Adult Health - Archer Review (8/8) - Infectious Disease, Integumentary, and Reproductive

Choice B is correct. Contraceptive pills do not take effect until seven days after they are started. The nurse should instruct the client to use another form of contraception during the initial seven days that she takes the pills.

A 28-year-old married woman was just prescribed a pack of oral contraceptive pills. The nurse's initial instruction would be: A. "Once you've taken the pills, you are now safe from pregnancy whenever you have sexual contact." B. "You need to use another form of contraception for the next 7 days as these pills will not take effect during the first week." C. "You should take two pills today and take two pills tomorrow." D. "Expect to have breakthrough bleeding. This is because of the increased estrogen levels in your system brought about by the pills."

Choices A, B, C, E, and F are correct. Wild skunks have a high incidence of rabies and should be considered rabid. The patient should receive rabies immune globulin and vaccine. The CDC recommends the irrigation of the wound with povidone-iodine since that solution is virucidal and may help prevent infection. In the clinical judgment of the provider, saline can be safely substituted for povidone-iodine. Debridement of the wound edges may also help to prevent disease by cutting away tissue, clots, and other material in the wound. Any bite wound should be considered potentially infected, so an appropriate antibiotic and tetanus prophylaxis will be administered.

A 30-year-old man comes into the clinic after being bitten by a wild skunk approximately 12 hours ago. The nurse knows that treatment for this client is likely to include: Select all that apply. Rabies immune globulin and vaccine Wound cleansing with povidone-iodine or saline solution and debridement Treatment with an appropriate antibiotic Suturing of the wound Debridement of wound edges Tetanus vaccine prophylactically

Choice C is correct. The patient is experiencing symptoms of Rocky Mountain Spotted Fever (RMSF): fever, chills, headache, and a macular rash that appears on the palms of hands, wrists, soles of feet, and ankles within ten days of exposure. RMSF occurs due to Rickettsia rickettsii bacteria that can be transmitted to humans via the Ixodes tick (deer tick). The patient has been hiking, which puts them at risk for coming into contact with ticks. RMSF is hard to diagnose in the early stages and without treatment can be fatal.

A 35-year-old patient presents to the emergency department complaining of fever, chills, and headaches for the past two days. There is a pink, macular rash on the palms, wrists, and soles of the feet. Which statement by the patient would indicate to the nurse a potential medical emergency? A. "I am allergic to amoxicillin." B. "There have been cases of hand-foot-mouth in the child's daycare recently." C. "I went hiking 2 weeks ago." D. "I switched my laundry detergent last week because of my sensitive skin."

Choice C is correct. The nurse acknowledges the client's emotions and educates the client regarding the situation. False reassurance is not given and client expectations are set. The client's age and the symptoms she has been experiencing over the last few months indicate that she is likely peri-menopausal or post-menopausal. Pregnancy around such an age is unusual.

A 52-year-old client comes to the clinic and tells the nurse: "I can't believe it! I've been having hot flashes the last few months and thought I was going into menopause, but I guess I'm pregnant!" The client then shows her the positive pregnancy test kit. What is the most appropriate response of the nurse? A. "Wow! That's good news! Let's celebrate!" B. "Really? How can that be? You're too old." C. "That sounds exciting, but we will have to confirm with an ultrasound. People undergoing menopause tend to have a false-positive pregnancy test." D. "Let's do another urine pregnancy test and check if it's still positive."

Choice C is correct. Hydrocolloid dressings protect shallow ulcers and promote an appropriate healing environment. Several factors contribute to the formation of pressure ulcers: friction and shearing, immobility, inadequate nutrition, fecal and urinary incontinence, decreased mental status, diminished sensation, excessive body heat, advanced age, and certain chronic conditions. The stage of the pressure ulcer will determine treatment. Nurses should review standing orders from their facility and any additional physician's orders for pressure ulcer care.

A client has a pressure ulcer with a shallow, partial skin thickness, eroded area but no necrotic areas. The nurse would treat the area with which dressing? A. Alginate B. Dry gauze C. Hydrocolloid D. No dressing is indicated

Choice C is correct. This is an incorrect statement and therefore the correct answer to the question. Genetic counseling aims to let people understand that they have no control over inherited traits. Marriages and relationships can suffer because of this unless they are given adequate support.

A couple in a fertility clinic tell the nurse that they are concerned about transmitting a particular disease to their children. The nurse refers them to genetic counseling. All of the following are the purposes of genetic counseling, except: A. Reassure people who are concerned about their children inheriting a particular disorder as well as provide concrete and accurate information. B. Allow people who are affected by inherited disorders to make informed choices about future reproduction. C. Educate the couple on how to prevent their child from acquiring inherited disorders. D. Educate the couple about inherited disorders and the process of inheritance.

Choice B is correct. Lyme disease is a disease that is caused by the bacteria, Borrelia burgdorferi, which is carried by deer ticks. Symptoms of Lyme disease include a localized rash progressing to generalized symptoms. Doxycycline is one of the antibiotics used to treat this infection.

A nurse is caring for a client who has Lyme disease. The nurse should anticipate a prescription for which medication? A. Finasteride B. Doxycycline C. Valacyclovir D. Diphenhydramine

Choice C is correct. Hepatitis C is often asymptomatic and frequently goes unrecognized until the manifestation of chronic liver disease occurs, making detection and testing difficult. Many clients are asymptomatic and do not have jaundice, although some have malaise, anorexia, fatigue, and nonspecific upper abdominal discomfort. Often, the first findings are signs of cirrhosis (e.g., splenomegaly, spider nevi, palmar erythema) or complications of cirrhosis (e.g., ascites, encephalopathy, etc.).

A nurse is educating a client recently diagnosed with hepatitis C. Which of the following should the nurse include in the teaching? A. Disinfect your bathroom with bleach after each use. B. It is important that you not prepare food for others. C. You may not experience any symptoms of hepatitis C. D. It will be important that we vaccinate individuals in your household.

Choice A is correct. Abdominal tenderness, pain, and a "low-grade fever" may be indicative of a uterine infection. The client should report this to their health care provider (HCP) immediately.

A nurse is reviewing discharge instructions for a client nearing discharge after undergoing a dilation and curettage (D&C) procedure for an elective abortion at 14 weeks gestation. As part of the discharge instructions, the nurse instructs the client on complications that would warrant the client to seek medical attention. Which statement, if made by the client, would indicate a need for additional education on this topic? A. "If I have stomach pain, tenderness, and a low-grade fever, I can just take a tablet of acetaminophen, and I will be fine." B. "There will be instances where I will feel a sense of loss." C. "I should anticipate minimal vaginal bleeding for 10 to 14 days." D. "I need to see a doctor if my temperature reaches 100°F or higher."

Choice C is correct. During the initial post-burn period, fluid shifting occurs, causing large amounts of plasma fluid to extravasate into interstitial spaces. Hypovolemia, causing hypoperfusion of burned tissue and sometimes shock, can result from fluid losses due to burns that are deep or that involve large parts of the body surface; whole-body edema from the escape of intravascular volume into the interstitium and cells also develops. Also, insensible fluid losses can be significant. The best intervention to address the fluid loss and prevent the resultant hypovolemic shock is administering intravenous fluids as ordered.

A nurse is taking care of a client with severe burns. Which of the following is the best intervention to prevent shock in this client? A. Administer dopamine as ordered B. Apply medical anti-shock trousers C. Infuse IV fluids as indicated D. Infuse fresh frozen plasma

Choice C is correct. A punch biopsy is usually performed using a circular blade ranging in size from 1 mm to 10 mm. The priority post-procedure concern is to monitor the site for bleeding.

A nurse receives a client who has just returned from a circular skin punch biopsy to confirm a skin cancer diagnosis. The nurse should prioritize observing the site for: A. Dehiscence B. Infection C. Bleeding D. Swelling

Choice A is correct. The client's serum albumin level is low, indicating hypoalbuminemia. The normal range of serum albumin is 3.5-5 g/dL (34-50 g/L). Undernutrition is common among clients with pressure injuries and is a risk factor for delayed healing. Markers of undernutrition include albumin < 3.5 g/dL (< 35 g/L) or weight < 80% of ideal. Here, the client's serum albumin level of 2.5 g/dL(25 g/L) indicates undernutrition, thus placing the client at risk for delayed healing. Following the receipt of this information, some appropriate nursing interventions would include performing client education related to dietary intake, educating the client's family members regarding bringing high-protein foods from home (if allowed by the client's current dietary order) to promote intake, and/or speaking with the client's health care provider (HCP) regarding placing an order for a dietary consultation.

A nurse receives the following laboratory results for a client with severe pressure ulcers. Which of the following lab values should prompt the nurse to intervene? A. Serum albumin level of 2.5 g/dL (25 g/L) B. Serum potassium level of 4 mEq/L (4 mmol/L) C. Serum sodium level of 140 mEq/L (140 mmol/L) D. White blood cell count of 9,000 cells/uL (9x10⁹)

Choice C is correct. Ganglion cysts are common, benign tumors over a tendon sheath or joint capsule. They are typically non-tender unless the tumor puts pressure on a nerve. When on the wrist, they become more noticeable with flexion. A ganglion cyst generally resolves on its own and does not require treatment, but can be drained/removed if causing discomfort.

A patient presents with a round, non-tender nodule on the left wrist that is more pronounced upon flexion. The nurse would recognize this as which of the following conditions? A. Olecranon bursitis B. Bouchard node C. Ganglion cyst D. Pilar cyst

Choice A is correct. For all degrees of partial-thickness-to-full-thickness frostbite, rapid rewarming in a water bath at a temperature range of 37° to 40°C (99° to 102°F) is indicated to thaw the frostbitten region. The nurse should ensure the frostbitten areas (here, the client's hands) should be swirled in the water, not allowing them to touch the sides of the container, as doing so would cause further tissue damage. Analgesia is usually required during this process.

After finishing a shift in the emergency department, a nurse notices a homeless individual outside with frostbite on their hands. The nurse brings the individual into triage and begins treating the frostbitten area by rewarming the client's hands. Which action by the nurse is most appropriate? A. Immerse the affected area in warm water between 37 to 40°C (99 to 104°F). B. Immerse the affected area in heated water between 60 to 70°C (140 to 158°F). C. Remove the blood-filled blisters. D. Apply snug, sterile dressings.

Choice D is correct. Performing and documenting a focused assessment on skin integrity is appropriate since this is a newly identified problem.

Although you were informed that your assigned patient has no special skincare needs, upon your assessment, you observe reddened areas over bony prominences. What action is appropriate? A. Correct the initial assessment form B. Redo the assessment and document current findings C. Conduct and document an emergency assessment D. Perform and document a focused assessment of skin integrity

Choice C is correct. Anthrax is a gram-positive bacterial infection. Following exposure to inhalation anthrax, the client should receive post-exposure prophylaxis, which includes two or more intravenous antibiotics with bactericidal activity and one intravenous antibiotic that inhibits protein synthesis. Ciprofloxacin is a mainstay of anthrax treatment. The client's medical history and route of exposure influence the antibiotic treatment selected.

An emergency department (ED) nurse just received a client exposed to inhalation anthrax. The nurse should anticipate that the ED health care provider (HCP) will prescribe which medication? A. Acyclovir B. Zidovudine C. Ciprofloxacin D. Oseltamivir

Choice D is correct. The exhibit shows inflammation of the nail folds. This disorder is referred to as onychia. Onychia is characterized by inflammation of the nail bed and matrix resulting from either injury or infection.

As you bathe your client and provide foot care, the client's toenails appear as shown in the exhibit. Which condition would you suspect? View Exhibit A. Onychomycosis B. Onychomadesis C. Onychorrhexis D. Onychia

Choice C is correct. Based on the description of the client's nails, the client has clubbing of the fingernails. Clubbing indicates that the client has a pulmonary or cardiac condition resulting in significant hypoxia over a considerable duration of time.

As you bathe your client and provide nail care, you notice that the client's fingertips are enlarged, as the amount of soft tissue beneath the nail beds has increased. Based on this finding, which disorder or disease would you suspect? A. Diabetes B. Iron deficiency anemia C. Hypoxia D. Nail fungus

36%

Based on the client's injuries, the client has sustained a ____ total body surface area burn.

fluid volume deficit

Based on the clinical data, the nurse's immediate concern is the client's risk for infection. thermoregulation. airway patency. fluid volume deficit.

Choices B, C, D, and E are correct. About 25% of Hepatitis B-infected clients develop severe liver disease - liver cancer (choice B) and liver cirrhosis (choice C). Hepatitis B is an infection of the liver caused by the hepatitis B virus. Unfortunately, symptoms may not occur until the liver has been damaged by cirrhosis or liver cancer. The disease is transmissible even when asymptomatic (choice D). The absence of symptoms can also increase the risk of transmission since the infected person may not know they are infected and may not take any safety measures. Hepatitis B is spread through blood or body fluid from an individual with the disease to a person who is not infected. Hepatitis B can also be transmitted from an infected mother to a newborn at birth (choice E).

Choices B, C, D, and E are correct. About 25% of Hepatitis B-infected clients develop severe liver disease - liver cancer (choice B) and liver cirrhosis (choice C). Hepatitis B is an infection of the liver caused by the hepatitis B virus. Unfortunately, symptoms may not occur until the liver has been damaged by cirrhosis or liver cancer. The disease is transmissible even when asymptomatic (choice D). The absence of symptoms can also increase the risk of transmission since the infected person may not know they are infected and may not take any safety measures. Hepatitis B is spread through blood or body fluid from an individual with the disease to a person who is not infected. Hepatitis B can also be transmitted from an infected mother to a newborn at birth (choice E).

Choice B is correct. The skin disorder that is appropriately paired with an independent nursing intervention that can correct or prevent the condition from worsening is "excessive dryness: using limited mild soap for bathing." This intervention can be performed independently of the health care provider (HCP) and does not require a written order; therefore, is classified as an independent nursing intervention. Additionally, using limited mild soap for bathing is an effective intervention for clients with excessive skin dryness.

Select the skin disorder that is appropriately paired with an independent nursing intervention to correct or prevent the condition from worsening. A. Erythema: Applying a topical antiseptic spray B. Excessive dryness: Using limited mild soap for bathing C. Abrasions: Applying an antimicrobial cream D. Hirsutism: Washing the area carefully and gently

Choices A, B, and D are correct. Classic features of Lyme disease include erythema migrans which is a bullseye type appearing rash. Additional features of Lyme disease include myalgias, arthralgias, fatigue, lymphadenopathy, and conjunctivitis.

The nurse is assessing a client with Lyme disease. Which of the following would be an expected finding? Select all that apply. Lymphadenopathy Fatigue Petechial rash Arthralgias Hemoptysis

Choices A, C, D, and E are correct. ABCDE stands for: asymmetry, border, color, diameter, and evolution.

The ABCDEs of melanoma identification include which of the following? Select all that apply. Asymmetry: one half does not match the other half Birthmark: cafe au lait spot that does not fade Color: pigmentation is not uniform Diameter: greater than 6 mm Evolving: any change in size, shape, color, elevation, or any new symptom such as bleeding, itching, or crusting

endometrosis

The client is at highest risk of developing ___

trichomoniasis; wet mount microscopy

The client is demonstrating signs and symptoms of ____ To confirm this diagnosis, the nurse anticipates a physician's order for ____

increase the CD4/CD8 count; lower the viral load

The client should be taught that the overall treatment goal for HIV is to ____ and ___

Choice D is correct. Serum lactic acid levels are a high-yield blood test to determine if a client may have sepsis. This laboratory test, combined with septic manifestations (tachycardia, hypotension, fever (or hypothermia), and leukocytosis), is essential to determine if a client has this life-threatening condition. The normal serum lactate level is less than 2 mmol/L. The higher the level, the worse the acidosis the client is experiencing. Lactic acidosis frequently accompanies severe illnesses and tissue hypoperfusion. If the client has responded favorably to the isotonic fluid bolus given for sepsis (30 mL/kg), the lactic acid level will decline.

The emergency department (ED) nurse is caring for a client admitted with septic shock. After administering prescribed intravenous fluids (IVF), which laboratory test does the nurse anticipate the physician will order to evaluate the IVF's efficacy? A. serum troponin B. serum glucose C. serum white blood cells D. serum lactic acid

Perform a respiratory assessment and inspect the client's nose and mouth Initiate a large-bore peripheral vascular access device Administer prescribed intravenous (IV) fluids Administer prescribed intravenous (IV) pain medication Perform wound care to the affected area(s)

The emergency department (ED) nurse is caring for a client who sustained a partial thickness thermal burns to 18% total body surface area burn (TBSA). The nurse should perform which action? Place the actions in the appropriate order starting with the highest priority action. Press and hold an option to rearrange Administer prescribed intravenous (IV) pain medication Perform wound care to the affected area(s) Administer prescribed intravenous (IV) fluids Perform a respiratory assessment and inspect the client's nose and mouth Initiate a large-bore peripheral vascular access device

Choice D is correct. Inhalation anthrax outbreak is rare and, when it does occur, is regarded as an act of bioterrorism. The nurse must immediately notify hospital administration so an emergency response plan may be activated and public health services can be informed of the outbreak.

The emergency department (ED) nurse is triaging a client who is highly suspected of having inhalation anthrax. The nurse should plan to A. place a surgical mask on the client. B. place the client in a room with negative airflow with an anteroom. C. obtain a urine sample from the client. D. report the situation to the hospital administration.

Choice A is correct. Inhalation anthrax poses a serious threat because the progression of symptoms may be rapid and become life-threatening. Anthrax may cause hypoxia, and continuous pulse oximetry monitoring is essential. This would enable the nurse to determine if the client's condition is deteriorating and may allow the nurse to immediately apply supplemental oxygen.

The emergency department nurse is caring for a client exposed to inhalation anthrax. It would be essential for the nurse to take which action? A. Initiate continuous pulse oximetry B. Obtain a prescription for a chest radiograph C. Notify the public health department D. Prepare the client for a lumbar puncture

Choice C is correct. Luteinizing hormone is the hormone chiefly responsible for the release of an ovum from a woman's ovary.

The fertility nurse is providing education to a woman hoping to become pregnant. This nurse would be most correct in stating that which of the following hormones is chiefly responsible for the release of an ovum from a woman's ovary? A. Estrogen B. Testosterone C. Luteinizing hormone D. Human chorionic gonadotropin

Choices B, D, and E are correct. Anthrax is caused by a bacteria known as Bacillus anthracis. It is spread by inhaling bacterial spores, eating raw or contaminated meats, or through open wounds and scratches on the skin. Anthrax is not spread person to person or animal to person.

The local community health nurse is teaching a course to nursing students on biological terrorism. When discussing anthrax, the nurse should inform their students that this agent is transmitted via: Select all that apply. Mosquito bites Breathing in bacterial spores Sexual contact with an infected person Ingestion of contaminated animal products Through an open wound or scratch on the skin

0.5 mL/kg/hr.

The nurse assesses the urine output and determines whether the client is meeting the treatment goal when it is 0.10 mL/kg/hr. 0.25 mL/kg/hr. 0.4 mL/kg/hr. 0.5 mL/kg/hr.

Choice A is correct. Oil-based lubricants should not be used because they adhere to the mucous membrane for long periods and provide a medium for bacterial growth. Water-soluble lubricants are recommended. This client statement requires follow-up by the nurse. Choice B is correct. Black cohosh has demonstrated efficacy in reducing the vasomotor symptoms of menopause, specifically hot flashes. Black cohosh does not help with osteoporosis, whereas calcium, vitamin D, and weight-bearing exercises help increase bone density. This client statement requires follow-up by the nurse. Choice C is correct. The client should not stop exercising because menopause increases cardiovascular disease risk. In fact, most women who have a myocardial infarction are post-menopausal. Exercise should be encouraged, and exercise does not cause more hot flashes. This client statement requires follow-up by the nurse.

The nurse at a health fair is talking with a client who is in perimenopause. Which of the following client statements requires follow-up by the nurse? Select all that apply. "I am using oil-based vaginal lubricants to lessen the discomfort during intercourse." "My doctor recommended I start taking Black cohosh to help with the loss of bone density" "I stopped exercising to reduce my hot flashes." "I recently started increasing my water intake to help prevent urinary tract infections." "Doing Kegel exercises will increase muscle tone around my vagina and urinary meatus."

Choice C is correct. Trichomoniasis is a protozoan infection primarily spread through sexual contact. The treatment for this infection is metronidazole because of its antibiotic and antiprotozoal properties. This effective treatment may be prescribed in a single dose or over several days.

The nurse cares for a client newly diagnosed with Trichomonas vaginalis. The nurse plans to take which appropriate action? A. Start a 24-hour urine collection B. Initiate contact precautions C. Obtain a prescription for metronidazole D. Contact the local health department

Choice A is correct. Hyperkalemia is an expected finding for a client with a major burn (any full-thickness burn > 10% TBSA). This results from significant cellular damage, which allows intracellular potassium to leak.

The nurse cares for a client who sustained full-thickness thermal burns to 30% of their total body surface area (TBSA). Which of the following initial laboratory values would be expected? A. Potassium 5.6 mEq/L B. Hematocrit 30% C. BUN 14 mg/dL D. Glucose 89 mg/dL

Choice C is correct. An eschar is a slough or dead tissue over the skin's surface, usually after a full-thickness (3rd or 4th degree) circumferential burn injury. Eschar is inelastic and may result in burn-induced compartment syndrome. Once the compartment syndrome develops, pulses distal to the injury may become feeble or absent. Escharotomies are completed to remove eschar, slough, or dead tissue from the skin and relieve compartment syndrome, sometimes after severe burns. An escharotomy is considered successful when pulses distal to the affected site return.

The nurse caring for a client who has received third-degree burns to his arm notes that he is scheduled for an escharotomy. The nurse plans to keep a close eye out for which of the following anticipated outcomes of this procedure? A. Severe bleeding from the site B. Reduced edema C. Return of pulses distal to the site D. The formation of granular tissue

Choices A, C, D, and F are correct. Low socioeconomic status, a history of being a sex worker, illicit drug use, and a previous history of sexually transmitted infections (STIs) are all risk factors for contracting STIs. Other factors include numerous sexual partners and being unmarried. Low socioeconomic status creates inequality in access to healthcare, including education, prevention, and STI screening. If a client engages in indiscriminate sexual activity or has multiple sexual partners, this is a risk factor for an STI. Illicit drug use may cause an individual to engage in risky behavior because of impulsivity and impairment.

The nurse conducts a community health course on sexually transmitted infections (STIs). The nurse recognizes which of the following are risk factors for an STI? Select all that apply. Low socioeconomic status A monogamous relationship A past history of working in the sex industry Illicit drug use History of cancer Previous history of STIs

Choices A, C, D, and E are correct. The copper intrauterine device is non-hormonal; therefore, it does not raise the risk of breast cancer. Unlike depot medroxyprogesterone, the IUD does not cause bone demineralization, so weight-bearing exercises are not a relevant teaching point for this type of contraception (where they would be for depot medroxyprogesterone). An increase in cardiovascular disease is not associated with the copper IUD as it is non-hormonal. The IUD is to be replaced every ten years (US FDA approved duration) - not fifteen.

The nurse counsels a client about a newly inserted copper intrauterine device (IUD) for contraception. It would require follow-up if the client states which of the following? Select all that apply. "This device may raise my risk for breast cancer." "I may continue to have bleeding and cramping." "I should perform weight-bearing exercises." "I will need my device replaced after 15 years." "This device may raise my risk for a stroke."

Choices C and D are correct. Plaque and nodules are palpable, elevated, solid masses that may measure 1 cm.

The nurse documents the presence of a skin lesion as a "palpable solid mass measured at 1 cm." What types of skin lesions might this describe? Select all that apply. Macule Patch Plaque Nodule Bulla Pustule

Choice C is correct. Limiting the duration of indwelling urinary catheter use and promptly removing them when no longer needed is a crucial and evidence-based intervention to prevent catheter-associated infections. Prolonged catheter use increases the risk of infection, so timely removal when appropriate helps reduce this risk.

The nurse has attended a staff education program about indwelling urinary catheter-associated infections (CAUTI). Which nursing intervention is most effective in preventing a CAUTI in hospitalized clients? A. Implementing strict sterile technique during catheter insertion and maintenance. B. Using antibacterial indwelling urinary catheters for all clients requiring urinary catheterization. C. Limiting the duration of indwelling urinary catheter use and promptly removing them when no longer needed. D. Administering prophylactic antibiotics to all clients with indwelling urinary catheters in place.

Choice D is correct. HIV is a retrovirus because of its ability to insert itself into a cell's DNA via its viral RNA. This process causes the CD4/T-cell to be hijacked. HIV infection causes a virion to dock with a CD4/T-cell, which causes it to seize its nucleus. This hijacking alters the cell's DNA by inserting its viral RNA, which DNA then converts by an enzyme reverse transcriptase. This integrative process completes the process, making the CD4/T-cell able to create more HIV viral particles to infect other healthy CD4/T-cells

The nurse has instructed a client newly diagnosed with the human immunodeficiency virus (HIV). Which of the following statements by the client would indicate effective understanding? This disease is caused by a retrovirus leading to A. encapsulation of CD4+ T-cells. B. inflammation of the CD4+ T-cells. C. abnormal proliferation of CD4+ T-cells. D. viral integration into the CD4+ T-cells.

Choices C and D are correct. PrEP (pre-exposure prophylaxis) is helpful to those at risk for HIV to reduce infections. PrEP is highly effective in protecting a person from getting HIV from sex or injection drug use if taken as prescribed before the risky event. Combined antiretroviral therapy (cART) is the drug regimen indicated for HIV and AIDS. Maternal adherence to cART therapy may significantly reduce the risk of transmitting the disease to the fetus.

The nurse has just completed a continuing education lecture regarding the human immunodeficiency virus (HIV). Which of the following statements by the nurse indicate correct understanding? Select all that apply. "I will clean contaminated surfaces with soap and hot water." "The goal of treatment is for the client's viral load to increase and CD4 cells to decrease." "Pre-exposure prophylaxis (PREP) is available to those with risk factors for HIV." "Vertical transmission (mother to fetus) may be reduced with the use of antiretrovirals." "It is possible to spread the infection through contaminated water."

Choice B is correct. Clients should be discouraged from using over-the-counter topical glucocorticoids on their faces because these creams may cause permanent hypopigmentation and thinning of the skin. If a topical corticosteroid must be applied to the face, it is usually a low-dose formulation for less than two weeks.

The nurse has received a prescription for a high-potency topical corticosteroid lotion. The nurse should instruct the client to avoid applying the lotion to the client's A. feet. B. face. C. outer thigh. D. abdomen.

Choice D is correct. A second method of birth control is necessary until the sperm count is zero. A follow-up semen assessment to ensure no sperm is present is typically performed within eight to twelve weeks after this procedure. Until the client is informed that the count is zero, a birth control method should be utilized, as pregnancy may still be possible.

The nurse has taught a client scheduled for a vasectomy. Which of the following statements by the client would indicate a correct understanding of the teaching? A. "This surgery is easily reversible." B. "This procedure could increase my risk for prostate cancer." C. "I won't be able to have this surgery because I have erectile dysfunction." D. "I will need to use another type of birth control until my sperm count is zero."

Choice C is correct. Ebola virus disease is endemic in certain regions of West Africa. Travel to these areas, especially during an outbreak, increases the risk of exposure to the virus. The manifestations of ebola include conjunctival injection (injection; not infection), fever, rash, vomiting, and blood in their stool. This information makes it reasonable to raise the suspicion that this client may have EVD.

The nurse in the emergency department (ED) is triaging a client who reports recent international travel to West Africa and has signs and symptoms of conjunctival injection, fever, rash, vomiting, and blood in their stool. The nurse is concerned that this client may have A. pulmonary tuberculosis. B. encephalitis. C. Ebola virus disease. D. inhalation anthrax.

Choice C is correct. Contact special enteric is the appropriate precaution for Clostridium difficile. Clostridium spores are transmitted by direct contact but are not killed with an alcohol-based hand sanitizer. Handwashing with soap and water is required after exiting a room under special enteric precautions.

The nurse is admitting a client for treatment of C. difficile. Which sign should the nurse affix to the client's door?

Choices A and D are correct. Bacterial meningitis manifests as a stiff neck, photophobia, fever, altered mental status, and malaise. The nurse would need to perform an oral temperature and the Glasgow Coma Scale to discern the client's current mental status.

The nurse is assessing a client for bacterial meningitis. Which of the following assessments should the nurse perform? Select all that apply. Oral temperature Patellar reflexes Weber and Rinne tests Glasgow Coma Scale Orthostatic blood pressure

Choice C is correct. Syphilis is a sexually transmitted infection caused by T. pallidum. This insidious infection causes a client to experience a painless chancre in the area where the infection was contracted. That could be the penis, vagina, or rectum. This chancre lesion will eventually disappear and cause constitutional symptoms such as a generalized macular rash and malaise.

The nurse is assessing a female client with syphilis. Which of the following would be an expected finding? A. Dysuria B. Vaginal discharge C. Chancre lesion D. Dyspareunia

Choice D is correct. An RPR is a common screening test for syphilis infections. This test is often confirmed with a fluorescent treponemal antibody absorption (FTA-ABS) test.

The nurse is caring for a client at the first prenatal visit. The primary healthcare provider (PHCP) has prescribed testing for syphilis. The nurse anticipates which laboratory testing? A. Brain Natriuretic Peptide (BNP) B. Comprehensive Metabolic Panel (CMP) C. Complete Blood Count (CBC) D. Rapid Plasma Reagin (RPR)

Choice D is correct. The client states that she is sleeping more and eating less, which are two depressive symptoms that signify ineffective coping and warrant follow-up.

The nurse is caring for a client recently diagnosed with ovarian cancer. Which of the following statements, if made by the client, would indicate ineffective coping? A. "I joined a local community support group." B. "I am unsure of my overall prognosis." C. "The radiation I receive has made intercourse difficult." D. "I find myself sleeping more and eating less."

Choice A is correct. Depot medroxyprogesterone acetate is an injection that provides contraception for 13 weeks. The client should return for another injection at 13-week intervals - not 8 weeks.

The nurse is caring for a client who has been prescribed depot medroxyprogesterone acetate. Which of the following statements, if made by the client, requires follow-up? A. "I will need another injection in 8 weeks." B. "I may gain weight while on this medication." C. "I can expect increased vaginal bleeding." D. "I should increase my weight-bearing exercises."

Choices A and C are correct. Stage II pressure ulcers occur when the epidermis and a part of the dermis are lost (choice A). Stage III pressure ulcers expose subcutaneous fat but do not extend deep enough to expose the bone and muscle (choice C).

The nurse is caring for a client who is at risk of developing pressure ulcers. Which of the following would the nurse recognize as accurate statements regarding pressure ulcers? Select all that apply. In a stage II pressure ulcer, part of the dermis and epidermis are lost. In a stage I pressure ulcer, there is a loss of integrity of the epidermis only. In a stage III pressure ulcer, there is a deep tissue injury that can expose fat. In a stage IV pressure ulcer, the base of the wound is covered by eschar. Stage III involves extensive tissue damage and can lead to bone and muscle involvement

Choice D is correct. The treatment of burns is separated into three phases: resuscitative (emergent), acute, and rehabilitative. The goals of the resuscitative (emergent) phase are to maintain airway patency, provide pain control, and initiate parenteral fluids to restore and maintain hemodynamic stability. This stage is critical because insults to the airway may cause problems with both gas exchange and perfusion. This, coupled with severe fluid loss, makes treatment quite complicated.

The nurse is caring for a client who sustained 18% full-thickness burns. The nurse understands that the treatment goal during the acute emergent (resuscitation) phase is to A. collaborate with occupational and physical therapy. B. provide outpatient referrals. C. administer parenteral nutritional replacement. D. initiate intravenous (IV) fluids.

This client sustained a 45% TBSA burn ➢ Anterior torso, 18% ➢ Entire back, 18% ➢ Bilateral anterior arms, 4.5% each x 2 = 9% 45%

The nurse is caring for a client who sustained a full-thickness burn to his anterior torso, back, and bilateral anterior arms. Using the rule of nine's, calculate the total body surface area (TBSA) burned. Fill in the blank. _____%

Choice A is correct. Electrical burns are serious and require the client to undergo cardiac monitoring because of the risk of dysrhythmias. The nurse's priority action is to obtain telemetry monitoring or perform a 12-lead electrocardiogram.

The nurse is caring for a client who sustained an electrical burn. The nurse should take which priority action? A. Perform an electrocardiogram (ECG) B. Obtain an order for an arterial blood gas (ABG) C. Gather supplies for wound care D. Initiate supplemental oxygen

Choice A is correct. Electrical burns are serious and require the client to undergo cardiac monitoring because of the risk of dysrhythmias. The nurse's priority action is to obtain telemetry monitoring or perform a 12-lead electrocardiogram.

The nurse is caring for a client who sustained an electrical burn. Which priority action should the nurse take? A. Obtain an electrocardiogram (ECG) B. Obtain an order for an arterial blood gas (ABG) C. Perform wound care D. Initiate supplemental oxygen

Choice A is correct. When caring for a client with a significant thermal burn (greater than 10% TBSA), the priority is assessing respiratory status. Smoke inhalation injuries and carbon monoxide poisoning are immediate concerns that must be addressed.

The nurse is caring for a client who sustained full-thickness burns to their entire torso and back. The nurse plans to take which priority action? A. Assess the client's respiratory status B. Prepare an infusion of lactated ringers C. Insert an indwelling urinary catheter D. Obtain an accurate weight

Choices A, B, and D are correct. All of these client statements are false and indicate a knowledge deficit. The nurse should correct the client and remind them they have HIV - not AIDS. AIDS is when the client is HIV positive and has either a CD4+ T-cell count of fewer than 200 cells/mm 3 (0.2 × 10 9 /L) or less than 14% (even if the total CD4+ count is above 200 cells/mm 3 [0.2 × 10 9 /L]) or an opportunistic infection. HIV and AIDS is not transmitted through household utensils, towels, or toilets. The client will be able to continue their job as a phlebotomist because standard precautions are utilized, which will inhibit the transmission of HIV. The client will not have to take any additional precautions.

The nurse is caring for a client who was recently diagnosed with human immunodeficiency virus (HIV). Which of the following statements, if made by the client, would indicate a knowledge deficit? Select all that apply. "I started researching ways to tell my family that I have AIDS." "I recently stopped sharing household utensils and towels." "I will need periodic blood tests to measure the amount of virus." "I will not be able to continue my job as a phlebotomist." "If I achieve undetectable viral load status, I won't be able to transmit the virus to others."

Choice D is correct. You should recognize that the use of this defense mechanism of denial is useful and constructive for the client at this time because this denial protects the client from an extreme stressor until the client can cope with it.

The nurse is caring for a client who, upon receiving a diagnosis of human immunodeficiency virus (HIV), is exhibiting the defense mechanism of denial by insisting that the diagnosis must be a mistake. In this situation, the nurse should: A. Know that all reasonable clients should know that mistakes like this are rarely made in healthcare. B. Tell the client that this is not a mistake and that the client must accept this diagnosis as accurate. C. Recognize the fact that this denial of the diagnosis is not rational or adaptive for the client. D. Recognize that the use of this defense mechanism is useful and constructive for the client at this time.

Choices B, D, and F are correct. Acquired Immunodeficiency Syndrome is the final stage of untreated chronic HIV infection. AIDS ensues due to progressive depletion of CD4 T-lymphocytes. AIDS is defined by the presence of any AIDS-defining conditionor a CD4 cell count < 200cells/microliter. Kaposi's sarcoma, mycobacterium tuberculosis, toxoplasma gondii, mycobacterium avium complex, herpes simplex, histoplasmosis, cryptococcosis, cytomegalovirus retinitis, and salmonella septicemia are some of the AIDS-defining opportunistic illnesses. Opportunistic illnesses are often opportunistic infections (OIs) but may also include malignancies such as invasive cervical cancer and Kaposi sarcoma. OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. OIs are caused by a variety of pathogens (viruses, bacteria, fungi, and parasites). HIV associated Kaposi's sarcoma is one of the AIDS defining opportunistic condition and is caused by Kaposi Sarcoma Associated Herpes Virus, also known as human herpesvirus 8 (HHV8). For people with HIV, the best protection against progressing to AIDS and OIs is to adhere to HIV medica

The nurse is caring for a client with Human Immunodeficiency Virus ( HIV). Which of the following conditions, if present in the client, should make the nurse concerned about Acquired Immunodeficiency Syndrome ( AIDS)? Select all that apply. Chronic, progressive visual loss Kaposi's sarcoma Wilms sarcoma Tuberculosis Peripheral neuropathy Toxoplasma gondii

Choices B, C, D, and E are correct. Following a major burn, significant fluid and electrolyte changes occur from cellular damage, which causes potassium to leak into the extracellular space. Thus, life-threatening hyperkalemia may occur. Metabolic acidosis is likely because of the impairment the burn causes to the kidney's ability to recycle bicarbonate. The discharge of catecholamines causes glucose release from the liver, raising the blood glucose. Finally, the loss of fluid causes hemoconcentration, illustrated by elevated hematocrit.

The nurse is caring for a client with a major thermal burn. Which initial laboratory abnormalities does the nurse anticipate in response to the burn? Select all that apply. Hemodilution Hyperkalemia Metabolic Acidosis Hyperglycemia Hemoconcentration

Choices B and C are correct. The nurse should immediately cleanse the area after urine and bowel incontinence with a solution that has a pH between 4.0 and 6.8. The solution should not have any alcohol or fragrances that could irritate the dermatitis. Zinc oxide should be applied once the affected area is cleansed because of its moisture-wicking effects. Incontinence pads are recommended over a brief because they allow aeration of the site and prevent encapsulating moisture against the client's skin.

The nurse is caring for a client with incontinence-associated dermatitis. The nurse should take which action? Select all that apply. Cleanse the affected area with isopropyl alcohol Apply zinc oxide to the affected area Use an incontinence pad instead of a brief Applying an extra incontinence brief to encapsulate the moisture Apply a transparent dressing to the affected area

Choice B is correct. Although rewarming should not be delayed, rewarming should be performed slowly while closely monitoring cardiac rhythm, as hypothermic clients are especially susceptible to the development of cardiac arrhythmias (ventricular extra systoles, atrial fibrillation, and ventricular fibrillation).

The nurse is caring for a hypothermic client and receiving warmed intravenous fluids. The nurse understands that rewarming must be done slowly for which primary reason? A. To prevent burns in the client B. To prevent ventricular fibrillation C. To prevent frostbite D. To avoid muscle spasms

Choices A, B, C, and D are correct. Age-related skin changes include decreased dermal blood flow, which causes dry skin. The development of actinic lentigo (known as liver spots but have nothing to do with the liver) are darkened parts of the skin commonly found on the wrists, back of the hands, and forearms. Other age-related changes include the degeneration of elastic fibers, which causes decreased tone and elasticity. Finally, loss of subcutaneous fat is an expected finding which may cause hypothermia and pressure ulcers.

The nurse is conducting a community health class on skin changes for older adults. It would be appropriate for the nurse to state which of the following are normal age-related changes? Select all that apply. Decreased dermal blood flow Development of actinic lentigo Degeneration of elastic fibers Loss of subcutaneous fat Increased epidermal thickness

Choice C is correct. Two vaccines exist caused by S. pneumonia. The first is a 13-valent conjugate vaccine (PCV13) and a 23-valent polysaccharide vaccine (PPSV23). The PPSV23 is recommended for adults older than 65. If the client received one dose of the PPSV23 before age 65, they should receive another dose as long as it has been five years since the previous dose. If both PCV13 and PPSV23 are indicated, the PCV13 is given first, and then the PPSV23 is given one year later.

The nurse is conducting a community health class. Which immunization should the nurse recommend to the older adult? A. Human papilloma virus (HPV) vaccine B. Haemophilus influenzae type B (Hib) vaccine C. Pneumococcal polysaccharide vaccine (PPSV23) D. Measles, mumps, and rubella (MMR) vaccine

Choice A is correct. The Parkland formula is widely used to calculate fluid requirements following a major thermal burn. The formula, 4 mL x the client's weight in kilograms x the body surface area burned, determines the 24-hour fluid requirement. After calculating the total fluid amount, it should be divided by two to account for the two phases of fluid resuscitation (8 hours initially and then the remaining 16 hours).

The nurse is conducting a staff in-service on managing an acute burn. The nurse should reinforce the utilization of which formula to guide fluid resuscitation? A. 4 mL x kg x Total Body Surface Area (TBSA) burned B. 30 mL/kg C. 0.5 mL/kg/hr D. 0.10 mL/kg/hr

Choices B, C, D, and E are correct. Substance use during pregnancy puts the fetus at risk for abnormal growth, abruptio placentae, and fetal bradycardia. This severe risk factor should be discussed with women trying to conceive (Choice B). Abuse and violence put both the mother and fetus at risk. There are higher instances of abruptio placentae, preterm birth, and infections from unwanted and forced sex (Choice C). Concurrent medical conditions such as diabetes mellitus and hypertension cause the pregnancy to be considered high risk. Different risks depend on the situation, such as macrosomia and hypoglycemia in infants of a diabetic mother. These should be discussed thoroughly for women wishing to become pregnant who live with a severe medical condition (Choice D). Sexually transmitted infections, such as syphilis, gonorrhea, and chlamydia, can increase the risk of spontaneous abortion, premature rupture of membranes, subsequent labor, and transmission during a vaginal birth (Choice E).

The nurse is conducting continuing education courses on the threats to pregnancy. Which of the following are threats to a normal pregnancy? Select all that apply. Women older than 30 years of age or less than 18 years of age Substance abuse Abuse and violence Concurrent medical conditions Sexually transmitted infections

Choice C is correct. A Pap smear is an excellent screening tool to detect precancerous or cancerous cells of the cervix. There is a long lag time between the appearance of precancerous cells and the development of invasive cervical cancer. Therefore, early detection of precancerous lesions by PAP smear and addressing them promptly with localized treatments help prevent cervical cancer.

The nurse is counseling a client considering scheduling a pap smear. The nurse recommends this test because it screens for A. ovarian cancer. B. endometrial cancer. C. cervical cancer. D. vaginal cancer.

Choice A is correct. Depot medroxyprogesterone acetate is an intramuscular (IM) injection that provides contraception for 13 weeks. Considering that the client prefers no pills or anything invasive, this would be an appropriate recommendation to the PHCP.

The nurse is counseling a female client interested in starting contraception. The client tells the nurse a preference for contraception that does not involve pills or any device. Based on the client's preferences, the nurse may recommend which contraceptive product to the primary healthcare provider (PHCP)? A. Depot medroxyprogesterone B. Intrauterine device (IUD) C. Hormonal vaginal ring D. Combined estrogen-progestin pill

Choices A, C, and E are correct. The initial outbreak of herpes simplex is often the worst (as it pertains to symptoms). Clients typically experience prodromal symptoms such as headaches, a low-grade fever, malaise, paresthesia, and itching at the site of the outbreak. Then the client will experience the eruption of the painful vesicles.

The nurse is counseling a female client newly diagnosed with herpes simplex virus in the genitals. Which symptoms should the nurse educate the client to expect before an outbreak? Select all that apply. Lymphadenopathy Vaginal discharge Paresthesia Dysmenorrhea Malaise

Choice D is correct. Legionnaire's disease refers to a type of pneumonia caused by the Legionella bacteria, typically found in water or soil. An appropriate nursing diagnosis would be ineffective airway clearance, as this disease impairs the airway and lung function.

The nurse is developing a care plan for a client with Legionnaires' disease. Which nursing diagnosis would be appropriate? A. Disturbed body image B. Impaired skin integrity C. Risk for infection D. Ineffective airway clearance

Choice C is correct. Acute osteomyelitis is manifested by localized bone pain, a fever, and swelling to the affected extremity.

The nurse is discussing acute osteomyelitis with staff members. The nurse would be correct to state which of the following? A. "IV antibiotic therapy is typically given for seven to fourteen days." B. "The most common cause of acute osteomyelitis is a virus." C. "A significant fever is present with typically greater than 101°F (38.3°C)." D. "Petechiae on the affected extremity is a common finding."

Choices A, C, and E are correct. The following are recommended guidelines for foot care: Bathe the feet thoroughly in mild soap and a lukewarm water solution Dry the feet thoroughly, including the area between the toes. This helps prevent moisture-related skin issues and fungal infections. Signs of fungal infection should be reported. Manifestations include scaling of the skin and nail discoloration.

The nurse is discussing how to provide foot care to clients to a group of unlicensed assistive personnel (UAPs). The nurse should reinforce that Select all that apply. mild soap and tepid water should be used. the feet should be soaked in hot water and oil. the feet should be dried thoroughly, as well as in between the toes. an alcohol rub may be used if the feet appear dry. scaling and discoloration of the feet should be reported to the nurse. the toenails should be cut at the lateral corners when trimming the nails.

Choice D is correct. Acyclovir is an antiviral medication that interferes with the synthesis of DNA and viral replication and is primarily excreted through the kidneys. Unless contraindicated, this patient should increase fluid intake while on this medication to reduce the risk of potential nephrotoxic effects. The nurse should also review the symptoms of kidney issues that should be reported, including oliguria, hematuria, and renal pain.

The nurse is educating a client who has been prescribed acyclovir for newly diagnosed shingles. Which information would be the most important for the nurse to include? A. Take this medication 30 minutes before meals B. Continue taking this medication until the rash resolves C. If a dose is missed, take it with the next scheduled dose D. Increase fluid intake while taking this medication

Choice D is correct. This statement is incorrect. Oral contraceptives work by stopping the process of ovulation, preventing implantation, and inhibiting sperm travel. Prevention of sperm from entering the cervical os is the mechanism of action of barrier contraceptive methods (example: diaphragm).

The nurse is educating the client regarding oral contraceptives. Which of the following statements is incorrect? A. "Combination oral contraceptives are drugs containing combined doses of estrogen and progesterone that stop ovulation." B. "Oral contraceptives increase your risk for thrombophlebitis and hypertension." C. "Oral contraceptives are highly effective when taken consistently." D. "They prevent sperm from entering the cervical os."

Choice B is correct. Some redness at the surgical site is a normal finding three days after surgery. Signs of infection include pus, excess wound drainage, increasing warmth from the wound, and red streaks from the site.

The nurse is evaluating a patient three days post-operative for signs and symptoms of infection. Which of the following is not a sign of infection from a surgical wound? A. Pus and clear drainage from the site B. Some redness along the edges of the site C. Increasing warmth from the wound D. Red streaks from the site

Choice D is correct. Clients are encouraged to wear loose-fitting clothing and cotton underwear, avoid tight pants and thongs, and avoid using tampons to facilitate ventilation and improve circulation.

The nurse is giving discharge instructions to a client recently diagnosed with vaginitis. Which of the following instructions should the nurse include? A. Urinate before having sexual intercourse B. Practice regular douching C. Clean the vulva with moisturizing soap D. Wear loose-fitting clothing and cotton underwear

cardiac dysrhythmias; pulse

The nurse is immediately concerned that the client is at risk for developing ____ as evidenced by the client's ____

Choice A is correct. Signs and symptoms of cervical cancer include back and leg pain, spotting between menstrual periods and after intercourse, vaginal discharge, and lengthening of a menstrual period. A pap smear is needed to assess cellular changes (i.e. check for cancerous and precancerous conditions).

The nurse is in the screening room of a women's health clinic. The nurse notices a particular woman complaining of back and leg pain, spotting after intercourse with her husband, and vaginal discharge for the past few months. The nurse suspects: A. Cervical cancer B. Endometrial cancer C. Ovarian cancer D. Vaginitis

Choice A is correct. Self-testing is done at home (or in a private environment), where the results are only shown to the client. Unlike laboratory testing, where reactive results are reported (by law) to public health services, self-testing requires a swab of the client's gum line to determine the presence of HIV antibodies. These test kits may be purchased over the counter and will result in 20 minutes. An advantage of this type of testing is that it increases access to testing with 100% anonymity. A downside to this testing is the cost, lack of counseling for positive and negative results, and the potential for user error. Self-testing can be done by an oral swab of the gum line, or the client can provide a blood sample on a designated card, ship the sample to the lab, and call in with a unique identifier for their results.

The nurse is interviewing a client who wants to anonymously test themselves for the human immunodeficiency (HIV) virus. The nurse should recommend which type of testing? A. HIV home self testing B. Rapid testing at the primary healthcare providers (PHCPs) office C. Inpatient antibody testing D. Community health fair rapid testing

Choice C is correct. As individuals age, several changes occur in the integumentary system (the skin) due to physiological aging processes. One of these normal age-related changes is the tendency for the skin to become drier and more prone to itching. This is often attributed to a decrease in the production of natural skin oils (sebum) and a reduction in the skin's ability to retain moisture.

The nurse is performing a head-to-toe assessment for an older adult. Which finding from the integumentary assessment does the nurse recognize as a normal age-related change? A. Moist skin B. Increased nail growth C. Dry, itchy skin D. Increased skin pigmentation

Choice C is correct. Lyme disease is spread by a deer tick commonly found in heavily wooded areas. Wearing long-sleeved clothing, applying tick repellent. and showering after hikes in the woods is an effective strategy in preventing being bitten by a tick and further infected with the bacteria.

The nurse is planning a community health course about the prevention of Lyme disease. Which of the following information should the nurse include? A. "You should try limiting your outdoor activities between 10 a.m. and 4 p.m." B. "Wear sunglasses that wrap around and block UVA and UVB rays." C. "Wear long-sleeved clothing when in heavily wooded areas." D. "Apply sunscreen with at least an SPF of 30."

Choices A and B are correct. Ebola virus disease (EVD) can be fatal if not treated. The transmission of EVD includes person-to-person, primarily through unprotected contact with blood and body fluids. Additionally, the nurse should institute droplet precautionswhile wearing a face shield to prevent splashing of infected body fluids. Inhalation anthrax is not spread from person to person and is treated with aggressive dosing of antibiotics such as levofloxacin, ciprofloxacin, or doxycycline.

The nurse is planning a staff development conference about bioterrorism. Which of the following information should the nurse include? Select all that apply. Ebola virus disease (EVD) requires contact and droplet precautions Early treatment with prescribed ciprofloxacin is essential in inhalation anthrax A client with inhalation anthrax should be assigned to a room with monitored negative air pressure The plague is spread by infected bird droppings The plague produces a "bull's eye" rash at the site of infection

Choice D is correct. A woman using oral contraceptives is not at risk for toxic shock syndrome (TSS) since there is no area where the Staphylococcus aureus bacteria can infect or establish a colony. TSS is a rare but potentially life-threatening medical condition that can result from an infection with certain types of bacteria, primarily Staphylococcus aureus (staph) bacteria or Streptococcus pyogenes (strep) bacteria. TSS can affect people of all ages, including children and adults.

The nurse is talking to a group of women about the dangers and ways of acquiring toxic shock syndrome (TSS). The nurse would mention that all of the following women have a high risk of acquiring TSS, except for: A. A teenage girl using an absorbent tampon. B. A 29-year-old woman using a cervical cap. C. A 31-year-old woman using a diaphragm. D. A 35-year-old woman using oral contraceptives.

Choices A, B, C and E are correct. "Opportunistic" infections are those that take hold once the host immunity declines significantly. A is correct. Kaposi's sarcoma (KS) is a cancer that grows in the blood vessel lining and is caused by an opportunistic infection with Human Herpes Virus-8 (HHV-8). HHV-8 is also known as Kaposi Sarcoma Associated Herpes Virus (KSHV). KS can cause severe illness in an immunocompromised client and lead to hospital admission. Pulmonary KS can present with severe hemoptysis. B is correct. Tuberculosis is a severe bacterial disease that most commonly affects the lungs. It is sporadic in most healthy individuals but is an opportunistic infection that can be devastating for an immunocompromised client. C is correct. Toxoplasmosis is a parasitic infection most commonly occurring in immunocompromised clients. It can be severe and cause hospital admission for clients with a lowered immune system like AIDS/HIV clients. E is correct. Cytomegalovirus (CMV) infection is a viral infection that can affect various organs in the body, and is common in clients who have undergone organ transplants or chemotherapy.

The nurse is preparing a lecture on opportunistic infections for immunocompromised individuals. Which of the following opportunistic conditions would be included as possible causes for increased hospital admissions? Select all that apply. Kaposi's sarcoma Tuberculosis Toxoplasmosis Transesophageal fistula (TEF) Cytomegalovirus (CMV) infection

Choice D is correct. Bleach is the most effective agent against Clostridium difficle. C. diff is a spore-producing bacterium that can be transmitted between clients, environmental surfaces, and contaminated hands. The nurse should instruct the client to launder their clothes (especially underwear) with bleach and use hot water and a hot dryer temperature.

The nurse is providing discharge instructions to a client with Clostridium difficile. Which of the following instructions should the nurse include? A. Your family will need prophylactic antibiotics for two weeks. B. Disinfect your countertops and other surfaces with isopropyl alcohol. C. Wear a disposable surgical mask when you are out in public. D. If possible, use chlorine bleach when laundering underwear.

Choice D is correct. MRSA transmission requires contact with a colonized individual or contaminated surface. The nurse should advocate for appropriate infection control by advising the client to cover the wound with a dry bandage. This will help decrease the pathogen from being deposited onto surfaces.

The nurse is providing discharge instructions to a client with a skin abscess that has tested positive for methicillin-resistant Staphylococcus aureus (MRSA). Which of the following instructions should the nurse include? A. Avoid using alcohol hand-based sanitizers. B. Use disposable dishes and utensils for all meals. C. Wear a surgical mask when you are out in public. D. Keep the wound covered with a dry bandage.

Choice D is correct. While a client is being treated for hepatitis, they should consult with their primary healthcare provider, so they are not taking any medications or substances that are hepatotoxic. Exposing a client with hepatitis to a hepatotoxic medication would significantly complicate their recovery.

The nurse is providing discharge instructions to a client with hepatitis A. Which of the following instructions should the nurse include? A. You will need to take daily showers or baths with chlorhexidine. B. It is important to clean common surfaces with warm soapy water. C. You will need to have repeat stool testing to determine if you are still infectious. D. Check with your primary healthcare provider prior to taking any medications.

Choice C is correct. Douching within 24 hours of the pelvic exam kills the flora as well as other cells in the cervix and surrounding areas leading to inaccurate results.

The nurse is talking to a client who is scheduled to undergo a pelvic exam the following week. The nurse would include which instruction to the client? A. The client will undergo local anesthesia during the procedure. B. She should relax by clenching her fists or squeezing her eyes during insertion of the speculum. C. She should avoid douching 24 hours before the examination. D. She should open her mouth wide when the speculum is inserted.

Choice D is correct. Vaginal intercourse following a vaginal colposcopy with a biopsy is not advised 48 hours after the procedure. Following the 48-hour pelvic rest, the first intercourse following this procedure may be painful, which is expected.

The nurse is teaching a client scheduled for a vaginal and cervical colposcopy with biopsy. Which of the following information should the nurse include? A. You should not eat or drink eight hours before this test B. You will need to have someone drive you home after this test C. A metallic taste is common once you get the contrast dye D. Vaginal intercourse may be painful after the procedure

Choices C, D, and E are correct. Infectious conditions are reportable to the local health department including Human immunodeficiency virus (Choice C), Hepatitis-A(Choice D) and Syphilis (Choice E). Other reportable conditions include chlamydia, pulmonary tuberculosis, rabies, chickenpox, influenza, and gonorrhea. Healthcare providers have the responsibility to report these to the state/local health departments.

The nurse is teaching a group of nursing students infectious diseases that are reportable to the local health department. Which of the following conditions should be reported? Select all that apply. Bacterial vaginosis Herpes simplex virus (HSV) Human immunodeficiency virus (HIV) Hepatitis A Syphilis Human Papilloma Virus infection (HPV)

Choice D is correct. Hormonal implants may be placed subdermally and should be removed, and if the client elects, replaced after three years. Three years is the approved duration for this device.

The nurse is teaching individuals at a local health fair about female contraception options. Which information should the nurse include? A. "Intrauterine devices (IUDs) may be safely continued during pregnancy." B. "Contraceptive rings may be rinsed with rubbing alcohol if they are expelled." C. "Combined estrogen-progestin contraception may lower your blood pressure." D. "Hormonal implants that are placed subdermally need to be removed after 3 years."

Choice A is correct. SARS can be potentially deadly, and the nurse's first action should be to initiate transmission-based precautions to protect others from infection. If an airborne isolation room is unavailable in the emergency department, droplet precautions should be commenced until the client can be moved to a negative-pressure room. SARS is spread through infected aerosolized droplets that may be transmitted when a person coughs, sneezes, or spits when they talk. Other people may get the virus by touching something that comes in contact with the droplets, then touching their nose, eyes, or mouth. Airborne and contact precautions are highly recommended for SARS over droplet isolation.

The nurse is triaging a client who reports recent international travel. The primary healthcare provider (PHCP) suspects the client may have severe acute respiratory syndrome (SARS). The nurse should initially A. place the client on contact and airborne precautions. B. obtain blood, urine, and sputum for culture. C. prepare the client for a chest radiograph (x-ray). D. infuse 0.9 saline at 100mL/hr.

Choice B is correct. C. diff is a spore-producing bacterium that allows it to be transmitted between clients, environmental surfaces, and contaminated hands. Obtaining vital signs with disposable equipment is recommended to prevent the transmission of this pathogen.

The nurse is visiting the home of a client with Clostridium difficile. Which infection control measure should the nurse include? A. Ask the client to wear a surgical mask during the visit. B. Obtain vital signs with a disposable blood pressure cuff. C. Interview the client while maintaining 3 feet distance. D. Use sterile gloves when performing venipuncture.

Lactated ringers; Parkland formula; insert and indwelling urinary catheter

The nurse should plan to obtain a prescription for ____ to restore circulating volume.The ____ will be used to determine the 24-hour fluid requirement. To measure the effectiveness of the fluid replacement, the nurse plans to ____

Choice A is correct. Many changes occur in the aging body. With age, the loss of adipose tissue causes sagging skin and wrinkles. This is especially noticeable around the head and face. Wrinkles on the face become more pronounced and tend to take on the general "mood" of the client over the years. For example, laugh lines or wrinkles around the lips, cheeks, and eyes are usually more noticeable. Choice B is incorrect. The nose and ears of the aging client become more extended and broader. Over time, the nose and ears appears to grow in size due to gravity. As individuals age, gravity causes cartilage in the ear and nose to break down and sag which gives these features an elongated appearance.

The nurse should recognize which of the following are physical changes associated with the aging client? Select all that apply. Pronounced wrinkles on the face Decreased size of the nose and ears Increased growth of facial hair Neck wrinkles Increased height

Choices A, B, C, D, and E are correct. Recommendations for human immunodeficiency virus (HIV) testing Adolescents and adults aged 15 to 65 years (at least one time) Individuals with a sexually transmitted infection Pregnancy The use of injection drugs Engaging in sex work Men who have sex with Men (MSM) Housed in a correctional institution such as jail and prison

The nurse teaches individuals about the human immunodeficiency virus (HIV) at a health fair. It would be correct for the nurse to state which of the following would indicate the need for HIV testing? Select all that apply. Pregnancy Engaged in sex work Have a sexually transmitted infection The use of injection drugs Men who have sex with men (MSM)

Choice C is correct. When obtaining a menstrual history, the nurse should ask for information only related to the menstrual function. This includes information about the last menstrual period (LMP, date of the first day of bleeding), cycle length, and frequency (e.g. 4/28, 4 days of bleeding every 28 days), the heaviness of bleeding (number of tampons used per day), history of intermenstrual bleeding, history of postcoital bleeding (PCB), age of menarche/menopause, and presence or absence of postmenopausal bleeding.

The nurse, while admitting a new client, is assessing the client's menstrual history. Which of the following questions would be appropriate to ask? A. How many sexual partners have you had? B. Do you have a history of any type of cancer in your family? C. Do you experience any missed periods? D. Do you use condoms during intercourse?

Choice D is correct. The semi-lithotomy position allows the patient to maintain eye contact with the practitioner and communicate while the procedure is being performed. It also allows adequate visualization of the female genitalia.

What position will the nurse assist the female patient into for a comfortable genital examination? A. Semi-fowler's B. Supine with the knees bent C. Prone with the knees bent D. Semi-lithotomy

Choice C is correct. Prolonged inadequate nutrition causes weight loss, muscle atrophy, and the loss of subcutaneous tissue. These three conditions reduce the amount of padding between the skin and bones, thus increasing the risk of pressure ulcer development. Specifically, inadequate protein, carbohydrates, fluids, zinc, and vitamin C intake contribute to pressure ulcer formation. Immobility resulting from prolonged bed rest is a risk factor. Several factors contribute to the formation of pressure ulcers: friction and shearing, immobility, inadequate nutrition, fecal and urinary incontinence, decreased mental status, diminished sensation, excessive body heat, advanced age, and certain chronic conditions.

Which client is at the highest risk for developing a decubitus ulcer among the following patients in a long-term care facility? A. An incontinent client who had 3 diarrheal stools. B. An 80-year-old ambulatory diabetic client. C. A 79-year-old malnourished client on bed rest. D. An obese client who occasionally uses a wheelchair.

Choice C is correct. Intrinsic refers to anything essential or belonging naturally. Impaired tissue perfusion is an internal risk factor. Other intrinsic risk factors associated with skin breakdown include: Poor nutritional status Incontinence Alterations in fluid balance Altered neurological functioning

Which is an intrinsic risk factor that increases the risk of patients developing pressure ulcers? A. Shearing B. Friction C. Impaired tissue perfusion D. Pressure

Choice C is correct. The primary purpose of skin care and hygiene is to protect the body's first line of defense against infection, which is the skin. In addition to this primary purpose, skin care and hygiene also prevent bodily odors by eliminating skin surface bacteria, providing the client with comfort and well-being.

Which of the following accurately summarizes the primary purpose of skin care and hygiene? A. Maintain skin sterility and prevent infection B. Prevent bodily odors by eliminating bacteria C. Protect the body's first line of defense D. Provide the client with comfort and well-being

Choice D is correct. Several factors increase the risk of infection for this client. Central lines are associated with a higher risk of infection because the neck and chest skin harbor a high number of microorganisms. Additionally, because the line is non-tunneled, the risk for infection is higher. Non-tunneled catheters are mostly used for short-term access in indications requiring rapid resuscitation or pressure monitoring. Such non-tunneled catheters are good for about 5 to 7 days. They carry a higher risk of infection and are inappropriate for patients who require central venous access for longer than 2 weeks.

Which of the following clients, receiving normal saline via IV infusion, is at the highest risk for bloodstream infections? A. A client who has a midline IV catheter in the left antecubital fossa. B. A client with a peripherally inserted central catheter (PICC) line in the right upper arm. C. A client with an implanted port in the right subclavian vein. D. A client who has a non-tunneled central line in the left internal jugular vein.

Choices B, C, and E are correct. Generally, tuberculosis (TB) does not affect those with healthy CD4 levels. Symptomatic TB is a sign of AIDS. An infection with Toxoplasmosis of the brain indicates a serious infection directly related to the condition. Affecting the lung, pneumocystis carinii pneumonia is typical of patients with AIDS and a serious sign of low CD4 counts.

Which of the following opportunistic illnesses are a sign that a patient with HIV now has AIDS? Select all that apply. Stomach ulcers Symptomatic tuberculosis Toxoplasmosis of the brain Osteoporosis Pneumocystis carinii pneumonia

Choice C is correct. Testicular torsion requires immediate surgical intervention to prevent strangulation of the testicle.

Which of the following suspected diagnoses requires immediate referral for a 21-year-old patient with complaints of scrotal pain? A. Epididymitis B. Inguinal hernia C. Testicular torsion D. Hydrocele

Extent of injury Type of burns

Which two (2) assessment findings is the nurse most concerned with? Respiratory status Extent of injury Oral temperature Type of burns Sensation in the right arm

Choice A is correct. Onychomycosis is a fungal infection of the nail plate, nail bed, or both. In clients with onychomycosis, the client's nails typically appear deformed with a white or yellow discoloration. Onychomycosis can cause pain, discomfort, and disfigurement and may produce serious physical and occupational limitations and reduce the client's quality of life.

While bathing your client and providing nail care, you notice the client's nails look abnormal. You would document this nail abnormality as: See exhibit. View Exhibit A. Onychomycosis B. Onychomadesis C. Onychorrhexis D. Onychia

Choice A is correct. Deep partial-thickness burns (also known as second-degree burns) involve the deeper dermis. These burns appear yellow or white, are dry, and will have minimal to no blanching with pressure. Clients with deep partial-thickness burns experience minimal pain due to a decreased sensation.

While working in the emergency department, a client arrives with burns present on their legs and torso. The nurse notices that the wounds appear dry and pale white with a sluggish to absent capillary refill. Based on this finding, the nurse should classify the injury as which of the following? A. Deep partial-thickness B. Full-thickness C. Superficial partial-thickness D. Superficial