EXAM #4

When assisting the client to interpret a negative HIV test result, what does the nurse tell the client that this result means? A) The body has not produced antibodies to the AIDS virus. B) The client has not been infected with HIV. C) The client is immune to the AIDS virus. D) Antibodies to the AIDS virus are in the client's blood.

A) The body has not produced antibodies to the AIDS virus. A negative test result indicates that antibodies to the AIDS virus are not present in the blood at the time the blood sample for the test is drawn. A negative test result should be interpreted as demonstrating that, if infected, the body has not produced antibodies (which takes from 3 weeks to 6 months or longer). Therefore, subsequent testing of an at-risk client must be encouraged. The test result does not mean that the client is immune to the virus, nor does it mean that the client is not infected. It just means that the body may not have produced antibodies yet. When antibodies to the AIDS virus are detected in the blood, the test is interpreted as positive.

The nurse is teaching a client about the characteristics of osteoarthritis. How will the nurse determine the client teaching was successful? A) Clients may have swan neck deformity. B) Clients may develop Heberden nodes. C) Clients will develop boutonniere deformity. D) Clients will have an ulnar deviation.

B) Clients may develop Heberden nodes. Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis.

The nurse understands that which cells circulate throughout the body looking for virus-infected cells and cancer cells? A) Natural killer cells B) Cytokines C) Interleukins D) Interferons

A) Natural killer cells Natural killer cells are lymphocyte-like cells that circulate throughout the body looking for virus-infected cells and cancer cells. Cytokines are chemical messengers released by lymphocytes, monocytes, and macrophages. Interleukins carry messages between leukocytes and tissues that form blood cells. Interferons are chemicals that primarily protect cells from viral infections.

The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as? A) Positive babinski B) Clonus C) Hypertrophy D) Ankle reflex

B) Clonus The nurse may elicit muscle clonus (rhythmic contractions of a muscle) in the ankle or wrist by sudden, forceful, sustained dorsiflexion of the foot or extension of the wrist.

A patient with common variable immunodeficiency (CVID) is extremely fatigued and not feeling well. What lab test does the nurse anticipate the patient will have to detect a common development related to the disease? A) Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) B) Blood urea nitrogen (BUN) and creatinine C) Glucose level D) B12 level

D) B12 level More than 50% of patients with CVID develop pernicious anemia, a condition in which the body cannot make enough red blood cells due to an inability to absorb vitamin B12.

The nurse is caring for a client with an autoimmune disease. What is a characteristic of autoimmune disorders? A) Progressive tissue damage without any verifiable etiology B) Absence of a triggering event C) Profound fatigue with no identifiable cause D) Affects only older adults and infants less than 3 months

A) Progressive tissue damage without any verifiable etiology Diseases are considered autoimmune disorders and are characterized by unrelenting, progressive tissue damage without any verifiable etiology. In many autoimmune disorders, there tends to be a triggering event, such as an infection, trauma, or introduction of a drug that integrates itself into the membranes of the host's cells. Although older adults face a greater risk of developing autoimmune disorders, persons belonging to any age-group can be affected. Chronic fatigue syndrome is primarily characterized by profound fatigue with no identifiable cause, and this is not a characteristic of autoimmune disorders.

A client has undergone a kidney transplant. The nurse is concerned about a compromised immune system in this client for which reason? A) Use of anti-rejection drugs B) Excess circulating lymphocytes C) Deficient circulating antibodies D) Excess circulating hemoglobin

A) Use of anti-rejection drugs Clients who receive a kidney transplant must take immunosuppressant drugs to prevent rejection of the transplant. These drugs cause a compromised immune system. Renal transplant is not associated with excess lymphocytes, deficient circulating antibodies, or excess hemoglobin.

Which immunoglobulin assumes a major role in bloodborne and tissue infections? A) IgA B) IgG C) IgM D) IgD

B) IgG IgG assumes a major role in bloodborne and tissue infections. IgA protects against respiratory, gastrointestinal, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? A) detection of systemic complications B) strategies for remaining active C) disease-modifying antirheumatic drug therapy D) prevention of joint deformity

B) strategies for remaining active The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? A) Magnesium level B) Potassium level C) Alkaline phosphatase D) Troponin levels

C) Alkaline phosphatase Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

Dupuytren contracture causes flexion of which area(s)? A) Thumb B) Index and middle fingers C) Fourth and fifth fingers D) Ring finger

C) Fourth and fifth fingers Dupuytren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? A) Bone scan B) Computed tomography (CT) C) Magnetic resonance imaging (MRI) D) Muscle biopsy

D) Muscle biopsy As with other diffuse connective tissue disorders, no single test confirms polymyositis. An electromyogram is performed to rule out degenerative muscle disease. A muscle biopsy may reveal inflammatory infiltrate in the tissue. Serum studies indicate increased muscle enzyme activity.

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint? A) Between the vertebrae B) In the fingers C) At the hip D) Skull at the temporal and occipital bones

D) Skull at the temporal and occipital bones A synarthrodial joint is immovable and can be found at the suture line of the skull between the temporal and occipital bones. Amphiarthrodial joints are slightly moveable and are found between the vertebrae. The finger and hip joints are examples of diarthrodial joints that are freely moveable.

Choose the correct statement about the endosteum, a significant component of the skeletal system: A) Covers the marrow cavity of long bones B) Supports the attachment of tendons to bones C) Contains blood vessels and lymphatics D) Facilitates bone growth

A) Covers the marrow cavity of long bones The endosteum is a thin vascular membrane that covers the marrow cavity of long bones and the spaces in cancellous bone. Osteoclasts are located near the endosteum.

A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? A) TMP-SMZ B) Cephalexin C) Azithromycin D) Garamycin

A) TMP-SMZ TMP-SMZ (Bactrim, Cotrim, Septra) is the treatment of choice for PCP; it is as effective as parenteral pentamidine isethionate (Pentacarinat) and more effective than other regimens.

Which condition is associated with impaired immunity relating to the aging client? A) Increase in humoral immunity B) Breakdown and thinning of the skin C) Decrease in inflammatory cytokines D) Increase in peripheral circulation

B) Breakdown and thinning of the skin The aging process stimulates changes in the immune system. Age-related changes in many body systems also contribute to impaired immunity. Changes such as poor circulation, as well as the breakdown of natural mechanical barriers such as the skin, place the aging immune system at even greater disadvantage against infection. As the immune system undergoes age-associated alterations, its response to infections progressively deteriorates. Humoral immunity declines and the number of inflammatory cytokines increase with age.

While interviewing a client with an allergic disorder, the client tells the nurse about an allergy to animal dander. The nurse knows that animal dander is what type of substance? A) Immunoglobulin B) Complete protein antigen C) Chemical mediator D) T-lymphocyte

B) Complete protein antigen Animal dander is considered a complete protein antigen. Immunoglobulins are antibodies formed by lymphocytes and plasma cells. Chemical mediators are substances released by the mast cells upon stimulation by an antigen. T-lymphocytes assist the B cells in producing antibodies.

Which of the following tests determines initiation of antiretroviral treatment? A) CD4/CD8 ratio B) Enzyme immunoassay (EIA) C) Western blot D) Viral load

A) CD4/CD8 ratio The CD4/CD8 ratio determines initiation of antiretroviral treatment and use of prophylactic medications. EIA is an enzyme immunoassay that detects HIV antibodies. The Western blot test detects antibodies to HIV and is used to confirm EIA. Viral load quantifies HIV RNA in the plasma. It monitors efficacy of antiretroviral treatment through virological suppression.

The nurse is teaching a client who has been diagnosed with Hashimoto's thyroiditis. Which statement correctly describes the process of autoimmunity? A) The normal protective immune response attacks the body, damaging tissues. B) The body produces inappropriate or exaggerated responses to specific antigens. C) The body overproduces immunoglobulins. D) A deficiency results from improper development of immune cells or tissues.

A) The normal protective immune response attacks the body, damaging tissues. Autoimmunity happens when the normal protective immune response paradoxically turns against or attacks the body, leading to tissue damage. It is not an immune deficiency. An exaggerated immune response describes a hypersensitivity. An overproduction of immunoglobulins is the definition of gammopathies.

Activation of a natural immunity response is enhanced by physical and chemical barriers. Which of the following is a physical barrier, which the nurse knows can be altered by illness, nutrition, or lifestyle? A) Mucus B) Acidic gastric secretions C) Cilia of the respiratory tract D) Enzymes in saliva

C) Cilia of the respiratory tract Cilia are considered a physical barrier, along with intact skin and mucous membranes.

In which deformity does the great toe deviate laterally? A) Hammertoe B) Pes cavus C) Hallux valgus D) Plantar fasciitis

C) Hallux valgus Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.

The nurse is caring for a client with renal failure. Which factor indicates a compromised immune system? A) A deficiency of circulating lymphocytes B) An excess of circulating lymphocytes C) A deficiency of circulating antibodies D) An excess of circulating hemoglobin

A) A deficiency of circulating lymphocytes Renal failure is associated with a deficiency in circulating lymphocytes, which make up a large part of the immune system. Renal failure is not associated with excess lymphocytes, deficient circulating antibodies, or excess hemoglobin.

Which test indicates the quantity of allergen necessary to evoke an allergic reaction? A) Serum-specific IgE test B) Provocative testing C) Scratch test D) Intradermal test

A) Serum-specific IgE test The serum-specific IgE test, formerly known as RAST, is a radioimmunoassay that measures allergen-specific IgE. It indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following? A) Joint B) Muscle C) Ligament D) Cartilage

B) Muscle Tendons attach muscles to the periosteum of bone. Joints are a junction between two or more bones. Ligaments connect two freely movable bones. Cartilage is a dense connective tissue used to reduce friction between two structures.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis? A) congenital deformity B) age C) trauma D) obesity

B) age Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? A) Short leg cast B) Long leg cast C) Walking cast D) Hip spica cast

A) Short leg cast A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

T-cell and B-cell lymphocytes are the primary participants in the immune response. What do they do? A) T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. B) T-cell and B-cell lymphocytes respond to the body's invasion by macrophages. C) T-cell and B-cell lymphocytes react to the body's lack of B12 . D) T-cell and B-cell lymphocytes distinguish harmful treatments from curative treatments.

A) T-cell and B-cell lymphocytes distinguish harmful substances and ignore those natural and unique to a person. T-cell and B-cell lymphocytes are the primary participants in the immune response. They distinguish harmful substances and ignore those natural and unique to a person. Options B, C, and D are incorrect.

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend. A) 1,800 mg; 1,600 IU B) 1,600 mg; 1,400 IU C) 1,400 mg; 1,200 IU D) 1,200 mg; 1,000 IU

D) 1,200 mg; 1,000 IU The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.

An older woman's X-rays reveal a diagnosis of osteoporosis. The nurse advises the woman that the radiolucency seen in the bones indicates a minimal level of demineralization of which percentage? A) 10% B) 15% C) 20% D) 25%

D) 25% Demineralization seen on X-rays occurs when bone loss of 25% to 40% occurs.

Which term refers to fixation or immobility of a joint? A) Hemarthrosis B) Diarthrodial C) Arthroplasty D) Ankylosis

D) Ankylosis Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

Which laboratory study indicates the rate of bone turnover? A) Urine calcium B) Serum calcium C) Serum phosphorous D) Serum osteocalcin

D) Serum osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis? A) Thrombocytopenia B) Eczema C) Thrush D) Vascular lesions

D) Vascular lesions Ataxia-telangiectasis is characterized by loss of muscle coordination and vascular lesions. Thrombocytopenia and eczema are associated with Wiskott-Aldrich syndrome. Thrush is a manifestation associated with severe combined immunodeficiency (SCID).

In a client infected with human immunodeficiency virus (HIV), CD4+levels are measured to determine the: A) presence of opportunistic infections. B) level of the viral load. C) extent of immune system damage. D) resistance to antigens.

C) extent of immune system damage. CD4+ levels in the blood of an individual with HIV infection determine the extent of damage to the individual's immune system. The test indicates the individual's risk of an opportunistic infection but doesn't identify specific infections. Viral loads and resistance to specific antigens are determined using other diagnostic tests.

The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement? A) "We need to increase aerobic exercise." B) "We need to consume a low-calcium, high-phosphorus diet." C) "Estrogen deficiency increases bone density." D) "We need an adequate amount of exposure to sunshine."

D) "We need an adequate amount of exposure to sunshine." The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk for osteoporosis. Estrogen deficiency is linked to decreased bone mass.

The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder? A) anaphylaxis B) allergic rhinitis C) contact dermatitis D) atopic dermatitis

C) contact dermatitis Tuberculosis and contact dermatitis are type IV hypersensitivity reactions. Anaphylaxis, allergic rhinitis, and atopic dermatitis are type I hypersensitivity reactions.

A nurse would most likely expect the need for open reduction for a client with which of the following? A) Closed fracture B) Little bone separation C) Soft tissue free of bone ends D) Joint fracture

D) Joint fracture An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed.

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? A) Bind the toes so that they will straighten. B) Do active range of motion on the toes. C) Have surgery to fix them. D) Wear properly fitting shoes.

D) Wear properly fitting shoes. Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count? A) Less than 200/mm3 B) Between 200 to 350/mm3 C) Between 350 to 499/mm3 D) Greater than 500/mm3

D) Greater than 500/mm3 A client is classified as HIV asymptomatic when the CD4+ T lymphocyte count is greater than 500/mm3. A person is considered HIV symptomatic when the CD4+ count is 200 to 499/mm3. A person is considered to have acquired immunodeficiency syndrome (AIDS) when the CD4+ count is less than 200/mm3.

Which is a major manifestation of Wiskott-Aldrich syndrome? A) Thrombocytopenia B) Ataxia C) Episodes of edema D) Bacterial infection

A) Thrombocytopenia Major symptoms of Wiskott-Aldrich syndrome include thrombocytopenia, infections, and malignancies. Ataxia occurs with ataxia-telangiectasia. Episodes of edema in various body parts occur with angioneurotic edema. Bacterial infection occurs with hyperimmunoglobulinemia E syndrome.

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? A) Polyethylene-induced infection B) Pneumonia C) Fat emboli syndrome D) Disseminated intravascular coagulation

C) Fat emboli syndrome Fat embolism syndrome (FES) (see Chapter 43) may occur with orthopedic surgery. The nurse must be alert to any signs and symptoms that may suggest the development of FES. These may include respiratory distress; onset of delirium or any acute change in level of consciousness; and development of unusual skin rashes, especially a papular rash on the upper torso.

A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class? A) Mast cell stabilizer B) C) Corticosteroid D) Leukotriene-receptor antagonist

D) Leukotriene-receptor antagonist Montelukast is classified as a leukotriene-receptor antagonist. Cromolyn sodium is a mast cell stabilizer. Cetirizine, loratadine, and fexofenadine are nonsedating antihistamines. Beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, and triamcinolone are corticosteroids.

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition? A) applications of ice B) encouraging the client to eat a healthy diet C) avoiding caffeine and alcohol D) regular exercise and stress reduction

A) applications of ice

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? A) Radial B) Peroneal C) Median D) Ulnar

B) Peroneal The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

What intervention is a priority when treating a client with HIV/AIDS? A) Assessing neurologic status B) Monitoring skin integrity C) Assessing fluid and electrolyte balance D) Monitoring psychological status

C) Assessing fluid and electrolyte balance Fluid and electrolyte deficits are a priority in monitoring clients with HIV/AIDS, and assessment of fluid loss and electrolyte imbalance is essential. Skin integrity should be monitored but is a lower priority. Neurologic and psychological status should also be monitored, but this is not as high a priority as fluid and electrolyte imbalance.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. When the nurse is considering all of the various types of bone fractures, which bone type is most anticipated? A) Collagen B) Cortical C) Cancellous D) Cartilage

C) Cancellous Cancellous bone or spongy bone is light and contains many spaces making it a less solid bone than the cortical or compact bone. Collagen and cartilage are not types of bone.

The nurse is admitting a client to the unit with a diagnosis of ataxia-telangiectasia. The nurse would recognize that the client is exhibiting telangiectasia when assessing the presence of what? A) Peripheral edema B) Uncoordinated muscle movement C) Vascular lesions caused by dilated blood vessels D) A condition marked by development of urticaria

C) Vascular lesions caused by dilated blood vessels Telangiectasia is the term that refers to vascular lesions caused by dilated blood vessels. Ataxia refers to uncoordinated muscle movement and is a clinical manifestation of combined B-cell and T-cell deficiencies. Telangiectasia is not peripheral edema, vascular lesions, or urticaria.

A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that humoral immunity is provided by which type of white blood cell? A) Neutrophil B) Basophil C) Monocyte D) Lymphocyte

D) Lymphocyte The lymphocyte provides humoral immunity — recognition of a foreign antigen and formation of memory cells against the antigen. Humoral immunity is mediated by B and T lymphocytes and can be acquired actively or passively. The neutrophil is crucial to phagocytosis. The basophil plays an important role in the release of inflammatory mediators. The monocyte functions in phagocytosis and monokine production.