MedSurg I: Exam 1 Review

Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.

5. Ans: a, b, c The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.

Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.

ANS: A A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.

An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/μL during chemotherapy is to: a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.

ANS: A Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.

Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia? a. Omelet and whole wheat toast b. Cantaloupe and cottage cheese c. Strawberry and banana fruit plate d. Cornmeal muffin and orange juice

ANS: A Eggs and whole grain breads are high in iron. The other choices are appropriate for other nutritional deficiencies but are not the best choice for a patient with iron-deficiency anemia.

Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.

ANS: A Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be addressed quickly. The other patient findings will also be discussed with the health care provider but are not life threatening.

Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate? a. "I will call my health care provider if my stools turn black." b. "I will take a stool softener if I feel constipated occasionally." c. "I should take the iron with orange juice about an hour before eating." d. "I should increase my fluid and fiber intake while I am taking iron tablets."

ANS: A It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this. The other patient statements are correct.

Which patient should the nurse assign as the roommate for a patient who has aplastic anemia? a. A patient with chronic heart failure b. A patient who has viral pneumonia c. A patient who has right leg cellulitis d. A patient with multiple abdominal drains

ANS: A Patients with aplastic anemia are at risk for infection because of the low white blood cell production associated with this type of anemia, so the nurse should avoid assigning a roommate with any possible infectious process.

The nurse has obtained the health history, physical assessment data, and laboratory results shown in the accompanying figure for a patient admitted with aplastic anemia. Which information is most important to communicate to the health care provider? History: Fatigue, which has increased over last month Frequent constipation Physical Assessment: Conjunctiva pale pink, moist Multiple bruises Clear lung sounds Laboratory Results: Hct 33% WBC 1500/μL Platelets 70,000/μL a. Neutropenia b. Constipation c. Increasing fatigue d. Thrombocytopenia

ANS: A The low white blood cell count indicates that the patient is at high risk for infection and needs immediate actions to diagnose and treat the cause of the leukopenia. The other information may require further assessment or treatment but does not place the patient at immediate risk for complications.

Which statements accurately describe thrombocytopenia (select all that apply)? a. Patients with platelet deficiencies can have internal or external hemorrhage. b. The most common acquired thrombocytopenia is thrombotic thrombocytopenic purpura (TTP). c. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. d. TTP is characterized by decreased platelets, decreased RBCs, and enhanced aggregation of platelets. e. A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physical examination of the patient is ecchymosis.

ANS: A, C, D. Immune thrombocytopenic purpura (ITP) is characterized by increased platelet destruction by the spleen. Thrombotic thrombocytopenic purpura (TTP) has decreased platelets and RBCs with enhanced agglutination of the platelets. Platelet deficiencies lead to superficial site bleeding. ITP is the most common acquired thrombocytopenia. Petechiae, not ecchymosis, is a common

A patient with aplastic anemia has a nursing diagnosis of impaired oral mucous membrane. The etiology of this diagnosis can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. White blood cells (WBCs)

ANS: A, C, E Aplastic anemia may cause an inflamed, painful tongue. The thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding. The leukopenia may lead to stomatitis and oral ulcers and infections. MCV will be normal or slightly increased. Ferritin and coagulation factors are not affected in aplastic anemia.

Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice. d. Clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss. e. A patient who has acute blood loss may have postural hypotension and increased heart rate.

ANS: A, D, E. With rapid blood loss, hypovolemic shock may occur. Clinical manifestations will be more reliable, as they reflect the body's attempt to meet oxygen requirements. As the percentage of blood loss increases, clinical manifestations worsen. Blood transfusions will first be used, then iron, vitamin B12, and folic acid supplements may be used

What is the most important method for identifying the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood and sputum cultures c. Assessing for redness and swelling d. Monitoring white blood cell (WBC) count

ANS: A. An elevated temperature is of most significance in recognizing the presence of an infection in the neutropenic patient because there is no leukocytic response to injury. When the WBC count is depressed, the normal phagocytic mechanisms of infection are impaired and the classic signs of inflammation may not occur. Cultures are indicated if the temperature is elevated but are not used to monitor for infection

When teaching the patient about a new prescription for oral iron supplements, what does the nurse instruct the patient to do? a. Increase fluid and dietary fiber intake b. Take the iron preparations with meals c. Use enteric-coated preparations taken with orange juice d. Report the presence of black stools to the health care provider

ANS: A. Constipation is a common side effect of oral iron supplementation and increased fluids and fiber should be consumed to prevent this effect. Because iron can be bound in the gastrointestinal (GI) tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.

The nurse determines that teaching about pernicious anemia has been effective when the patient says a. "This condition can kill me unless I take injections of the vitamin for the rest of my life." b. "My symptoms can be completely reversed if I take cobalamin (vitamin B12) supplements." c. "If my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "The least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."

ANS: A. Without cobalamin replacement individuals with pernicious anemia will die in 1 to 3 years but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reversed with therapy but long-standing neuromuscular complications might not be reversed. Because pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.

Which patient requires the most rapid assessment and care by the emergency department nurse? a. The patient with hemochromatosis who reports abdominal pain b. The patient with neutropenia who has a temperature of 101.8° F c. The patient with thrombocytopenia who has oozing gums after a tooth extraction d. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours

ANS: B A neutropenic patient with a fever is assumed to have an infection and is at risk for rapidly developing sepsis. Rapid assessment, cultures, and initiation of antibiotic therapy are needed. The other patients also require rapid assessment and care but not as urgently as the neutropenic patient.

After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? a. A 56-yr-old with frequent explosive diarrhea b. A 33-yr-old with a fever of 100.8° F (38.2° C) c. A 66-yr-old who has white pharyngeal lesions d. A 23-yr-old who is complaining of severe fatigue

ANS: B Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock. Rapid assessment and (if prescribed) initiation of antibiotic therapy within 1 hour are needed. The other patients also need to be assessed but do not exhibit symptoms of potentially life-threatening problems.

Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with aplastic anemia? a. Potential complication: seizures b. Potential complication: infection c. Potential complication: neurogenic shock d. Potential complication: pulmonary edema

ANS: B Because the patient with aplastic anemia has pancytopenia, the patient is at risk for infection and bleeding. There is no increased risk for seizures, neurogenic shock, or pulmonary edema.

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider? a. The platelet count is 52,000/μL. b. The patient is difficult to arouse. c. There are purpura on the oral mucosa. d. There are large bruises on the patient's back.

ANS: B Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life threatening and requires immediate action. The other information should be documented and reported but would not be unusual in a patient with thrombocytopenia.

The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the a. Schilling test. b. bilirubin level. c. gastric analysis. d. stool occult blood.

ANS: B Jaundice is caused by the elevation of bilirubin level associated with red blood cell hemolysis. The other tests would not be helpful in monitoring or treating a hemolytic anemia

An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to: a. provide a diet high in vitamin K. b. alternate periods of rest and activity. c. teach the patient how to avoid injury. d. place the patient on protective isolation.

ANS: B Nursing care for patients with anemia should alternate periods of rest and activity to encourage activity without causing undue fatigue. There is no indication that the patient has a bleeding disorder, so a diet high in vitamin K or teaching about how to avoid injury is not needed. Protective isolation might be used for a patient with aplastic anemia, but it is not indicated for hemolytic anemia.

Which action will the admitting nurse include in the care plan for a patient who has neutropenia? a. Avoid intramuscular injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.

ANS: B The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed.

The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)? a. Verify the patient identification (ID) according to hospital policy. b. Obtain the temperature, blood pressure, and pulse before the transfusion. c. Double-check the product numbers on the PRBCs with the patient ID band. d. Monitor the patient for shortness of breath or chest pain during the transfusion.

ANS: B UAP education includes measurement of vital signs. UAP would report the vital signs to the registered nurse (RN). The other actions require more education and a larger scope of practice and should be done by licensed nursing staff members.

What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Nursing management of the patient undergoing treatment for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.

ANS: B. The patient is monitored for infection as leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.

Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. A 44-yr-old with sickle cell anemia who says his eyes always look sort of yellow b. A 23-yr-old with no previous health problems who has a nontender lump in the axilla c. A 50-yr-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. A 19-yr-old with hemophilia who wants to learn to self-administer factor VII replacement

ANS: B. A 23-yr-old with no previous health problems who has a nontender lump in the axilla. The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.

Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure

ANS: B. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the patient with aplastic anemia. The patient will experience fatigue from anemia but bleeding and infection are the major causes of death in aplastic anemia.

A patient with a hemoglobin (Hgb) level of 7.8g/dL (78g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. At this severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold

ANS: B. The patient's hemoglobin (Hgb) level indicates a moderate anemia and at this severity additional findings usually include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hgb level is below 6 g/dL (60 g/L).

A 52-yr-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states, a. "I need to start eating more red meat and liver." b. "I will stop having a glass of wine with dinner." c. "I could choose nasal spray rather than injections of vitamin B12." d. "I will need to take a proton pump inhibitor such as omeprazole (Prilosec)."

ANS: C Because pernicious anemia prevents the absorption of vitamin B12, this patient requires injections or intranasal administration of cobalamin. Alcohol use does not cause cobalamin deficiency. Proton pump inhibitors decrease the absorption of vitamin B12. Eating more foods rich in vitamin B12 is not helpful because the lack of intrinsic factor prevents absorption of the vitamin.

Which of these patients being seen at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a. Patient whose latest CD4+ count is 250/µL b. Patient whose rapid HIV-antibody test is positive c. Patient who has had 10 liquid stools in the last 24 hours d. Patient who has nausea from prescribed antiretroviral drugs

ANS: C The nurse should assess the patient for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock.

A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Give the PRN diphenhydramine . b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Draw blood for a new type and crossmatch.

ANS: C The patient's clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered. A urine specimen is needed if an acute hemolytic reaction is suspected. Diphenhydramine is used for allergic reactions. This type of reaction does not indicate incorrect crossmatching.

Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum

ANS: C, D, F. Iron-deficiency anemia is the most common type of anemia and occurs with chronic blood loss or malabsorption in the duodenum so it may occur with duodenal removal. The other options are associated with cobalamin deficiency.

A patient is admitted to the hospital for evaluation and treatment of thrombocytopenia. Which action is most important for the nurse to implement? a. Taking the temperature every 4 hours to assess for fever b. Maintaining the patient on strict bed rest to prevent injury c. Monitoring the patient for headaches, vertigo, or confusion d. Removing the oral crusting and scabs with a soft brush four times a day

ANS: C. The major complication of thrombocytopenia is hemorrhage and it may occur in any area of the body. Cerebral hemorrhage may be fatal and evaluation of mental status for central nervous system (CNS) alterations to identify CNS bleeding is very important. Fever is not a common finding in thrombocytopenia. Protection from injury to prevent bleeding is an important nursing intervention but strict bed rest is not indicated. Oral care is performed very gently with minimum friction and soft swabs.

A 76-year-old woman has an Hgb of 7.3g/dL (73g/L) and is experiencing ataxia and confusion on admission to the hospital. What is a priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient. c. Keep top bedside rails up and call bell in close reach d. Question the patient about possible causes of anemia

ANS: C. In the older adult, confusion, ataxia, and fatigue are common manifestations of anemia and place the patient at risk for injury. Nursing interventions should include safety precautions to prevent falls and injury when these symptoms are present. The nurse, not the patient's family, is responsible for the patient and although a quiet room may promote rest, it is not as important as protection of the patient.

During the assessment of a patient with cobalamin deficiency, what manifestation would the nurse expect to find in the patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux

ANS: C. Neurologic manifestations of weakness, paresthesiasof the feet and hands, and impaired thought processes are characteristic of cobalamin deficiency and pernicious anemia. Hepatomegaly and jaundice often occur with hemolytic anemia and the patient with cobalamin deficiency often has achlorhydria or decreased stomach acidity and would not experience effects of gastric hyperacidity

A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia b. Vomiting c. Oral ulcers d. Lip swelling

ANS: D Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The nurse should stop the infusion and further assess for anaphylaxis. The other findings may occur with chemotherapy but are not immediately life threatening.

Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy

ANS: D The chemotherapy used in treating Hodgkin's lymphoma results in a high incidence of secondary malignancies; follow-up screening is needed. The fertility of a 55-yr-old woman will not be impacted by chemotherapy. Maintenance chemotherapy is not used for Hodgkin's lymphoma. Pruritus is a clinical manifestation of lymphoma but should not be a concern after treatment.

A 62-year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include? a. an RBC count of 4,500,000/L. b. a hematocrit (Hct) value of 38%. c. normal red blood cell (RBC) indices. d. a hemoglobin (Hgb) of 8.6 g/dL (86 g/L)

ANS: D The patient's clinical manifestations indicate moderate anemia, which is consistent with a Hgb of 6 to 10 g/dL. The other values are all within the range of normal.

The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron-deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia

ANS: D. Because red meats are the primary dietary sources of cobalamin, a strict vegetarian is most at risk for cobalamin deficiency anemia. Meats are also an important source of iron and folic acid but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.

What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High-efficiency particulate air (HEPA) filtration rooms d. Strict hand washing by all persons in contact with the patient

ANS: D. Despite its seeming simplicity, hand washing before, during, and after care of the patient with neutropenia is the major method to prevent transmission of harmful pathogens to the patient. IV antibiotics are administered when febrile episodes occur. Some oral antibiotics may be used prophylactically in some neutropenic patients. High-efficiency particulate air (HEPA) filtration and laminar airflow (LAF) rooms may reduce the number of aerosolized pathogens but they are expensive and LAF use is controversial.

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

Ans: A HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification would the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruit and vegetables d. A diet emphasizing whole and organic foods

Ans: A Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. High-protein, high-calorie, and whole organic foods do not diarrhea.

A patient has been diagnosed with human immunodeficiency virus (HIV) infection. What rationale for taking more than one antiretroviral medication should the nurse give to the patient to improve compliance? A. Viral replication will be inhibited. B. They will decrease CD4+ T cell counts. C. It will prevent interaction with other drugs. D. More than one drug has a better chance of curing HIV.

Ans: A The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases. HIV cannot be cured. CD4+ T-cell counts increase with therapy. There are dangerous interactions with many antiretroviral drugs and other commonly used drugs.

A patient undergoing outpatient chemotherapy reports feeling lonely and isolated and wants to resume normal activities, such as socialization with friends. Which precaution would the nurse recommend for the patient when resuming these activities? a. Avoid crowds of people b. Drink only bottled water c. Refrain from eating outside the home d. Use the bathroom at home, not in public places

Ans: A The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infection, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions.

Transmission of HIV from an infected individual to another most commonly occurs as a result of a. unprotected anal or vaginal sexual intercourse. b. low levels of virus in the blood and high levels of CD4+ T cells. c. transmission from mother to infant during labor and delivery and breastfeeding. d. sharing of drug-using equipment, including needles, syringes, pipes, and straws.

Ans: A Unprotected sexual contact (semen, vaginal secretions, or blood) with a partner infected with human immunodeficiency virus (HIV) is the most common mode of HIV transmission.

To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program. b. Ignore the fatigue as much as possible. c. Do the most stressful activities when fatigue is tolerable. d. Schedule rest periods throughout the day whether fatigue is present or not.

Ans: A Walking programs, or activity the patient enjoys, scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves, stimulate appetite, enhance functional capacity, and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary.

Which diagnostic test allows the health care provider to directly visualize the presence of leukemic cells? a. Blood culture b. Bone marrow biopsy c. MRI d. Wood's lamp examination

Ans: B A bone marrow biopsy provides a sample to determine the presence of leukemic cells. Blood cultures are done to detect the presence of microorganism, such as bacteria or fungi, in the blood. Blood cultures will not detect leukemic cells. An MRI creates a detailed image of the organs and tissues in the body but does not identify specific cell types. A Wood's lamp examination is usually done on the surface of the skin and can detect the presence of bacterial or fungal skin infection.

A patient's laboratory report reveals a hemoglobin (Hgb) level of 11 g/dL. The nurse expects to observe which clinical manifestation? a. Glossitis b. Palpitations c. Dyspnea at rest d. Roaring in the ears

Ans: B An Hgb range of 10 to 12 g/dL indicates mild anemia. Therefore the patient with an Hgb of 11 g/dL may experience palpitations. Glossitis is one of the manifestations of severe anemia in which the patient would have an Hgb level below 6 g/dL. Exertional dyspnea is seen in patients with moderate anemia whose Hgb values range between 6 and 10 g/dL.

A patient with multiple myeloma is sleeping most of the day, has no energy or appetite, and does not seem to care about anything. The patient reports nocturia. Which complication will the nurse suspect? a. Hypokalemia b. Hypercalcemia c. Tumor lysis syndrome d. Spinal cord compression

Ans: B Hypercemia can occur with multiple myeloma.The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, ECG changes, poluria and nocturia, anorexia, nausea, and vomiting. Serum levels of calcium in excess of 12 mg/dL often produce these symptoms, and significant calcium elevations can be life threatening. The symptoms are not indicative of tumor lysis syndrome, spinal cord compression, or hypokalemia.

A nurse was accidently stuck with a needle used on a patient who is infected with human immunodeficiency virus (HIV). After reporting the incident, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager

Ans: B Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed but would not occur first.

The nurse is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count

Ans: C A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? a. teach the patient about the medications available for treatment. b. inform the patient how to protect sexual and needle-sharing partners. c. remind the patient about the need to return for retesting to verify the results. d. ask the patient to notify individuals who have had risky contact with the patient.

Ans: C After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals

Which method will the nurse explain to a patient as being the only definitive way to diagnose cancer? a. Genetic markers b. Radiographic studies c. Pathologic evaluation d. Endoscopic examination

Ans: C Pathologic evaluation are the only definitive method for cancer diagnosis. Genetic markers, radiographic studies, and endoscopic examinations may all be usde in the diagnostic process, but these methods are not definitive for the diagnosis of cancer on their own.

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would the nurse use to increase the patient's caloric intake? a. Increase intake of liquids at mealtime to stimulate the appetite b. Serve three large meals per day plus snacks between each meal c. Add skim milk powder, cheese, honey, or peanut butter to selected foods d. Avoid the use of liquid protein supplements to encourage eating at mealtime.

Ans: C Small, frequent meals of high-protein, high-calorie foods are better tolerated than large meals. The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small, frequent meals are tolerated best. Supplements can be helpful to promote improved nutritional status and so should not be avoided.

A patient undergoing radiotherapy has developed erythema desquamation. Which information would the nurse include when education the patient about skin care in the radiated area? a. Use perfumes and cosmetics on the treatment area as desired b. Wear fabrics such as wool and corduroy to prevent exposure exposure to cold c. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth d. Allow brief periods of direct exposure to sunlight for good bone health

Ans: C The skin should be gently cleansed using a mild soap, tepid water, and a soft cloth. Fabrics such as wool and corduroy should not be worn because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area because they are harsh on skin and can increase the irritation of the skin. The skin should not be exposed to direct sunlight. Protective clothing should be worn if exposure to sun is expected.

A patient was exposed to human immunodeficiency virus (HIV) 2 weeks ago through sharing needles with other substance users. What symptoms will the nurse teach the patient to report that would indicate the patient has developed an acute HIV infection? A. Cough, diarrhea, headaches, blurred vision, muscle fatigue B. Night sweats, fatigue, fever, and persistent generalized lymphadenopathy C. Oropharyngeal candidiasis or thrush, vaginal candidal infection, or oral or genital herpes D. Flu-like symptoms such as fever, sore throat, swollen lymph glands, nausea, or diarrhea

Ans: D Clinical manifestations of an acute infection with HIV include flu-like symptoms between 2 to 4 weeks after exposure. Early chronic HIV infection clinical manifestations are either asymptomatic or include fatigue, headache, low-grade fever, night sweats, and persistent generalized lymphadenopathy. Intermediate chronic HIV infection clinical manifestations include candidal infections, shingles, oral or genital herpes, bacterial infections, Kaposi sarcoma, or oral hairy leukoplakia. Late chronic HIV infection or acquired immunodeficiency syndrome (AIDS) includes opportunistic diseases (infections and cancer).

Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking lamivudine (Epivir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact

Ans: a Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment. Lamivudine alone is not appropriate for treatment in pregnancy. Barrier methods reduce but do not eliminate risk.

Which actions would the nurse take to decrease feelings of isolation in a patient with leukemia who has been admitted for induction therapy? Select all that apply. a. Set aside time to sit with patient b. Determine interests and hobbies c. Arrange for video conference calls d. Provide religious support and prayer e. Allow the patient's young children to visit

Ans: a, b, c Because the patient will be on neutropenic precautions and visitors will be limited, the nurse should set aside time to sit with the patient, as this can alleviate loneliness and provide support. The nurse should also determine the patient's interests and hobbies to plan further activities. The nurse could also contact the information technology department to determine video conference call capability for the patient to be able to keep in contact with friends and families. The nurse can provide support but should arrange for pastoral care to offer religious support and prayer. Young children should refrain from visiting, as the patient's immune system will be compromised and young children can harbor infection.

Which method would the nurse recommend to prevent cancer? Select all that apply. a. Eating a diet high in fiber b. Maintaining a healthy weight c. Participating in regular exercise d. Having an annual complete physical e. Scheduling a colonoscopy upon physician recommendation

Ans: a, b, c Prevention methods for developing cancer include eating a diet high in fiber, maintaining a healthy weight, and participating in regular exercise. Physical examinations and screenings as well as colonoscopies are early detection methods, not prevention methods.

A patient with breast cancer who is receiving chemotherapy has developed alopecia and is noticeably upset. Which recommendations would the nurse make? Select all that apply. a. Shampoo every day b. Use scarves and wigs c. Avoid using hair dryers d. Cut long hair before therapy e. Brush and comb hair frequently

Ans: b, c, d Alopecia refers to loss of hair from the head or the body and is common side effect off cancer treatment. The patient can use scarves and wigs to improve body image. Long hair should be cut before therapy, because it needs more care and is more prone to fall out. Hair dryers should be avoided because their use can worsen alopecia. Shampoos are chemicals that may harm the hair and should not be used daily. Brushing and combing should be done carefully and infrequently because excessive brushing and combing can worsen alopecia.