fluid weight gain is of concern since the drug should be used with caution with impaired renal function. Dosage adjustment may be needed with renal insufficiency since the drug is excreted in the urine. Nausea, mild temperature elevation, and fatigue are symptoms that should be monitored, but are associated with hepatitis.

When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which physiologic functions?

bleeding tendencies Explanation: Aplastic anemia decreases the bone marrow production of RBCs, white blood cells, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the client's intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.

On the fourth day after surgery, a client's incision is red and inflamed. There is moderate drainage from the incision. The client has a temperature of 102° F (38.9° C). The total white blood count (WBC) 10,000/mm3 (10 × 109/L). The nurse should first:

notify the health care provider (HCP). Explanation: The findings (WBC count above normal; inflammation and drainage at the incision site; and an elevated temperature) indicate the client has an infection. The nurse should first notify the HCP. Encouraging fluids will be helpful, but it is not the first action. The client may have incisional pain, and after the nurse has contacted the HCP, the nurse can determine if the client needs pain management. The nurse should not cleanse the site until the HCP writes a prescription to do so.

The nurse is teaching a client about preventing toxic shock syndrome (TSS). Which action is a risk factor for toxic shock syndrome?

using only tampons at night Explanation: Risk factors for TSS include the use of tampons at night, when the tampon would be in place for 7 to 9 hours. TSS can occur in other situations, but it is commonly associated with women during menses, particularly women who use tampons. The longer the tampon is left in place, the greater the risk for TSS. Changing tampons every 3 hours or more frequently, avoiding use of deodorized tampons, and alternating tampons with sanitary pads are actions that decrease the risk of TSS.

A nurse is caring for several clients on an oncology unit. Which client should the nurse see first?

Client with a white blood cell count of 2000 µL Explanation: A white blood cell count of 2000 µL puts the client at risk for infection. The nurse would want to see this client in order to reduce the transmission of bacteria and other organisms from working with other clients. The client on bed rest can wait and the other clients are stable.

A young adult has been bitten by a human, and the skin on the forearm is broken. The client's last tetanus shot was about 8 years ago. The nurse should prepare the client for:

an injection of tetanus toxoid. Explanation: Tetanus toxoid is indicated, since there has been no booster in the last 5 years. With a human bite there is a risk of severe infection; application of a steroid cream does not prevent infection. The closure of the wound should be delayed until it is determined that there is no infection, in approximately 24 to 48 hours. Tuberculosis is not transmitted through human bites.

A client with iron deficiency anemia is taking iron supplements. The nurse emphasizes to the client that the drug will have increased absorption if taken with:

orange juice. Explanation: Ascorbic acid (vitamin C) increases iron absorption. Taking iron with a food rich in ascorbic acid, such as orange juice, increases absorption. Milk delays iron absorption. It is best to give iron on an empty stomach to increase absorption. Beta-carotene does not affect iron absorption.

A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report symptoms of:

respiratory infection. Explanation: Clients receiving chronic steroid therapy can become immunosuppressed and are prone to infections. Signs of infection can also be masked with prednisone. Signs and symptoms of infection should be reported immediately. Joint pain, constipation, and joint swelling are not related to the adverse effects of steroid therapy.

The parent brings a child to the clinic after discharge from the hospital for Guillain-Barré syndrome. Which statement by the parent indicates that the discharge plan is being followed?

"I take her to the pool where she can exercise with other children." Explanation: Developmentally appropriate activities and therapeutic play should be used as rehabilitation modalities. Taking the child to the pool to exercise with other children indicates that the child is participating in exercise as well as engaging with other children, thus fostering development. Arguing with the sister does not address the discharge plan. Inappropriate rewards or threats should not be used to coerce a child into compliance. Although the mother is attempting to comply with the discharge plan, bribery is an inappropriate technique to foster compliance. Missing therapy sessions delays recovery. The parents need to help set the child's schedule to ensure that she gets adequate rest to be able to follow her treatment plan.

A client with pernicious anemia asks why she must take vitamin B12 injections forever. Which is the nurse's best response?

"The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient amounts of a factor that allows the vitamin to be absorbed." Explanation: Most clients with pernicious anemia have deficient production of intrinsic factor in the stomach. Intrinsic factor attaches to the vitamin in the stomach and forms a complex that allows the vitamin to be absorbed in the small intestine. The stomach is producing enough acid, there is not an excessive excretion of the vitamin, and there is not a rapid production of red blood cells in this condition.

A nurse is caring for a female client who is receiving antibiotics to treat a gram-negative bacterial infection. The client experiences an adverse effect related to the destruction of the normal flora in the GI tract. What finding does the nurse expect to assess?

Diarrhea Explanation: Broad-spectrum antibiotics that destroy aerobic and anaerobic bacteria also destroy the normal flora of the GI tract, which are responsible for absorbing water and certain nutrients (such as vitamin K). Destruction of the GI flora, in turn, leads to diarrhea. Although antibiotics may cause platelet dysfunction, stomatitis, renal dysfunction (indicated by oliguria and dysuria), and liver dysfunction, these adverse effects don't result from destruction of the GI flora. Oral candidiasis and vaginitis are not related to GI flora.

A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption?

Intrinsic factor Explanation: Vitamin B12 absorption depends on intrinsic factor, which is secreted by parietal cells in the stomach. The vitamin binds with intrinsic factor and is absorbed in the ileum. Hydrochloric acid, histamine, and liver enzymes don't influence vitamin B12 absorption.

In addition to teaching regarding medications, what would the nurse include to reinforce health promotion and illness prevention for a client with acquired immunodeficiency syndrome (AIDS)?

Measures to prevent transmission, maintaining optimal nutrition, and exercise Explanation: When a client has been identified as human immunodeficiency virus (HIV) positive, prevention of transmission is an important legal consideration. It is also critical to support of the immune system through proper exercise and nutrition. There is no need for isolation precautions at home. The other choices are not appropriate for health promotion and illness prevention.

A client with acquired immunodeficiency syndrome is receiving zidovudine. Which laboratory value indicates an adverse reaction to zidovudine?

Red blood cell (RBC) count of 1.8 million/μl (1.8 million x 10 to the 12th/L) Explanation: Because anemia (characterized by a decrease in RBCs below 4.0 million/μl) (4.0 million x 10 to the 12th/L) is a major adverse effect of zidovudine, the nurse should monitor the client's RBC count and assess for signs and symptoms of decreased cellular oxygenation. Zidovudine doesn't affect the blood glucose level, serum calcium level, or platelet count and the values listed are within normal limits.

The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. The most appropriate goal for this client is to:

gradually increase activity tolerance. Explanation: The most appropriate goal for this client with hepatitis is to increase activity gradually as tolerated. Periods of alternating rest and activity should be included in the plan of care. There is no evidence that the client is physically immobile, unable to provide self-care, or needs to adapt to new energy levels.

A nurse is monitoring a client who developed facial edema after receiving a medication. What should the nurse do next?

Assess for shortness of breath. Explanation: The client's edema is related to an allergic reaction to the medication. Further assessment of the airway is necessary given the location of edema. After notifying the physician, the medication should be changed and treatment given, based on the assessment findings.

A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching?

"I can eat whatever I want as long as it's low in fat." Explanation: The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client.

A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication?

"I'll call my physician if I have ringing in the ears." Explanation: The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears). Dysuria and constipation are not associated with aspirin use or toxicity. Bleeding is so the client is instructed to take with food.

A client with allergic rhinitis asks the nurse what to do to decrease rhinorrhea. Which instruction would be appropriate for the nurse to give the client?

"Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks." Explanation: It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Nasal decongestant sprays should not be used regularly because they can cause a rebound effect. Antibiotics are not appropriate for allergic rhinitis because an infection is not present. Increasing activity will not control the client's symptoms; in fact, walking outdoors may increase them if the client is allergic to pollen.

Which client is most at risk for developing disseminated intravascular coagulation (DIC)?

A client with an amniotic fluid embolism Explanation: The client with the amniotic fluid embolism is at greatest risk for developing DIC. Other risk factors for developing DIC include trauma, cancer, shock, and sepsis. Possible cocaine overdose, a stage IV pressure ulcer, and heart failure and renal failure aren't risk factors for DIC.

The nurse is teaching the parents of a child with sickle cell disease. To instruct them on how to prevent sickle cell crisis, she should include which instruction?

Drink at least 2 quarts (2.3 liters) of fluids per day. Explanation: Increasing fluid intake and being well hydrated will help prevent cell stasis in the small vessels. Restricting fluids causes stasis of red blood cells and promotes obstruction and increases the chance of sickling with hypoxia and pain to the part that is involved. Clients with sickle cell should avoid exercising in cool temperatures or swimming in cold water. Clients with sickle cell disease should stay away from others who have infections. When the spleen of a client who has sickle cell disease has become fibrotic and nonfunctional, the client is more susceptible to infections. Clients with sickle cell disease should not avoid physical activity as long as the client stays well hydrated.

The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's disease is present, the histologic examination will reveal which of the following?

Reed-Sternberg cells. Explanation: A definitive diagnosis of Hodgkin's disease is made if Reed-Sternberg cells are found in the histologic examination of the excisional lymph node biopsy. Tay-Sachs disease is an inherited disease carried by an autosomal recessive gene. Sarcoidosis is an inflammatory granulomatous disease. Duchenne's disease is a type of muscular disorder.

The nurse is working in an internal medicine office. A daughter brings her elderly mother to the doctor's appointment. Upon reviewing the medication list, the daughter states, "Which medication is prescribed to prevent a stroke?" The nurse is correct to answer which medication?

Ticlopidine Explanation: Ticlopidine inhibits platelet aggregation by interfering with adenosine diphosphate release in the coagulation cascade and, therefore, is used to prevent thromboembolic stroke. Allopurinol is an antigout medication used to reduce uric acid. Claritin is an over-the-counter allergy medication. Methylprednisolone, a steroid with anticoagulant properties, is not used to treat thromboembolic stroke.

A staff member on the transplant unit is having problems logging into the computer to chart client information. The staff member asks a nurse for her personal identification number (PIN) to log in. What is the nurse's best response?

"I'll be happy to contact Information Services to assist you with the problem." Explanation: By telling the staff member she will contact Information Services, the nurse is providing support and help without disclosing private information. Although telling the staff member that her request is inappropriate maintains confidentiality and security, this response may create interpersonal tension. Sharing a PIN or allowing someone to chart under another person's name may inadvertently put confidential client information at risk.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?

Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification. A serum potassium level of 4.9 mEq/L, a serum sodium level of 135 mEq/L, and a temperature of 99.2° F are normal assessment findings.

Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution?

anaphylactic reaction Explanation: The client who is receiving a blood product requires astute assessment for signs and symptoms of allergic reaction and anaphylaxis, including pruritus (itching), urticaria (hives), facial or glottal edema, and shortness of breath. If such a reaction occurs, the nurse should stop the transfusion immediately, but leave the IV line intact, and notify the health care provider. Usually, an antihistamine such as diphenhydramine hydrochloride) is administered. Epinephrine and corticosteroids may be administered in severe reactions. Fluid balance is not an immediate concern during the blood administration. The administration should not cause pain unless it is extravasating out of the vein, in which case the IV administration should be stopped. Administration of a unit of blood should not affect the level of consciousness.

The nurse is assisting with a bone marrow aspiration and biopsy. Place the tasks in the order in which the nurse should perform them, from highest priority to least priority. All options must be used.

Verify the client has signed an informed consent. Position the client in a side-lying position. Clean the skin with an antiseptic solution. Apply ice to the biopsy site. Explanation: First, before the procedure begins, the nurse must verify that the client understands the procedure and has voluntarily signed a consent form. The nurse should then position the client in a side-lying, or lateral decubitus, position with the affected side up. Then the nurse should clean the skin site and surrounding area with an antiseptic solution, such as povidone-iodine, before the health care provider numbs the site and collects the specimen. When the procedure is finished, the nurse should apply ice to the biopsy site to reduce pain.

A client with acute lymphocytic leukemia is receiving vincristine. Prior to infusing the drug, the nurse administers diphenhydramine. The nurse should inform the client that the expected outcome of using diphenhydramine in this situation is to:

decrease incidence of a reaction to the vincristine. Explanation: Diphenhydramine is an antihistamine. This drug helps reduce the incidence of an allergic response by blocking the release of histamine. Diphenhydramine also possesses anticholinergic effects and can reduce the incidence of nausea and vomiting for clients receiving chemotherapy. Although diphenhydramine may promote sleep, it is not the primary reason for its administration in this instance. Diphenhydramine will not reduce anxiety or potentiate the action of the vincristine.

When starting the client's intravenous infusion line, the nurse applies a tourniquet and selects the site for inserting the needle. When should the nurse remove the tourniquet?

as soon as the needle is in the vein Explanation: When starting an IV infusion, the nurse should remove the tourniquet as soon as the needle is in the vein. Until then, the tourniquet keeps the vein distended so that it is more visible and easier to enter. Leaving the tourniquet in place longer can impair circulation.

A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement?

"I will need to take an iron supplement even if my laboratory values are normal." Explanation: Sickle cell disease is an autosomal recessive disorder requiring both parents to have a sickle cell trait to pass the disease to a child. Deoxygenated hemoglobin cells assume a sickle shape and obstruct tissues. Tissue obstruction causes hypoxia to the area (vaso-occlusion) and results in pain, called sickle cell crisis. This type of anemia is an inherited disorder; it is not caused by lack of iron in the diet. Iron supplementation is needed only if there is laboratory evidence of iron deficiency anemia. Self-monitoring for any type of infections or sickle cell crisis and increased frequency of antenatal care visits are part of the teaching plan of care.

A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement made by the client about safer sex practices for persons with HIV is accurate?

"A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse." Explanation: A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse. The nurse should caution the client not to have unprotected sex because continued exposure to HIV in a seropositive client may hasten the course of the disease or result in infection with another strain of HIV. Hormonal contraceptives, implants, and injections offer no protection against HIV transmission. Safe sex practices include hugging, petting, mutual masturbation, and protected sexual intercourse. Abstinence is the most effective way to prevent transmission.

The nurse is developing a care plan for a client who has had radiation therapy for Hodgkin's lymphoma. What is the primary goal of care for this client?

Prevent infection. Explanation: The client with Hodgkin's lymphoma who has had radiation therapy is prone to infection; therefore, the primary goal is to prevent infection. The nurse instructs the client to perform frequent hand hygiene, avoid crowded areas, and report a temperature over 100° F (37.7° C). Maintaining fluid balance, exercising, and maintaining mental health are also important, but not the primary goal at this time.

A client is having a blood transfusion reaction. What must the nurse do in order of priority from first to last? All options must be used.

Stop the transfusion. Keep the IV open with normal saline infusion. Notify the health care provider (HCP) and blood bank. Complete the appropriate Transfusion Reaction Form(s). Explanation: When the client is having a blood transfusion reaction, the nurse should first stop the transfusion and then keep the IV open with normal saline infusion. Next, the nurse should notify the health care provider (HCP) and blood bank and then complete the required form(s) regarding the transfusion reaction.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?

maintaining the joints in a flexed position Explanation: 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.

While obtaining a health history, a nurse learns that a client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which medication on hand?

Diphenhydramine Explanation: A client who is allergic to bee stings should keep diphenhydramine on hand because its antihistamine action can prevent a severe allergic reaction. Pseudoephedrine is a decongestant, which is used to treat cold symptoms. Guaifenesin is an expectorant, which is used for coughs. Loperamide is an antidiarrheal agent.

A client with acquired immunodeficiency syndrome is admitted with Pneumocystis carinii pneumonia. During a bath, the client begins to cry and says that most friends and relatives have stopped visiting and calling. What should the nurse do?

Listen and show interest as the client expresses feelings. Explanation: The nurse should listen actively and nonjudgmentally as the client expresses feelings. Telling the client not to worry would provide false reassurance. A psychiatric consultation would be appropriate only after further assessment. Stating that the client's friends aren't true friends would discount the client's feelings.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why did my health care provider not let me try that?" Which response by the nurse would be most appropriate?

"Every person is different. What works for one client may not always be effective for another." Explanation: 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 HCP'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. 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 advanced disease demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client that he or she is not eligible for the drug now is not within the scope of the nurse's practice.

Which instructions should a home care nurse provide for a client with acquired immunodeficiency syndrome (AIDS)?

"Do not share your razor or toothbrush." Explanation: AIDS is transmitted through body fluids such as blood, semen, vaginal and rectal secretions, and breast milk. Tooth brushing and shaving have the potential to cause bleeding; therefore, personal items such as a razor or a toothbrush should not be shared. Casual contact such as touching and hugging is not a means of transmission. Washing eating utensils separately is not necessary, nor is wearing a mask when in crowded places.