PN 2: Exam 3 COMBO (End of ch. Q's, Pwpt, JulieYang)

Med Surg 43 4. Atopic individuals have an inherited tendency to hyperproduce what type of antibodies in response to common environmental allergens? 1. IgE 2. Mast cells 3. Histamine 4. Prostaglandin

1 Rationale: Production of IgE levels to specific aller- gens tends to be an inherited trait.

10 A client has been diagnosed with eczema. Which statement made by the client indicates an understanding of its management? 1. "I will avoid excessive use of soap and water and keep my skin well-hydrated with emollients." 2. "I will take daily baths and use strong antibacterial soaps to prevent skin infections." 3. "I will make sure to expose my skin to the sun at least 1 hour a day." 4. "I will wait 3 hours after bathing to apply lotion to my skin."

1

17 A client has just been diagnosed with herpes virus type 2. The nurse should share with the client which item of information? 1. "The initial outbreak of herpes is often the most uncomfortable. Recurrent infections usually present with a tingling and burning sensation prior to outbreak of the vesicle." 2. "Each outbreak of herpes is uncomfortable, with the amount of pain at the genital area worsening each time." 3. "You can only have one outbreak of herpes, so you will never experience another." 4. "You should never experience discomfort with herpes; thus, if you have pain in the genital area, you probably have a sexually transmitted infection."

1

21 A child was admitted to the emergency department with a thermal burn to the right arm and leg. Which assessment by the nurse requires immediate action? 1. Coughing and wheezing 2. Bright red skin with small blisters on the burn sites 3. Thirst 4. Singed hair

1

3 The nurse practitioner documents in a client record that the adolescent has closed comedones. The nurse explains to the client that this means the lesions are what type of skin eruption? 1. Whiteheads 2. Blackheads 3. Pustules 4. Cysts

1

5 A client with contact dermatitis asks the nurse how he could have developed the condition. Which etiology should the nurse include in a response to the client? 1. Allergic reaction mediated by IgE 2. Poor hygiene 3. Reactivation of IgA antibodies 4. Side effect of oral medication

1

8 The client comes to the office for evaluation of a skin rash. What question would the nurse include when obtaining a client history? 1. "Have you ever had a skin rash like this before?" 2. "Do you smoke?" 3. "How long have you had that mole on your left arm?" 4. "Do you have a family history of skin cancer?"

1

Med Surg 57 Which of the following types of insulin can be administered intravenously? 1. Regular 2. Lente 3. Semi-Lente 4. NPH

1 Rationale: Regular insulin can be administered intravenously.

Med Surg 45 3. Dermatological disorders are visually evident; therefore: 1. Lesions are difficult to differentiate without microscopic diagnostic analysis. 2. Lesions are readily identifiable. 3. Lesions must be covered so as not to attract attention. 4. Lesions can often be self-treated with OTC medications.

1 Rationale: A lesion's being visually evident does not necessarily make the etiology readily identifiable.

Med Surg 39 A client has an abnormality of the eye in which both eyes are affected, yet the problem is often more acute in one eye than the other. This is most likely which condition? 1. Cataract 2. Keratoconus 3. Glaucoma 4. Retinal detachment

1 Rationale: Cataract describes the condition asked for in the question.

Med Surg 42 7. Cell-mediated immunity is initiated by: 1. Specific antigen recognition by T cells 2. Nonspecific antigen recognition by B cells 3. Release of complement cells into the blood stream 4. Release of cytokines from white blood cells

1 Rationale: Cell-mediated immunity is initiated by spe- cific antigen recognition by T cells.

Med Surg 40 A client complains of hearing loss in the left ear. On examination with an otoscope the canal is found to be blocked with cerumen. What is the next course of action? 1. Gently irrigate the canal 2. Insert a cotton swab to remove debris 3. Use an ear curette 4. Refer to an otologist for removal

1 Rationale: External ear canals that are blocked by ce- rumen should be gently irrigated. An individual should not place anything into the canal, such as cotton-tipped swabs. Curettes can cause damage to the canal or tympanic membrane and therefore should not be used. It is not necessary to refer a client with cerumen to a specialist.

Med Surg 45 7. Most common dermatological problems encoun- tered by health care professionals are: 1. Tineas 2. Staphylococcal infections 3. Sexually transmitted infections 4. Malignancies

1 Rationale: Fungal infections, also known as tineas, are the most common dermatological problems encoun- tered by health care professionals.

Med Surg 57 Which of the following lab tests offers the best information about glycemic control? 1. HgbA1C 2. Fasting plasma glucose 3. Glucose tolerance test 4. Capillary glucose measurement

1 Rationale: HgbA1C is the lab test that offers the best information about glycemic control.

Med Surg 39 A client has a visual problem that is correct with convex corrective lenses. The problem is most likely what? 1. Hyperopia -far sighted (think oval convex lenses) 2. Myopia- near sighted (think cup-like, concave lenses) 3. Astigmatism 4. Corneal abrasion

1 Rationale: Hyperopia is the condition corrected with convex corrective lens.

Med Surg 39 What is the most common cause of ocular cancer? 1. Melanoma 2. Diabetes mellitus 3. Intracranial pressure problems 4. Hypertension

1 Rationale: Melanoma is the most common cause of ocular cancer.

Med Surg 40 Degrees of hearing impairment are categorized according to sound intensity measurements or decibels. Normal hearing is measured at what range? 1. 0-15 dB 2. 16-25 dB 3. 26-40 dB 4. 41-55 dB

1 Rationale: Normal hearing is measured at 0-15 dB; anything above that range indicates some loss.

Med Surg 43 1. A client has a history of abdominal bloating, cramping, and loose stools and thinks that she has a food allergy. As a nurse, you know: 1. Elimination and challenge diets form the basis for the diagnosis of food allergy. 2. An SPT will help locate the problem. 3. Blood testing will identify the food allergy. 4. Hair sample testing will identify the food allergy.

1 Rationale: The elimination and challenge diet is the cornerstone for treatment of food allergy.

Med Surg 57 What is the primary difference between DKA and HHNS? 1. The absence of ketosis is the distinguishing feature. 2. HHNS has much higher blood glucose levels. 3. DKA has associated hyperkalemia. 4. HHNS is usually a reaction to previous conditions of hypoglycemia.

1 Rationale: The primary difference between DKA and HHNS is the absence of ketosis.

Med Surg 40 Some work environments provide a sustained high noise setting, and protection of employee's hearing is therefore essential. The occupational nurse must follow OSHA guidelines, which include which of the following? (select all that apply) 1. Baseline and annual hearing testing of all workers 2. Monitoring sound levels in the workforce 3. Biannual education and training of noise pollution 4. Mandatory hearing protectors on all employees

1 , 2 Rationale: OSHA recommends that workers are tested on hearing yearly and monitoring sound levels on a regular basis. Training and education is man- dated yearly. It is not necessary for all employees to wear noise protection—only the ones who are exposed to high levels.

Med Surg 57 A client has just been admitted to the emergency department after being found disoriented at the grocery store. His medical alert bracelet indicates that he has type 1 diabetes. Which of the following clinical signs do you anticipate finding upon assessment? Check all that apply. 1. Hyperglycemia 2. Fruity odor of breath 3. Tachycardia 4. Hypertension

1 , 2, 3 Rationale: Clinical manifestations of type 1 diabetes are hyperglycemia, fruity odor of breath, and tachycardia.

Med Surg 40 A client comes into the clinic with gradual onset of hearing loss. What are some ways to improve communication with the client who has a hearing deficit? (select all that apply) 1. Get the client's attention before speaking 2. Stand with the lighting behind you 3. Speak very loudly 4. When asked to repeat, repeat same phase more slowly 5. Keep your hands away from your mouth while talking

1 , 5 Rationale: When communicating with a person who has a hearing deficit speaking loudly or yelling will not help the client and may cause anxiety. The light source should be placed behind the client, not the nurse. When it is placed behind the nurse, the light tends to glare into the client's face, making it diffi- cult to read lips or watch facial expressions. When hav- ing to repeat a word or phase, another phase should be used. Communicate in clear simple words.

2 A client with psoriasis has a follow-up visit with the health care provider. The nurse concludes that the client is receiving first-line therapy after seeing a medical record notation for which treatments? Select all that apply. 1. An emollient 2. Phototherapy 3. Topical corticosteroid 4. Methotrexate 5. Dermabrasion

1,2,3

7 The nurse assesses the client with rheumatoid arthritis for which characteristic joint changes? Select all that apply. 1. Swan-neck deformity 2. Heberden's and Bouchard's nodes 3. Tophi 4. Charcot's joints 5. Ulnar deviation

1,5

1 Which suggestion by the nurse would be most helpful to a human immunodeficiency virus (HIV) positive client who has altered taste perception? 1. Drink plenty of salty broths and other fluids to stimulate taste buds. 2. Try zinc supplementation to improve taste perception. 3. Increase intake of meat to at least one serving per day. 4. Avoid using plastic eating utensils.

2

12 What instructions regarding shampooing the hair would the nurse provide to a client diagnosed with seborrheic dermatitis of the scalp? 1. "Use any brand of shampoo because it does not make a difference in scalp therapy." 2. "Coal tar shampoos are recommended for seborrheic dermatitis of the scalp." 3. "Medicated shampoos are recommended because if not treated successfully, seborrheic dermatitis can cause permanent hair loss." 4. "Daily use of coal tar shampoos will cure seborrheic dermatitis."

2

13 The nurse should include which instruction when teaching a client measures to reduce the risk of developing basal cell carcinoma? 1. Limit the use of tanning beds. 2. Use sunscreen with SPF protection of 15 or higher when in the sun. 3. Limit exposure of the skin to the sun to between the hours of 10 a.m. and 2 p.m. 4. Eat a balanced diet as the most important means of preventing skin cancer.

2

19 The nurse examining the skin of a client notes vascular skin lesions that are flat, bright red in color, with tiny vessels that radiate out from its center. The nurse concludes that the lesions are probably which of the following? 1. Petechiae 2. Spider angiomas 3. Venous stars 4. Port wine stains

2

22 A school-age child develops atopic dermatitis secondary to food allergies. An appropriate nursing diagnosis for this child would be which of the following? 1. Imbalanced Nutrition: Less than Body Requirements 2. Disturbed Body Image 3. Risk for Ineffective Thermoregulation 4. Impaired Tissue Perfusion

2

4 A client diagnosed with scleroderma reports painful fingers that change colors (pale to red) when washing dishes. Which suggestion by the nurse might help the client with this symptom? 1. Increase the water temperature. 2. Use gloves during dishwashing. 3. Start physical therapy to increase blood flow to the hands. 4. Take over-the-counter H2 receptor antagonist medications.

2

6 A client is to start taking prednisone for treatment of rheumatoid arthritis (RA). Which client statement indicates that medication teaching was successful? 1. "I will take the medication on an empty stomach to maximize absorption." 2. "I will take the specific dose ordered at the same time every day." 3. "I will not have to limit my sodium intake." 4. "I will not have to adjust my insulin regimen."

2

6 When explaining the disorder to a client with tinea corporis, the nurse should include which information about this skin disorder? 1. It requires no treatment. 2. It can be passed human to human. 3. It should be exposed to sunlight. 4. It is a malignant skin condition.

2

7 A client with burn injury asks the nurse what the term "full-thickness" means. The nurse should respond that burns classified as full-thickness involve tissue destruction down to which level? 1. Epidermis 2. Subcutaneous tissue 3. Internal organs 4. Dermis

2

9 The nurse is assessing the client's skin and wants to evaluate a site for petechiae. What technique can the nurse perform to complete this assessment? 1. Rub the site and watch for bleeding. 2. Apply pressure to the site to evaluate for blanching of the skin. 3. Look for other lesions that are similar to that lesion. 4. Apply a tourniquet in a limb and watch for the development of petechiae.

2

Med Surg 45 5. Photoaging refers to: 1. The facial age lines, which are evident in close-up photographs 2. The facial age lines caused by prolonged expo- sure to ultraviolet B radiation 3. The patches of discoloration caused by pro- longed use of tanning beds 4. The erythema caused by prolonged exposure to the sun

2 Rationale: Photoaging is the multiple damaging effects the ultraviolet B radiation of the sun has on skin.

Med Surg 45 8. Which of the following is true concerning rosacea? 1. It is a highly contagious, pruritic skin infection caused by a mite. 2. It has an insidious onset, develops between 30 and 50 years of age, affects more women than men, and is more common in fair-skinned persons. 3. It is classified and evaluated by using the PASI method. 4. It is a T cell-mediated inflammatory disease characterized by epidermal hyperplasia

2 Rationale: Rosacea has an insidious onset, develops between 30 and 50 years of age, affects more women than men, and is more common in fair-skinned persons.

Med Surg 40 A client is diagnosed with a sensorineural hearing loss and asks if a hearing aid will help return his hearing to normal. Which statement about hearing aids is correct? 1. Hearing aids help only clients with conductive hearing loss. 2. Hearing aids increase volume but not clarity of sounds. 3. Hearing aids assist clients to hear sounds as normal. 4. Hearing aids eliminate background noises.

2 Rationale: Most hearing aids will increase the volume of sound but will not make it clearer. The hearing aid is an assistive device and will not return the client's hearing to normal.

Med Surg 39 A client is found after an accident with an impaled object in an eye. The nurse remembers to first do what? 1. Place a cup over the impaled object and tape in place 2. Assess the client for priority injuries 3. Pull out the object and observe for bleeding 4. Turn the client on his or her side, to prevent aspiration

2 Rationale: Assessment of the client with an impaled object is the priority.

Med Surg 40 A client complains of difficulty hearing when out to dinner with his family. The type of hearing loss he most likely has is: 1. Conductive hearing loss 2. Sensorineural hearing loss 3. Mixed hearing loss

2 Rationale: Clients with sensorineural hearing loss have difficulty hearing in noisy environments. The client with conductive loss is able to hear in these environments. Mixed would also have difficulty hear- ing in noisy environments.

Med Surg 40 A client complains of frequent attacks of vertigo, tinnitus, nausea, vomiting, and intermittent hearing loss. These manifestations are characteristic of: 1. Presbycusis 2. Meniére's disease 3. Otosclerosis 4. Mastoiditis

2 Rationale: Frequent attacks of vertigo, tinnitus, nau- sea, vomiting, and intermittent hearing loss are classic signs in Meniére's disease. Presbycusis is a degenera- tive hearing loss associated with the aging process and has constant loss. Otosclerosis is also a steady de- crease in hearing related to the formation of spongy bones around the oval window. Mastoiditis is inflam- mation of the mastoid process located behind the ear, and the client does not experience hearing loss.

Med Surg 43 2. A client being treated for anaphylaxis will be given what drug by intramuscular injection? 1. Hydrocortisone 2. Epinephrine 3. Theophylline 4. Captopril

2 Rationale: Intramuscular epinephrine (adrenaline) is the most effective drug in treating anaphylaxis. Epi- nephrine by inhalation is less effective.

Med Surg 39 A client has been rubbing her eye frequently for the past several weeks. Which complication results from the rubbing action? 1. Hyperopia 2. Keratoconus 3. Corneal ulceration 4. Refraction

2 Rationale: Keratoconus is caused by rubbing the eyes profusely. (A condition in which the clear tissue on the front of the eye (cornea) bulges outward.)

Med Surg 42 8. Passive immunity involves: 1. Transfer of antibodies through the heart of the mother to fetus 2. Inoculation with vaccine containing live or killed infectious organisms 3. Development of sensitized lymphocytes within the host body 4. Response of memory cells to entry of an infec- tious organism

2 Rationale: Passive immunity involves inoculation with vaccine containing live or killed infectious organisms.

Med Surg 42 9. Sero-conversion is the presence of antibodies of HIV in the blood and are detected by diagnostic studies within: 1. One to two weeks after exposure to HIV 2. One to three months or more after exposure to HIV 3. One month following the start of antiretroviral drug therapy 4. Six months, when immune-antibody complexes are formed

2 Rationale: Sero-Conversion antibodies to HIV are detached by diagnostic studies within one to three or more after exposure to HIV.

Med Surg 57 Which of the following is true of the dawn phenomena? 1. It manifests itself as morning hypoglycemia. 2. The corresponding hyperglycemia results from predawn release of counter-regulatory hormones. 3. It is best managed by decreasing the administered amounts of insulin. 4. The client is not allowed to take insulin in any form when diagnosed with the dawn phenomena.

2 Rationale: The corresponding hyperglycemia seen in the dawn phenomena results from predawn release of counter-regulatory hormones.

Med Surg 42 3. Early clinical manifestations of GVHD (graft vs. host disease) include: 1. Respiratory problems, for example interstitial pneumonitis 2. Skin rash and pruritus 3. Taut, firm, leather-like skin 4. Dry lacrimal ducts and oral mucosa

2 Rationale: The early clinical manifestations of GVHD are skin rash and pruritus.

Med Surg 57 A client with diabetes has just finished the teaching session on mixing insulins. The nurse knows that more teaching is needed when the client: 1. Injects air into the NPH insulin first followed by injecting air into the regular insulin vial 2. Withdraws too much NPH insulin and injects the extra back into the Lente vial 3. Withdraws too much regular insulin and injects the extra back into the regular insulin vial 4. Uses separate syringes to draw up 5 units of regular insulin and 4 units of NPH

2 Rationale: The nurse knows that more teaching is needed when the client who is mixing insulin with- draws too much NPH insulin and injects the extra back into the Lente vial.

Med Surg 42 6. The reversible form of SLE is due to reaction to drugs that are known to bind with the individual's DNA, such as: 1. Beta blockers, such as Inderal 2. Oral contraceptives, such as Levora 3. Antibiotics, such as tetracycline 4. Antimalarials, such as Plaquenil

2 Rationale: The reversible form of SLE is because of a reaction to drugs, such as oral contraceptives (e.g., Levora).

1 A nurse is teaching a group of young adults about skin lesions. Which item would be appropriate to include in discussions with these clients? Select all that apply. 1. The benefits of suntanning 2. Importance of monthly skin self-inspection 3. Evaluation of skin lesions using the ABCD method 4. Need to seek professional advice regarding lesions 5. Use of sunscreen with an SPF of 8 or higher

2,3,4

14 The client with cellulitis is being discharged from the hospital. What statement should the nurse include in discharge instructions to the client? 1. "If pustules develop, squeeze the lesions gently each day to remove the pus." 2. "If the lesion looks healed, stop taking the antibiotic so you will not develop resistance." 3. "Monitor for signs of infection such as fever, chills, malaise, and redness or tenderness at the site." 4. "Drainage from the site is an expected finding and is no cause for concern."

3

16 The client receives a prescription to treat a skin condition affecting the scalp and neck. The medications prescribed are coal tar shampoo and topical steroids. The nurse concludes that this client has which probable diagnosis? 1. Folliculitis 2. Cellulitis 3. Psoriasis 4. Furuncles

3

2 Which suggestion would the nurse give to a client with human immunodeficiency virus (HIV) infection to best alleviate nausea? 1. Drink liquids with meals. 2. Eat high-fat foods. 3. Eat small, frequent meals. 4. Lie down after eating

3

24 The parents of an 18-month-old with eczema are concerned that a secondary infection that has developed will permanently disfigure their child. How can the nurse best support the parents' feelings? 1. Divert the conversation to another topic. 2. Let them know that they are not being blamed for their feelings. 3. Encourage them to discuss their fears and concerns. 4. Tell them not to worry because scarring is unlikely with eczema.

3

25 The child has just been admitted to the pediatric burn unit. Currently, the child is being evaluated for burns to his chest and upper legs. He complains of thirst and asks for a drink. What is the most appropriate nursing action? 1. Give a small glass of a clear liquid. 2. Give a small glass of a full liquid. 3. Keep the child NPO. 4. Order a pediatric meal tray with extra liquid

3

8 In establishing a plan of care to manage pain for a client with rheumatoid arthritis (RA), what intervention would the nurse use to increase the client's mobility? 1. Have the client work through pain by continuing exercise in order to establish endurance. 2. Have the client use pain medication only when pain is present. 3. Teach the client that both heat and cold applications may help to relieve pain. 4. Teach the client to flex muscle groups when pain is felt in an extremity.

3

9 What information will the nurse include when explaining therapeutic measures to a client taking methotrexate (Rheumatrex) for rheumatoid arthritis (RA)? 1. Relief of symptoms will be assessed for within 1 week of starting medication. 2. Fluids should be restricted to prevent possible edema formation. 3. Drug doses will be adjusted for optimum effect at lowest dose once relief has been established. 4. Six months of therapy will be adequate to stop the disease process from progressing.

3

Med Surg 42 4. Monoclonal antibodies are: 1.B-cell antibodies developed against a foreign antigen 2. Defective T-cell antibodies that do not recognize self tissue 3. Genetically engineered immunosuppressant drugs 4. Used in vaccines to assist in preventing infections

3 Rationale: Monoclonal antibodies are genetically en- gineered immunosuppressant drugs.

Med Surg 45 9. The ABCDEs of melanoma include: 1. Altitude, brownness, circularity, diameter, and evolution 2. Always, be, careful, to diagnose, early 3. Asymmetry, border irregularity, color variation, diameter increase, and elevation 4. Age, black coloration, dryness, and erythema

3 Rationale: All other answers are fabrications.

Med Surg 43 5. Hyposensitization (immunotherapy for a specific allergen) has been proven a benefit in which of the following conditions? 1. Dust mite allergy 2. Peanut allergy 3. Wasp venom hypersensitivity 4. Urticaria

3 Rationale: Bee and wasp stings are the most common causes of anaphylaxis. The risk of hyposensitization is balanced against the much larger risk of being stung again.

Med Surg 43 10. A client is diagnosed with asthma. Which nursing diagnosis would be most appropriate for this patient? 1. High risk for infections 2. Sexual dysfunction 3. Ineffective airway clearance 4. Fluid volume deficit

3 Rationale: Bronchial hyperreactivity is a classic symp- tom of asthma.

Med Surg 42 1. During the early stages of a chronic disease, clients tend to focus on: 1. Medication schedule 2. Interpretation of symptoms 3. Impact of lifestyle changes 4. Understanding the disease process

3 Rationale: Clients tend to focus on lifestyle changes in the early stages of a chronic disease

Med Surg 43 8. Which signs and symptoms would be consistent with a diagnosis of atopic eczema in a 10-month-old infant? 1. Webbing between the fingers and toes 2. Lactose intolerance 3. Dermatitis on face and flexural aspects of arms and legs 4. Swollen eyes

3 Rationale: Dermatitis often appears in this distribu- tion first.

Med Surg 45 2. Commonly, treatments for dermatological dysfunc- tions are: 1. Managed pharmacologically 2. Managed with topical applications 3. Managed by combining topical and systemic therapies 4. Managed by removing the causative agent

3 Rationale: Dermatological dysfunctions are compli- cated and require a multifocused care plan that may include topical and systemic medications, dietary and lifestyle adjustments, and specialized procedures of multidisciplinary team members.

Med Surg 43 7. A client is restless and complains of itching. The client has an IV piggyback running. What first step should you take? 1. Tell him you will get his nurse 2. Take his blood pressure 3. Shut off the IV piggyback and slow the IV to a keep open rate 4. Give him a drink of water and turn on the call light

3 Rationale: Drug reactions are a common source of allergic response. The risk of a drug reaction is greater when the drug is given parenterally, rather than orally.

Med Surg 40 A client who is on high doses of aspirin to treat rheumatoid arthritis suddenly complains of tinnitus and difficulty hearing telephone conversations. The client asks what can be done. The nurse responds by: 1. Performing Rinne and Weber tests 2. Informing the client that tinnitus occurs with aging 3. Instructing the client that tinnitus is a side effect of aspirin 4. Directing the client to increase the volume on the receiver

3 Rationale: High doses of aspirin can cause tinnitus, and the client should report this finding to the health care provider. Tinnitus does not occur with normal aging process. Increasing the sound to drown out the ringing will not solve the problem, because it is most likely caused by the aspirin. Performing a Rinne or Weber test will not detect cause of tinnitus.

Med Surg 39 A client has an eye disorder with inflamed sweat glands that are reddened, swollen, and tender to touch. This is: 1. Uveitis 2. Iritis 3. Hordeolum 4. Conjunctivitis

3 Rationale: Hordeolum is the label for the condition described in the question. Uveitis: An inflammation of the middle layer of the eye (uvea). Conjunctivitis: pink eye

Med Surg 42 5. Hypersensitivity disorders are due to a (an): 1. Immune deficiency disorder, such as HIV 2. Autoimmune disorder, such as RA 3. Heightened immune response to an antigen 4. Desensitization of humoral immune components

3 Rationale: Hypersensitivity disorders are because of a heightened immune response to an antigen.

Med Surg 43 3. A client with a newly diagnosed latex allergy is be- ing discharged from the hospital today. As part of the discharge teaching plan, the client needs to seek immediate medical attention if the following occurs: 1. His medical alert bracelet falls off. 2. He accidentally ingests sunflower seeds. 3. He experiences swelling around the lips or eyes. 4. He feels his heart pounding after strenuous exercise.

3 Rationale: Swelling around the eyes and or mouth (angioedema) is an initial response to latex allergy. The cascade of symptoms can progress rapidly to anaphylaxis.

Med Surg 57 Which of the following is true regarding the autonomic neuropathy conditions associated with diabetic complications? 1. They result in bradycardia and profuse diaphoresis. 2. They are seldom seen in adult-onset diabetic conditions. 3. They lead to bowel and bladder incontinence and delayed gastric emptying. 4. They result in foot ulcers due to a lack of adequate circulation.

3 Rationale: The autonomic neuropathy conditions as- sociated with diabetic complications lead to bowel and bladder incontinence and delayed gastric emptying.

Med Surg 39 A client has blurred vision and states it is better in bright light. In addition, she sees wavy lines on the Amsler grid (diagnostic test). This is most likely which condition? 1. Glaucoma 2. Diabetic retinopathy 3. Age-related macular degeneration 4. Strabismus

3 Rationale: The condition described in the question is age-related macular degeneration.

Med Surg 39 A client has glaucoma, which was determined by testing the pressure within his eye. The diagnostic test revealing the presence of this eye pressure is: 1. Intracranial pressure 2. Ballottement 3. Tonometry 4. Trabeculectomy

3 Rationale: Tonometry is the diagnostic test used to reveal the presence of eye pressure.

Med Surg 57 A client is admitted to the hospital with DKA. The nurse can anticipate which of the following solu- tions will be administered initially intravenously? 1. 5% dextrose in water 2. Ringer's lactate 3. 0.9% NS 4. 5% dextrose in 0.45% NS

3 Rationale: When a client is admitted to the hospital with DKA, the nurse can anticipate that 0.9% NS will be administered.

4 The nurse evaluates that a client understands the clinical management of seborrheic keratosis when he explains the use of which therapy? Select all that apply. 1. Antibiotics 2. Antifungal creams 3. Liquid nitrogen 4. Corticosteroids 5. Electrocautery

3,5

11 A client diagnosed with psoriasis has been prescribed an antihistamine. The client asks the nurse what this is used for because she does not have nasal allergies and congestion. What is the most appropriate response? 1. "Antihistamines are not used for psoriasis and should not have been prescribed." 2. "The insert on the package will tell you what the medication is for." 3. "Let me ask the doctor because I'm not really sure." 4. "Antihistamines are used to help relieve itching associated with the lesions."

4

15 Which of the following is a priority nursing diagnosis for a client experiencing cellulitis of the arm? 1. Disturbed Sleep Pattern related to skin infection 2. Social Isolation related to skin infection 3. Powerlessness related to inability to control the infection 4. Pain related to skin infection of cellulitis

4

18 A client presents for removal of a skin lesion after it is determined that he meets all four criteria for removal according to the ABCD rule. The nurse interprets this to mean which of the following? 1. The lesion is symmetrical, with a smooth border, a single color, and the diameter has stayed the same. 2. The lesion is symmetrical with an irregular border, a single color, and the diameter has increased. 3. The lesion is asymmetrical with a regular border, two colors, and the diameter is smaller. 4. The lesion is asymmetrical with an irregular border, two colors, and has increased in diameter.

4

23 An infant has a positive family history of allergies. To reduce the risk of the infant developing eczema, the nurse teaches the family to do which of the following? 1. Avoid synthetic clothing—use natural fibers like cotton and wool. 2. Keep up with the schedule of childhood immunizations. 3. Avoid contact with infected personnel. 4. Introduce only one new food a week so food allergies can be recognized and eliminated.

4

3 To enhance meeting the psychosocial needs of a client on transmission-based precautions, the nurse should place highest priority on which of the following? 1. Letting the client sleep to build up stamina 2. Maintaining strict precautions when entering and leaving the room so that the client feels he or she is getting the best care 3. Providing client care within a limited time frame to maintain isolation and keep client safe 4. Providing the client with diversional activities to enhance sensory input

4

5 The white blood cell (WBC) count of a client with systemic lupus erythematosus (SLE) shows a shift to the left. Which nursing diagnosis reflects the highest priority for this client? 1. Ineffective Health Maintenance 2. Impaired Skin Integrity 3. Ineffective Individual Coping 4. Ineffective Protection

4

Med Surg 40 A client who has conductive hearing loss will have the following characteristics: 1. Hearing loss associated with higher pitch tones. 2. Sound perceived as distorted. 3. Louder speech to hear better. 4. Conversation can be heard in noisy environments.

4 Rationale: Clients with conductive hearing loss have difficulty hearing all pitches and therefore are able to hear in noisy environments, talk softer because they hear their voices as louder, and their speech is clear not distorted.

Med Surg 57 What are clinical manifestations of hypoglycemia? 1. Severe abdominal pain, accompanied by nausea 2. Cardiac arrhythmias 3. Neurological responses of the parasympathetic nervous system 4. Irritability, increasing confusion, tremors, hunger, sweating, weakness, and visual disturbances

4 Rationale: Clinical manifestations of hypoglycemia are irritability, increasing confusion, tremors, hunger, sweating, weakness, and visual disturbances.

Med Surg 40 The nurse is taking care of a client who just underwent a tympanoplasty. Which of the following interventions is appropriate? 1. Place the client lying on his or her operative side. 2. Encourage deep breathing and coughing. 3. Tell the client that hearing will return to normal immediately. 4. Assist the client with ambulation until vertigo is resolved.

4 Rationale: Commonly clients experience some vertigo after surgery and therefore need assistance with am- bulation. The client should lie on the unoperated ear; coughing can cause postoperative complications and should be discouraged. The client cannot be ensured that his or her hearing will be normal after the operation.

Med Surg 45 6. Which of the following is true concerning contact dermatitis? 1. It is an infection of the skin characterized by redness, heat, pain, and swelling. 2. It is usually diagnosed by biopsy. 3. It is an acute inflammation of the hair follicle. 4. It is treated by identifying the sensitizing sub- stance and controlling the symptoms.

4 Rationale: Contact dermatitis is treated upon identifi- cation of the sensitizing substance and controlling the symptoms.

Med Surg 42 10. Criteria used to diagnose AIDS in an individual with HIV include at least one of the following conditions: 1. CD4+ cell count above 200 cells/L 2. Anemia due to diminished RBC count 3. Dysfunction of one or more organs 4. Development of an opportunistic cancer

4 Rationale: Criteria used to diagnose AIDS in an indi- vidual with HIV includes development of an opportu- nistic cancer.

Med Surg 39 A client has an inflammation of the cornea and conjunctiva known as keratoconjunctivitis sicca or dry eye syndrome. Which is not an appropriate nursing intervention for this condition? 1. Make a conscious effort to blink more frequently 2. Avoid rubbing the eyes 3. Inform the client that high altitude, dry, or winter climates may make the condition worse 4. Decrease daily intake of water

4 Rationale: Decreasing daily intake of water is not an appropriate nursing intervention for keratoconjuncti- vitis sicca.

Med Surg 45 10. Pruritus: 1. Is one of the most common dermatological diseases 2. Is usually a sign that healing is underway 3. Should alert the health care provider to change the wound dressing 4. Can accompany malignant dermatological conditions

4 Rationale: Pruritus is a symptom, not a disease and can accompany both healing and infection.

Med Surg 43 6. A client with an immediate type 1 hypersensitivity will respond to a SPT with the appropriate antigen by: 1. A wheal and flare response immediately 2. A wheal and flare response 48 hours later 3. An increased susceptibility to herpes zoster 4. A wheal and flare response within 5 to 10 minutes

4 Rationale: The "wheal and flare" skin reaction is visi- ble within 5 to 10 minutes in a positive response to an allergen.

Med Surg 45 1. The fundamental principles of wound healing and skin repair include (select all that apply): 1. Clean the wound with an antibacterial substance, protect it with a dressing 2. Clean the wound with an antiseptic substance, cover it with a sterile dressing 3. Clean the wound with an antiseptic substance, leave it open to the air to heal 4. Clean the wound, remove devitalized tissue, and apply moist sterile dressings

4 Rationale: The appropriate cleansing agent is depen- dent on the underlying etiology of the problem. Ne- crotic or devitalized tissue left in the wound will impede healing. A moist wound environment must be provided and maintained for healing to take place.

Med Surg 42 2. The goal of HAART is to: 1. Minimize side affects of the drugs 2. Encourage client compliance to the medication schedule 3. Lower the CD4 cell levels 4. Avoid viral resistance for each drug

4 Rationale: The goal of HAART is to avoid viral resis- tance for each drug.

Med Surg 57 Diabetes is a chronic condition that requires effective long-term management. This management includes: 1. Initial treatment of all types of diabetes with dietary modifications for a three-month time period 2. Initial treatment of all diabetics with insulin administration to prevent complications 3. Initial treatment of all diabetics with an oral glucose lowering agent and an exercise program 4. Use of a glucose lowering agent, diet, and activity

4 Rationale: The long term management of diabetes includes the use of a glucose lowering agent, diet, and activity

Med Surg 43 9. Severe reactions to penicillin are more likely to happen when the medication is given by what route? 1. Oral 2. Intramuscular 3. Through a nebulizer 4. Parenteral (iv)

4 Rationale: The parental route gives a larger dose in a shorter period of time.

Med Surg 45 4. The etiology of dermatological dysfunctions may be: 1. Bacterial, chemical, or endocrine 2. Bacterial, viral, or fungal 3. Allergenic, vascular, or genetic 4. All of the above

4 Rationale: There are multiple etiologies for dermato- logical dysfunctions and all of the possible answers are among them.

WEEK 6 PPT question The nurse is caring for a patient who is receiving antiretroviral therapy (ART) for treatment of AIDS. Which assessment best indicates that the patient's condition is improving? A) Decreased viral load B) Increased drug resistance C) Decreased CD4+ T-cell count D) Increased aminotransferase levels

A

WEEK 6 PPT question The nurse working in an HIV testing and treatment clinic plans teaching about antiretroviral therapy for a A) patient who tested positive for HIV 3 years ago and has developed tuberculosis. B) male health care worker who is HIV negative but has unprotected sex with men. C) patient who was infected with HIV 10 years ago and has a CD4+ T-cell count of 650/μL. D) patient with persistent generalized lymphadenopathy who was exposed to HIV 2 years previously.

Answer: A Rationale: Antiretroviral therapy initiation is recommended for the following patients infected with HIV: history of AIDS-defining illness (such as tuberculosis), CD4+ T-cell count <200 cells/μL or between 200 and 350 cells/μL, pregnant women, persons with HIV-associated nephropathy, and persons co-infected with hepatitis B.

WEEK 6 PPT question The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is A) antibiotics should have been used to prevent pneumonia. B) all of the supplied antibiotics should be taken even when symptoms have resolved. C) enough antibiotics for 2 days' treatment should be reserved in case symptoms recur. D) patients should request antibiotics for upper respiratory infections to prevent development of streptococcal-related diseases.

Answer: B Rationale: To prevent the emergence of antibiotic-resistant organisms, the patient needs to take the entire prescription even if symptoms have resolved. Antibiotics should not be used routinely to prevent bacterial pneumonia.

WEEK 6 PPT question A diagnosis of AIDS can be made for a patient with HIV with A) a CD4+ T-cell count <500/µL. B) a WBC count <3000/µL (3 × 109/L). C) development of oral candidiasis (thrush). D) onset of Pneumocystis jiroveci pneumonia.

D (rationale- AIDs is diagnosed when an individual with HIV infections meets specific criteria including development of PCP; a CD4+T cell count <200; or candidiasis of the bronchi, trachea, lungs or esophagus. Oral candidiasis may occur in intermediate chronic infection and is not a diagnostic criterion for AIDS. WBC count is not a criterion for AIDs dx)

20 A client presents on admission with pressure ulcers extending into the bone. The nurse documents this ulcer at stage ____. Provide a numerical answer. Stage _____

Stage 4