Med-Surge: Immune and Infectious Diseases

A nurse is teaching a client who has HIV about the early manifestations of AIDS. Which of the following statements should the nurse include in the teaching? A. You can expect a persistent fever and swollen glands B. You can expect an elevated WBC count C. You can expect increased blood pressure and edema D. You can expect weight gain

A. You can expect a persistent fever and swollen glands Clients who have AIDS can have a persistent fever, swollen glands, diarrhea, weight loss, and fatigue. These manifestations indicate the onset of AIDS.

A nurse is providing discharge teaching to a client who has HIV. Which of the instructions about infection protection should the nurse include? (Select all that apply.) A. Avoid large gatherings of people B. Clean toothbrush by running through the dishwasher C. Change pet littler boxes with disposable gloves D. Consume fresh fruit and raw vegetables E. Avoid digging in the garden

A, B, E A. Avoid large gatherings of people B. Clean toothbrush by running through the dishwasher E. Avoid digging in the garden - The nurse should instruct the client to avoid large crowds or gathering of people, especially if individuals have been ill or exposed to illness; this can place clients who have HIV at risk of infection. - The client should clean the toothbrush by running it through the dishwasher. If the client does not have a dishwasher, rinsing the toothbrush with bleach followed by hot water is also effective at destroying bacteria on the toothbrush. - The client should avoid digging in the garden because exposure to the dirt, which contains bacteria and organisms, places the client at risk of infection. - C: The client should avoid changing pet litter boxes, which can expose the client to bacteria. - D: The client should avoid fresh fruit and raw vegetables, which contain bacteria. The client should consume only fruits and vegetables that have been cooked thoroughly.

A nurse is planning care for a client who has acute systemic lupus erythematous (SLE) and is scheduled to begin treatment for systemic manifestations. Which of the following types of medications should the nurse plan to administer? A. Corticosteroids B. Antimalarials C. Antidepressants D. Opioids

A. Corticosteroids Corticosteroids such as prednisone are the treatment of choice for systemic manifestations of SLE because of their rapid anti-inflammatory action. - B: Antimalarials such as hydroxychloroquine are prescribed to reduce the risk of skin manifestations in the treatment of the systemic disease process.

A nurse is teaching a female client with a new diagnosis of systemic lupus erythematosus (SLE) about factors that can trigger an exacerbation of SLE. The nurse should determine that the client requires further teaching if she identifies which of the following as an exacerbation factor? A. Exercise B. Pregnancy C. Infection D. Sunlight

A. Exercise SLE is a chronic autoimmune disease that develops when the immune system becomes hyperactive and attacks healthy body tissue. This attack results in generalized inflammation and creates manifestations associated with the specific involved tissues. - Most clients who have SLE can follow an exercise program to increase their cellular aerobic capacity and improve immune function, and the client should follow a program with her provider's assistance. - This client needs additional teaching about the importance of exercise to keep her muscles and joints active. - B: Due to hormonal changes, pregnancy can exacerbate SLE. The nurse should advise the client of the risks. If the client becomes pregnant, she should be monitored closely for renal and cardiovascular effects. - C: Infections, especially streptococcal or viral infections, stress the body and can trigger an exacerbation of SLE. In addition, many clients who have SLE take steroids, placing them at higher risk of infection. - D: Exposure to sunlight and artificial ultraviolet light is the leading cause of SLE exacerbations, especially the characteristic skin lesions and butterfly rash. Clients should use a sunscreen with a high sun protection factor (SPF) and cover their skin with appropriate clothing and hats when exposed to sunlight.

A nurse is providing discharge instructions to a male client who is being treated for genital warts. Which of the following statements indicates that the client understands how to prevent the transmission of this sexually transmitted infection (STI)? A. I will bring my sexual partner for treatment B. Now that I've had my first dose of medicine, I can resume sexual activity C. Once I have been treated, I don't have to use condoms anymore D. Once treatment is complete and I am free of symptoms, I don't have to return to the clinic

A. I will bring my sexual partner for treatment The client should bring his partner to be screened for genital warts and treated. - B: A client who has an STI should abstain from sexual intercourse until lesions are healed to prevent the spread of infection or reinfection. - C: The client should use condoms when resuming sexual activity. - D: After treatment is complete, a follow-up examination and recapture should be performed at least once to confirm a complete cure and to prevent relapse.

A nurse is teaching a client who has Raynaud's disease. Which of the following pieces of information should the nurse include in the teaching? A. Protect against the cold by wearing layers of clothing B. Begin an exercise program of 2-mile walks once per week C. Increase Vitamin A in the diet D. Elevate the hands above heart level when resting

A. Protect against the cold by wearing layers of clothing Clients who have Raynaud's disease are prone to attacks during cold weather. Extreme cold can lead to tissue damage, Therefore, the client needs to be protected with layers of clothing to promote warmth and increase circulation to the extremities.

A nurse is providing discharge teaching to a client who has AIDS about preventing infection while at home. Which of the following instructions should the nurse include in the teaching? A. Wash your genitalia using an antimicrobial soap B. Rinse your dishes with cold water C. Clean your toothbrush once per month D. Incorporate raw fruits and vegetables into your diet

A. Wash your genitalia using an antimicrobial soap The nurse should instruct the client to bathe daily using an antimicrobial soap to prevent the spread of infection. If bathing is not possible, washing the genitalia using an antimicrobial soap is recommended. - B: Dishes should be washed with hot, soapy water. - C: The client's toothbrush should be cleaned once per week by running it through the dishwasher or rinsing it with bleach. - D: The client should avoid raw fruits and vegetables due to the bacteria they carry.

A nurse is caring for a client who is 2 days postoperative. Which of the following findings indicates that the client is developing an infection? A. Temperature of 37.8c (100f) B. Erythema at the incision site C. WBC count 9,000/mm^3 D. Pain reported as 6 on a scale of 0 to 10

B. Erythema at the incision site Redness at the incision site is an initial sign of a wound infection and requires intervention by the nurse. - A: A temperature of 37.8c (100f) is within the expected reference range and does not indicate the client is developing an infection. - C: This WBC count is within the expected reference range and does not indicate the client is developing an infection. The expected reference range for a WBC count is between 5,000 and 10,000/mm^3 - D: A pain level of 6 on a 0 to 10 scale for a client who is 2 days postoperative without any other significant finding does not indicate the development of an infection. The client should be medicated for pain promptly.

A nurse is teaching a client about preventing the transmission of hepatitis A. The nurse should identify that hepatitis A is transmitted by which of the following routes? A. Maternal-fetal B. Fecal-oral contamination C. Genital sexual contact D. Blood to blood

B. Fecal-oral contamination Hepatitis A is most commonly transmitted by the fecal-oral route, usually through ingesting food or liquid that has been infected with the virus. Outbreaks from contaminated food are usually due to poor hygiene practices by food handlers or shellfish sourced from contaminated water. - A: Hepatitis B is transmitted by several routes, including the maternal-fetal route - C: Hepatitis B, C, and D are transmitted by several routes, including unprotected sexual intercourse - D: Hepatitis B and C are transmitted by several routes, including blood-to-blood exposure

A nurse is assessing a client who has systemic scleroderma. Which of the following findings should the nurse expect? A. Excessive salivation B. Finger contractures C. Periorbital edema D. Alopecia

B. Finger contractures - Scleroderma is a chronic disease that can cause thickening, hardening, or tightening of the skin, blood vessels, and internal organs. - There are 2 types of scleroderma: localized scleroderma, which mainly affects the skin, and systemic scleroderma, which can affect internal organs. - Manifestations include skin changes, Raynaud's phenomenon, arthritis, muscle weakness, and dry mucous membranes - With scleroderma, the body produces and deposits too much collagen, causing thickening and hardening. In addition to the client's skin and subcutaneous tissues becoming increasingly hard and rigid, the extremities stiffen and lose mobility. - Contractors develop with advanced systemic scleroderma unless clients follow a regimen of range-of-motion and muscle-strengthening exercises - A: Clients who have systemic scleroderma experience decreased salivation, which increases the risk of dental caries and gum disease. - C: Clients who have scleroderma develop ankle and pedal edema due to the constriction of blood vessels - D: Clients who have scleroderma can lose hair in affected areas; however, alopecia is not a finding associated with systemic scleroderma.

The nurse is caring for a client who is experiencing an acute exacerbation of rheumatoid arthritis. The nurse should anticipate that the client's affected joints will require which of the following treatments? A. An assistive device hen the client is ambulating B. Heat paraffin therapy applies to the client's joints C. Gentle massage of the client's hands D. Active range-of-motion exercises on the client's affected joints

B. Heat paraffin therapy applies to the client's joints The nurse should anticipate the use of heat paraffin to be prescribed as a non-pharmacological intervention. An elevated ESR indicates an acute inflammatory process due to a client's rheumatoid arthritis. The use of the warm paraffin relives the stiffness of the client's joints and provides comfort. - A: Clients who have rheumatoid arthritis do not need assistive devices. An assistive device is only needed when severe loss of range-of-motion occurs. - C: Massage can aggravate inflammation. Most clients have a tendency to rub inflamed, aching joints but should be taught instead to massage over surrounding muscles, not joints. - D: During exacerbations of rheumatoid arthritis, active rang-of-joint motion exercises should not be performed; only passive or isometric exercises are indicated

A nurse is providing discharge teaching to the partner of a client who has AIDS. Which of the following statements by the client's partner indicates a need for further teaching? A. I will dispose of soiled tissues in separate plastic bags B. I'll clean up blood spills immediately with hot water C. I know that hand washing is an important preventative measure D. I will wash soiled clothes in hot water

B. I'll clean up blood spills immediately with hot water The client's partner should clean blood or potentially contaminated body substances with a bleach solution and wear gloves when coming into contact with blood products. - A: The client's partner should use a separate plastic bag to dispose of soiled tissues. Any items that cannot be disposed of in the toilet should be kept in a closed plastic bag until trash disposal. - C: The client's partner should implement measures such as hand washing to prevent the spread of infection. - D: The client's partner should wash soiled clothes in hot water along with 1 cup of bleach.

A nurse is evaluating the injection site of a client who had a Mantoux skin test 48 hr ago. The nurse finds 10 mm of induration with slight redness. Which of the following conclusions should the nurse make? A. The client has active TB B. The client had an exposure to TB C. The nurse must re-evaluate the result in 24 hr D. The test is negative for TB

B. The client had an exposure to TB A Mantoux test is a skin test that determines exposure to TB. The nurse should look at the test site and palpate the area to determine if the injection site is raised and feels hard to the touch (induration). Then, the nurse should record the results in millimeters to represent the size of the raised bump. Redness along does not determine a positive result. - A: To confirm active TB, the client would require additional diagnostic evaluations through a chest X-ray or sputum testing. - C: The nurse should read the results of a Mantoux test 48 to 72 hours after the intradermal injection. False-negative results are more common at 48 hours than at 72 hours; however, a positive result does not require any re-evaluation. - D: An example of a negative result is a reddened, flat area with no induration.

A nurse in a clinic is assessing a client who was diagnosed with mononucleosis 2 weeks ago. Which of the following findings should the nurse report to the provider immediately? A. Headache and fatigue B. Swollen lymph nodes in the neck C. Abdominal pain in the left upper quadrant D. Fever and sore throat

C. Abdominal pain in the left upper quadrant When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding is left upper-quadrant pain, which can indicate an enlarged spleen. - An enlarged spleen can rupture, leading to internal hemorrhaging. - The nurse should encourage the client to refrain from engaging in strenuous activities until the splenomegaly is resolved. - A: A headache and fatigue are expected findings for a client who has mononucleosis and may last for 4 to 6 weeks. Therefore, there is another finding the nurse should report to the provider immediately. - B: Swollen lymph nodes in the neck are expected for a client who has mono. Therefore, there is another finding the nurse should report to the provider immediately. - D: A fever and a sore throat are expected findings for a client who has mono. Therefore, there is another finding the nurse should report to the provider immediately.

A nurse is caring for a client who has systemic lupus erythematosus (SLE) and is concerned about skin lesions on her face and neck. The client asks the nurse, "What should I do about these spots?" Which of the following responses should the nurse give? A. Keep the lesions covered with a light sterile dressing when going outdoors B. Rub lesions with a washcloth to dry after washing C. Apply moisturizer after bathing the lesions with warm water D. Apply antibiotic cream twice per day until scabs form on the lesions

C. Apply moisturizer after bathing the lesions with warm water The nurse should instruct the client to clean, dry, and moisturize the skin using warm (not hot) water and an unscented lotion. - A: The nurse should instruct the client to wear a hat and protective clothing when outside. However, covering SLE lesions with a sterile dressing when outdoors is unnecessary. Most often, the lesions are dry and scaly, not open and draining. - B: The nurse should instruct the client to gently pat the lesions to dry. - D: Topical corticosteroid creams, not antibiotic creams, are indicated for cutaneous manifestations of SLE.

A nurse is teaching a client who has tuberculosis about a new prescription for rifampin. Which of the following statements by the client indicates an understanding of the teaching? A. I should take this medication with food B. I need to take a B-complex vitamin while using this medication C. I can expect this medication to turn my skin orange D. I can expect this medication to make my vision blurry

C. I can expect this medication to turn my skin orange The nurse should instruct the client to expect the skin and urine to turn a reddish-orange color while taking rifampin. - A: The client should take rifampin on an empty stomach - B: The client should take isoniazid with a B-complex vitamin, not rifampin. Isoniazid can deplete the body of this vitamin. - D: Vision changes (e.g. blurry vision, reduced color changes, or a reduced visual field) can be an adverse effect of taking ethambutol.

A nurse in a provider's office is teaching a client with a recent diagnosis of rheumatoid arthritis who has a new prescription for naproxen tablets. Which of the following statements by the client indicates the need for further teaching? A. After taking this medication for 4 weeks, I'll start to notice relief in my joints B. I can take an antacid with this medication for indigestion C. I can take this medication with aspirin D. The naproxen goes down easier when I crush it and put it in applesauce

C. I can take this medication with aspirin The nurse should instruct the client to avoid taking this medication with any other NSAIDs such as aspirin because this can increase the risk of bleeding and gastrointestinal ulceration. - A: The therapeutic effects of naproxen will not be evident until 3 to 4 weeks of taking the medication. - B: NSAIDs such as naproxen can cause serious adverse GI upset (e.g. nausea, vomiting, and indigestion). An antacid is commonly prescribed to take with this medication. - D: Naproxen tablets can be crushed or swallowed whole. Medications that are enteric-coated or have sustained-release properties should not be crushed.

A nurse is providing teaching to a client who has a diagnosis of hepatitis A. Which of the following statements by the client indicates an understanding of the teaching? A. I am unable to donate blood B. I will need to get a booster shot of immune serum globulin every year C. I should stop eating raw clams D. I can develop this disease by getting a tattoo

C. I should stop eating raw clams Hepatitis A is transmitted via the fecal-oral route through consumption of contaminated fruits, vegetables, water, milk, or uncooked shellfish. Individuals who eat raw or steamed shellfish are at an increased risk of acquiring hepatitis A. - A: There is no danger of contracting any form of hepatitis or any blood borne pathogen from the sterile, single-donor blood collection process used at blood banks. - B: Passive immunity to hepatitis A can be conferred for 6 to 7 weeks by the administration of immune serum globulin during the incubation period if the treatment is instituted within 2 weeks of exposure. A booster shot every year is not required. - D: Hepatitis B can be transmitted by shared needles or unclean tattoo equipment. Hepatitis A is transmitted through fecal contamination or contaminated food and water.

A nurse is providing discharge teaching about foot care to a client who has diabetic neuropathy. Which of the following statements by the client demonstrates an understanding of the teaching? A. I can use a heating pad on my feet to keep them warm B. I can go barefoot as long as I stay inside the house C. I will wash my feet daily and apply lotion, except between my toes D. I will trim my toenails every morning by rounding the corners

C. I will wash my feet daily and apply lotion, except between my toes Diabetic neuropathy is a risk factor for amputation of an extremity. The client should inspect the feet daily in order to recognize early injury. The client should also clean the feet daily with mild soap and warm water. Lotion is applied to the feet to prevent drying and cracking. However, lotion should not be applied between the toes, as this can provide a moist environment that favors bacterial growth. - A: A heating pad can place the client at risk of a thermal injury - B: Going barefoot is not recommended due to the inability to feel injury. Protective shoes should be worn by a client who has peripheral neuropathy. - D: A client who has diabetic neuropathy should trim the toenails as needed after a shower or bath when the nail beds are softened. The toenails should be cut evenly, straight across, and following the contour of the toe. Nails that are trimmed down into the corners of the toe put the client at risk of an ingrown toenail, which can lead to infection.

The nurse is assessing a client who has an exacerbation of herpes zoster. Which of the following manifestations of the client's skin should the nurse expect? A. Confluent, honey-colored, crusted lesions B. A large, tender nodule located on a hair follicle C. Unilateral, localized, nodular skin lesions D. A fluid-filled vesicular rash in the genital region

C. Unilateral, localized, nodular skin lesions Herpes zoster, or shingles, results from the reactivation of a dormant varicella virus. It is the acute, unilateral inflammation of the dorsal root ganglion. The infection typically develops in adult and produces localized vesicular lesions confined to a dermatome. It produces localized, nodular skin lesions. - A: Confluent ("gathered together"), honey-colored, crusted lesions are typically associated with impetigo. - B: This describes furuncle or bacterial infection on a hair follicle. - D: This manifestation indicates genital herpes, which is caused by the herpes simplex virus.

A nurse is caring for a client with Clostridium difficile who has contact-isolation precautions in place. Which of the following actions should the nurse perform? A. Instruct visitors to maintain a distance of at least 1 m (3ft) from the client B. Wash hands with antimicrobial soap after leaving the client's room C. Use dedicated equipment for the client D. Keep the doors to the client's room closed at all times

C. Use dedicated equipment for the client The nurse should use dedicated equipment that is left in the room for a client who has contact-isolation precautions in place. - A: The nurse should instruct visitors to maintain a distance of at least 1 m (3ft) from a client who has droplet-isolation precautions, not contact. - B: The nurse should wash hands with antimicrobial soap BEFORE leaving the room. - D: The nurse should keep the doors to the client's room closed at all times when airborne-isolation precautions are in place, not contact.

A nurse is teaching a client who has genital herpes about self-management. Which of the following instructions should the nurse include in the teaching? A. Use an alcohol-based soap to clean lesions B. Wear a condom during sexual activity when lesions are present C. Take a sit bath once per day D. Apply a warm compress to the lesions

D. Apply a warm compress to the lesions The nurse should instruct the client to apply a warm compress to the lesions to relieve discomfort. - A: The nurse should instruct the client to use a mild soap to clean lesions and pat the area dry with a towel. - B: The nurse should instruct the client to avoid sexual activity when lesions are present. - C: The nurse should instruct the client to take 3 to 4 sits baths daily to relieve discomfort.

A nurse is performing a preoperative assessment of a client about to undergo a cholecystectomy. The nurse should identify a risk for a latex allergy when the client reports an allergy to which of the following foods? A. Cabbage B. Oatmeal C. Milk D. Bananas

D. Bananas An allergy to bananas is a risk factor that indicates the client could also be allergic to latex. Other cross-reactive foods include avocados, kiwi, chestnuts, mangoes, pineapple, and passion fruit. The health care team should wear non-latex gloves and use only latex-free supplies when caring for this client.

A nurse is caring for a client who is suspected to have tuberculosis. Which of the following findings should the nurse expect? A. Recent weight gain B. High fever C. Rhinitis D. Blood-streaked sputum

D. Blood-streaked sputum The nurse should expect blood-streaked sputum in a client who has tuberculosis. Sputum cultures are used to diagnose pulmonary TB. - A: The nurse should expect weight loss in a client who has TB. - B: The nurse should expect a low-grade fever in a client who has TB. - C: Rhinitis (inflammation and swelling of the mucous membranes of the nose) is not an expected finding of TB. Common s/s of TB include night sweats, fatigue, and coughing.

A nurse is caring for a client who underwent radioallergosorbent (RAST) testing due to seasonal allergies. The nurse should anticipate an elevation in which of the following immunoglobulin laboratory values? A. IgM B. IgA C. IgG D. IgE

D. IgE RSAT testing involves measuring the quantity of IgE present in serum after exposure to specific antigens selected on a basis of the client's symptom history. An elevated IgE indicates a positive response and is common among clients who have a history of allergic manifestations, anaphylaxis, and asthma. - A: An elevated IgM is associated with a bacterial or viral infection. IgM produces antibodies to protect the body against infections. - B: An elevated IgA is associated with autoimmune diseases and chronic infections. - C: An elevated IgG indicates the production of antibodies to all types of infections, especially blood-borne and tissue infections.

A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings should the nurse expect? A. Nonproductive cough, fever, and shortness of breath B. Lesions on the retina that produce blurred vision C. Onset of progressive dementia D. Reddish-purple skin lesions

D. Reddish-purple skin lesions Kaposi's sarcoma is commonly associated with AIDS and manifests as hyper pigmented multicentric lesions that can be firm, flat, raised, or nodular. Following a biopsy, the lesions are treated with radiation and/or chemotherapy.