Final
When conducting an information session for a group of clients with genital herpes which medication information should the nurse include? A. acyclovir B. penicillin C. doxycycline D. tetracycline
A. acyclovir
A child with sickle cell anemia is being treated for a vase-occlusive crisis and reports significant discomfort. Which actions can promote increased levels of comfort for the child? Select all that apply. A. cluster care interventions B. encourage fluid intake C. perform passive range of motion D. oxygen therapy as prescribed E. assist to knee-chest position
A. cluster care interventions B. encourage fluid intake D. oxygen therapy as prescribed
A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg by mouth every 6 hours. The nurse should instruct the client to notify the physician if which adverse drug reaction occurs? A. Dysuria B. Tinnitus C. Leg cramps D. Constipation
B. Tinnitus
A child with weakness in the legs and a history of influenza is admitted with a diagnosis of Guillain-Barre syndrome. Which symptom, indicative of a possible serious complication, would the nurse report immediately to the primary health care provider? A. tingling in the hands B. increased hoarseness C. weak muscle tone in the arms D. weak muscle tone in the legs
B. increased hoarseness
The nurse is caring for a client receiving chemotherapy. Which should the nurse consider the priority? A. self-image B. nutrition C. family support D. mobility
B. nutrition
A client arrives at the clinic requesting testing for HIV. Which response by the nurse is best? A. "Did you have sex with multiple partners?" B. "The test results won't be back for a while." C. "You will need to sign a consent form prior to testing." D. "We will call you with the results."
C. "You will need to sign a consent form prior to testing."
A nurse is reinforcing nutritional counseling to the parent of a child with celiac disease. Which statement by the parent indicates understanding of the diet? A. "I need to read food labels carefully to avoid gluten additives in foods." B. "My child needs a diet rich in all grains." C. "I should avoid feeding my child potatoes, rice, flour, and cornstarch." D. "My child can safely eat frozen and packaged foods."
A. "I need to read food labels carefully to avoid gluten additives in foods."
The parents of an infant report they are concerned about giving their child immunizations due to their association with autism. Which response by the nurse is appropriate? A. "Studies do not support a link between autism and immunizations." B. "There are limited risks of autism with the use of 'live' vaccines." C. "The administration of more than one immunization at a time has shown a slight relationship with the development of autism." D. "The use of inactivated vaccines has been linked to a slight increase in the development of autism in populations at risk."
A. "Studies do not support a link between autism and immunizations."
A client arrives in the emergency department reporting severe hives and wheezing after eating shrimp. The nurse observes the client experiencing symptoms of laryngeal edema. Which is the priority action by the nurse? A. Administer epinephrine. B. Administer montelukast (Singulair). C. Administer loratadine (Claritin). D. Administer pseudoephedrine (Sudafed).
A. Administer epinephrine.
The nurse is caring for a client diagnosed with chronic thrombocytopenia. Before discharge, the nurse reinforces which activities to the client to decrease excessive bleeding? Select all that apply. A. Avoid alcohol. B. Avoid aspirin and ibuprofen. C. Avoid the influenza vaccine. D. Check with your health care provider about taking OTC drugs. E. Change any lupus treatments.
A. Avoid alcohol. B. Avoid aspirin and ibuprofen. D. Check with your health care provider about taking OTC drugs.
How can a nurse best protect herself after she experiences a minor allergic reaction to latex? A. Avoid use of all latex products. B. Use latex products on a limited basis. C. Carry an allergic reaction kit. D. Avoid using latex gloves.
A. Avoid use of all latex products.
The nurse is teaching a client who will be discharged soon how to change a sterile dressing on the right leg. During the teaching session, the nurse notices redness, swelling, and induration at the wound site. What do these signs suggest? A. Infection B. Dehiscence C. Hemorrhage D. Evisceration
A. Infection
A 33-year-old client who tested positive for the human immunodeficiency virus (HIV) is admitted to the medical unit with pancreatitis. A nurse director from another unit comes into the medical unit nurses' station and begins reading the client's chart. The staff nurse questions the director, who says that the client is her neighbor's son. What should the nurse do to protect the client's right to privacy? A. Inform the nurse director that she's violating the client's right to privacy and ask her to return the chart. B. Remind the nurse director not to share the client's medical information with anyone because of his HIV status. C. Report the incident to the medical director. D. Ask the nurse director if she has permission to read the client's chart, and if not, tell her she needs to obtain it.
A. Inform the nurse director that she's violating the client's right to privacy and ask her to return the chart.
A client is taking methotrexate (Otrexup) for the treatment of rheumatoid arthritis. What expected finding does the nurse observe when reviewing laboratory results? A. Low neutrophil count B. Low hemoglobin C. Elevated leukocyte count D. Elevated sedimentation rate
A. Low neutrophil count
Which action must a nurse take first before drawing a blood sample for human immunodeficiency virus (HIV) testing? A. Make sure that an informed consent form has been signed. B. Inform the client that the sample is being obtained for routine testing. C. Put on gloves and a mask. D. Tell the client that he'll be informed if the test results are positive.
A. Make sure that an informed consent form has been signed.
How can a nurse best ensure the safety of a client who has a latex allergy? A. Make sure that the latex allergy is properly documented. B. Inform the oncoming shift of the latex allergy during the shift report. C. Warn the client to avoid products containing latex. D. Instruct the client to take antihistamines daily.
A. Make sure that the latex allergy is properly documented.
Which factor is most important when planning care for a client with a bleeding disorder? A. Prioritization B. Time management C. Delegation D. Verbal communication
A. Prioritization
The charge nurse is observing a new graduate providing care to a client who is HIV positive. Which action by the new graduate would require immediate intervention by the charge nurse? A. Recapping a needle after giving an injection B. Using gloves when changing a soiled dressing C. Wearing a face shield when irrigating a sacral wound D. Discarding gloves when exiting the client's room
A. Recapping a needle after giving an injection
Two days after a client undergoes splenectomy, a nurse changes his abdominal dressings according to the physician's order. How should the nurse proceed with the dressing change? A. Remove the soiled dressings using clean gloves. B. Dispose of the soiled dressings in the trash can. C. Put on a gown, sterile gloves, and a mask. D. Place clean dressings over the incision.
A. Remove the soiled dressings using clean gloves.
The nurse is teaching a client with human immunodeficiency virus (HIV) to understand the importance of medication adherence. Which information would the nurse include when reinforcing the education? Select all that apply. A. The use of pill containers and calendars B. Interaction with foods and other drugs C. Management of medication side effects D. Obtaining refills on time E. When to discontinue medications
A. The use of pill containers and calendars B. Interaction with foods and other drugs C. Management of medication side effects D. Obtaining refills on time
While obtaining a health history, the nurse learns that the client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which medication on hand? A. diphenhydramine hydrochloride B. pseudoephedrine hydrochloride C. guaifenesin D. loperamide
A. diphenhydramine hydrochloride
A nurse is reinforcing discharge instructions to a client after treatment for a severe allergic reaction from a bee sting. What instructions should the nurse include? Select all that apply. A. fill the prescription for injectable epinephrine to carry with you B. apply perfume liberally as a protection C. dress in sleeveless, easily removable garments D. obtain diphenhydramine to take following a bee sting E. wear bright colors to repel insects
A. fill the prescription for injectable epinephrine to carry with you D. obtain diphenhydramine to take following a bee sting
A nurse is caring for a child with juvenile arthritis (JA) who has oral prednisone prescribed. The nurse knows that the drug will be given at the lowest possible dosage and for the shortest period of time in order to avoid which adverse effects? A. growth retardation and increased risk of infection B. deafness and severe weight loss C. hypoglycemia and hypovolemia D. fibrotic skin changes and increased muscle mass
A. growth retardation and increased risk of infection
Which nursing action is most important to decrease the risk of postoperative complications in a child with sickle cell anemia? A. increasing fluids B. preparing the child psychologically C. discouraging coughing D. limiting the use of analgesics
A. increasing fluids
When caring for a child with sickle cell anemia in vaso-occlusive crisis, what does the nurse identify as the priority nursing intervention? A. manage pain B. provide a cool environment C. immobilize the affected part D. restrict fluids
A. manage pain
A client with human immunodeficiency virus (HIV) experiences frequent bouts of diarrhea. The nurse determines dietary teaching is effective when the client states which food to avoid? A. milk B. red licorice C. chicken soup D. broiled meat
A. milk
Which additional health care provider order should a nurse anticipate for a client who has been prescribed corticosteroids? A. perform blood glucose checks every six hours. B. restrict fluids to 1,000 ml in 24 hours. C. administer lactulose 40 g in 4 oz of water daily. D. obtain complete blood count (CBC) every 12 hours.
A. perform blood glucose checks every six hours.
A nurse is caring for a client who received 1 unit of fresh frozen platelets (FFP) for a platelet count of 20,000 mm3. Which repeat laboratory values will be of greatest concern to the nurse? A. platelet count 22,000 mm3 B. blood urea nitrogen 20 mg/dL C. white blood cell count 4.8 µL D. red blood cell count 5.2 µL
A. platelet count 22,000 mm3
A nurse is monitoring a client who's receiving a blood transfusion for volume replacement. The client reports itching about 20 minutes after the infusion begins. What is the priority action by the nurse? A. report the symptom so that the infusion can be stopped immediately B. call the health care provider immediately C. give the client oral diphenhydramine and continue to monitor the client's symptoms D. do nothing because itching is a normal response to a blood transfusion
A. report the symptom so that the infusion can be stopped immediately
A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity? A. swimming in rivers or lakes B. hiking in a forested area C. going horseback riding D. playing recreational softball
A. swimming in rivers or lakes
The nurse is reinforcing education prior to discharge for a client that has had a kidney transplant. Which statement made by the client indicates that education about rejection is understood? A. "I will take a laxative if I am unable to have a bowel movement." B. "I will report fever, chills, and profuse sweating to the primary care provider." C. "I will take my immunosuppressant drugs whenever I feel I am developing an infection." D. "I don't have to see my nephrologist any longer since I am cured of kidney disease."
B. "I will report fever, chills, and profuse sweating to the primary care provider."
A client with rheumatoid arthritis reports flatulence and heartburn after taking piroxicam. Which instruction should the nurse reinforce to address the client's concern? A. "These side effects will subside as you continue to take the medication." B. "Take an antacid at the same time that you take the medication." C. "This medication is used for short-term treatment of your arthritis." D. "Try taking a lower dose of the medication to relieve your symptoms."
B. "Take an antacid at the same time that you take the medication."
A client receiving ferrous sulfate therapy to treat an iron deficiency reports taking an antacid frequently to relieve heartburn. Which instruction should the nurse provide? A. "Take ferrous sulfate and the antacid together." B. "Take ferrous sulfate and the antacid at least 2 hours apart." C. "Avoid taking an antacid altogether." D. "Take ferrous sulfate and the antacid at least 1 hour apart."
B. "Take ferrous sulfate and the antacid at least 2 hours apart."
The nurse is caring for a client with pernicious anemia. Which question by the nurse explains the potential source of the anemia? A. "Did you have any surgery on your bladder?" B. "What type of diet do you follow?" C. "Do you have any changes in your vision?" D. "Have you added any new medications to your routine?
B. "What type of diet do you follow?"
A 1-year-old infant is pale, but the physical examination is normal. Blood studies reveal a hematocrit of 24% (0.24). Which question by the nurse to the parents would be most useful in helping to establish a diagnosis of anemia? A. "Is the infant on any medications?" B. "What's the infant's usual daily diet?" C. "Did the infant receive phototherapy for jaundice?" D. "What's the pattern and appearance of bowel movements?"
B. "What's the infant's usual daily diet?"
A child tests positive for the sickle cell trait, and the parents ask the nurse what this means. Which response by the nurse would be most appropriate? A. "Your child has sickle cell anemia." B. "Your child is a carrier but doesn't have the disease." C. "Your child is a carrier and will pass the disease to any offspring." D. "Your child doesn't have the disease now but may develop the disease as he gets older."
B. "Your child is a carrier but doesn't have the disease."
After undergoing testing, a client comes to a physician's office for a follow-up appointment. During the appointment, the physician informs the client that she has systemic lupus erythematosus (SLE). Which resource might be helpful for a nurse to recommend to this client? A. An occupational therapy consult B. A support group for clients with SLE C. A consult with a social worker D. A consult with a home health care nurse
B. A support group for clients with SLE
A client receiving antiplatelet therapy is being monitored for adverse reactions. For which most commonly produced adverse reaction would the nurse observe this client? A. Difficulty hearing B. Bleeding C. Confusion D. Agranulocytosis
B. Bleeding
A nurse is caring for a child with celiac disease. How should the nurse evaluate the effectiveness of nutritional therapy? A. Monitor vital signs every 4 hours. B. Monitor the appearance, size, and number of stools. C. Measure blood urea nitrogen (BUN) and serum creatinine levels. D. Measure intake and output.
B. Monitor the appearance, size, and number of stools.
A nurse is prescribed postexposure prophylaxis (PEP) antiretroviral medication after a needle stick from an HIV-positive client. Which side effect would the nurse likely experience when taking this medication? A. Fatigue B. Nausea C. Swollen lymph nodes D. Constipation
B. Nausea
A nurse administers etanercept by subcutaneous injection to a client with ankylosing spondylitis. Which action should the nurse take to prevent a needle-stick injury? A. Recap the needle using the one-handed scoop technique. B. Place the uncapped needle in the designated puncture-resistant container. C. Dispose of the needle in the receptacle designated for hazardous wastes. D. Recap the needle using two hands.
B. Place the uncapped needle in the designated puncture-resistant container.
A nurse is working with a support group for clients with human immunodeficiency virus (HIV). Which health promotion strategy should the nurse reinforce with the group? A. Avoid the use of recreational drugs and alcohol. B. Take antiretroviral medications as prescribed. C. Understand the importance of using safer-sex practices. D. Tell potential sex partners about the diagnosis.
B. Take antiretroviral medications as prescribed.
A client is receiving chemotherapy and is not required to be in reverse isolation. What activity will the nurse recommend to the client? A. bed rest B. activity as tolerated C. walks to bathroom only D. out of bed for brief periods
B. activity as tolerated
The nurse is reinforcing education to the parents of a child with leukemia about the three main consequences. What should the nurse inform the parents they should monitor for? A. bone deformities, spherocytosis, and infection B. anemia, infection, and bleeding tendencies C. lymphocytopoiesis, growth delays, and hirsutism D. polycythemia, decreased clotting time, and infection
B. anemia, infection, and bleeding tendencies
A nurse is reinforcing discharge instructions for a client with systemic lupus erythematosus (SLE). Which intervention is most important for the nurse to include? A. consume no more than 2 liters(L) of fluid daily B. apply sunscreens with SPF higher than 15 daily C. check blood sugar levels every morning before breakfast D. avoid foods containing peanuts
B. apply sunscreens with SPF higher than 15 daily
A client with autoimmune thrombocytopenia and a platelet count of 8,000/μl develops epistaxis and melena. Treatment with corticosteroids and immunoglobulins has been unsuccessful, and the physician recommends a splenectomy. The client states, "I don't need surgery — this will go away on its own." In considering her response to the client, the nurse must depend on the ethical principle of: A. beneficence. B. autonomy. C. advocacy. D. justice.
B. autonomy.
A client is placed on neutropenic precaution. Which nursing action is appropriate? A. putting flowers in the room B. avoiding yogurt for breakfast C. adding raw vegetables in the diet D. offering medium-rare cooked meat
B. avoiding yogurt for breakfast
A nurse is caring for several clients on an oncology unit. Which client should the nurse see first? A. client who is on complete bed rest B. client with a white blood cell count of 2000 µL C. client receiving brachytherapy for prostate cancer D. client who is 2 days postoperative following a hemicolectomy
B. client with a white blood cell count of 2000 µL
During the admission process, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for: A. muscle weakness. B. joint abnormalities. C. painful subcutaneous nodules. D. gait disturbances.
B. joint abnormalities.
The nurse is caring for a client diagnosed with leukemia who is going to have a chemotherapy treatment. Which test would the nurse expect to be done to evaluate the client's ability to metabolize chemotherapeutic agents? A. lumbar puncture B. liver function studies C. complete blood count (CBC) D. peripheral blood smear
B. liver function studies
An anxious client is brought to the walk in clinic with difficulty breathing following a bee sting. Which of the following is the nurse's priority action? A. assist the client to lie down B. monitor the client's airway C. administer 100% oxygen via mask D. assess the site to remove the stinger
B. monitor the client's airway
A nurse is caring for a client with deep vein thrombosis (DVT). The client suddenly reports shortness of breath, blood-tinged sputum, and chest pain. The nurse suspects that the client has developed which complication? A. pulmonary hypertension B. pulmonary embolism C. cerebrovascular accident (CVA) D. myocardial infarction
B. pulmonary embolism
The nurse is reinforcing nutritional information with a client with a leukocyte (WBC) count of 2,500/µL (2.50 × 109/L). What food should the nurse instruct the client avoid? A. white bread B. raw carrot sticks C. stewed apples D. well-done steak
B. raw carrot sticks
A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: A. lie supine with his neck extended. B. sit upright, leaning slightly forward. C. blow his nose and then put lateral pressure on his nose. D. hold his nose while bending forward at the waist.
B. sit upright, leaning slightly forward.
A client is admitted with hemophilia. Which sports should the nurse recommend for this client? Select all that apply. A. basketball B. swimming C. baseball D. golf E. soccer
B. swimming D. golf
The nurse is meeting with a 17 year-old client who has recently tested positive for human immunodeficiency virus (HIV). The client states, "What information will be disclosed to others." What information should be provided by the nurse? A. "You will need to disclose information to your teachers." B. "Your employers have a legal right to know your HIV status." C. "In some jurisdictions laws may require you share this information with future sexual partners." D. "You will be legally required to locate all past sexual contacts to inform them of your status."
C. "In some jurisdictions laws may require you share this information with future sexual partners."
A client's blood studies reveal a deficiency in all of the blood's formed elements. The physician suspects that the client's bone marrow is failing to generate enough new cells. Which disorder is most likely affecting this client? A. Sickle cell anemia B. Folic acid deficiency anemia C. Aplastic anemia D. Iron deficiency anemia
C. Aplastic anemia
A client was admitted with a platelet count of 95,000/µl (95 × 109/L). What would the nurse anticipate observing during data collection? A. Weakness and fatigue B. Dizziness and vomiting C. Bruising and petechiae D. Light-headedness and nausea
C. Bruising and petechiae
A client arrives at the emergency department reporting chest and stomach pain and a history of black, tarry stools for the past 2 months. Which orders should the nurse anticipate? A. cardiac monitor, oxygen, creatine kinase, and lactate dehydrogenase (LD) levels B. prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and fibrin split product values C. ECG, complete blood count, testing for occult blood, and comprehensive serum metabolic panel D. EEG, alkaline phosphatase and aspartate aminotransferase levels, and basic serum metabolic panel
C. ECG, complete blood count, testing for occult blood, and comprehensive serum metabolic panel
A client with hemophilia is admitted to the medical-surgical unit. When providing care for this client, which factor is most important? A. Performing effective client teaching B. Delegating tasks effectively C. Ensuring client safety D. Maintaining continuity of care
C. Ensuring client safety
A client with human immunodeficiency virus (HIV) infection is preparing for discharge from the hospital when he reports to a nurse that he continually feels weak. How should the nurse intervene? A. Recommend that the client exercise for 30 minutes a day to increase his strength. B. Notify the physician and request that the client's discharge be postponed. C. Explain to the client that he should schedule periods of rest throughout the day. D. Make arrangements for a wheelchair to be available for him after discharge.
C. Explain to the client that he should schedule periods of rest throughout the day.
The nurse administers an "allergy shot" to a client in the clinic. Which is the nurse's priority action? A. Have the client eat a small meal. B. Administer epinephrine before discharging the client. C. Have the client wait 20 min in the clinic after the injection. D. Administer ibuprofen (Motrin) 400 mg after injection for pain.
C. Have the client wait 20 min in the clinic after the injection.
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? A. IgA B. IgB C. IgE D. IgG
C. IgE
A licensed practical nurse (LPN) is coassigned with a registered nurse (RN) for the care of a client with hemophilia. The physician prescribes a blood transfusion for this client. Which task associated with blood transfusion is the responsibility of the LPN? A. Obtaining informed consent B. Making sure that the RN signs the transfusion form C. Monitoring the client during the transfusion D. Ensuring that a 20-gauge I.V. catheter is in place before obtaining the blood product
C. Monitoring the client during the transfusion
When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into the nurse's eyes. What should the nurse do next? A. Rinse their eyes with water, record the incident on the client's chart, and see Employee Health. B. Wash their hands, complete an incident report, and see a physician as soon as possible. C. Rinse their eyes with water, report the incident, and go to Employee Health. D. Rinse their eyes, contact Employee Health and document their findings.
C. Rinse their eyes with water, report the incident, and go to Employee Health.
A client has had heavy menstrual bleeding for 6 months. Her gynecologist diagnoses microcytic hypochromic anemia and prescribes ferrous sulfate, 300 mg by mouth daily. A review of her assessment reveals which condition that would indicate to the nurse that this medication is contraindicated in the use of ferrous sulfate? A. Pregnancy B. Asthma C. Ulcerative colitis D. Migraine headaches
C. Ulcerative colitis
The nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? A. Limit visits by family members. B. Encourage the client to use a wheelchair. C. Use the smallest needle possible for injections. D. Maintain accurate fluid intake and output records.
C. Use the smallest needle possible for injections.
Which intervention does the nurse determine has the most impact in delaying the development of acquired immunodeficiency syndrome (AIDS) once a client has been infected with human immunodeficiency virus (HIV)? A. monthly plasmapheresis B. eating a diet of balanced, nutritious foods C. adherence with the complete therapeutic regimen D. getting adequate rest and sleep
C. adherence with the complete therapeutic regimen
The nurse is caring for a teen diagnosed with acute lymphocytic leukemia (ALL). A review of the laboratory report indicates a platelet count of 125,500/?L. When gathering data, which finding is most consistent with this laboratory result? A. abdominal swelling B. joint swelling C. bruising D. swollen axillary lymph nodes
C. bruising
A client takes prednisone, as prescribed, for rheumatoid arthritis. The nurse should tell the client to look for common adverse reactions to this drug, such as: A. tetany and tremors. B. anorexia and weight loss. C. fluid retention and weight gain. D. flatus and diarrhea.
C. fluid retention and weight gain.
A client with allergic rhinitis is prescribed loratadine. On a follow-up visit, the client tells the nurse, "I take one 10-mg tablet of Claritin with a glass of water two times daily." The nurse concludes that the client requires additional teaching about this medication because: A. loratadine isn't available in 10-mg tablets. B. loratadine should be taken on an empty stomach. C. loratadine should be taken once daily for allergic rhinitis. D. loratadine isn't available in tablet form.
C. loratadine should be taken once daily for allergic rhinitis.
The nurse is caring for a child who has just been diagnosed with sickle cell anemia. Which initial action will be most therapeutic? A. discuss plans for contraception to prevent pregnancies at this time B. referral for genetic counseling C. offer emotional support D. reinforce the idea that transmission is unlikely in subsequent pregnancies
C. offer emotional support
Which nursing measure is helpful when mouth ulcers develop as an adverse effect of chemotherapy? A. use lemon glycerin swabs B. administer milk of magnesia C. provide a bland, moist, soft diet D. frequently wash the mouth with alcohol-based mouthwash
C. provide a bland, moist, soft diet
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS). To adhere to standard precautions, the nurse should: A. maintain strict isolation. B. keep the client in a private room, if possible. C. wear gloves when providing mouth care. D. wear a gown when delivering the client's food tray.
C. wear gloves when providing mouth care.
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority? A. Bathing or hygiene self-care deficit B. Ineffective tissue perfusion: cerebral C. Dysfunctional grieving D. Risk for injury
D. Risk for injury
The nurse is caring for a child who is receiving steroid therapy as a part of the cancer treatment plan. The child tearfully asks the nurse," Why does my face looks so "fat?" What information should be included in the nurse's response? A. The facial tissues are retaining fluid as a result of the cancer. B. An activity plan to promote calorie use will be helpful in reducing this facial appearance. C. Drinking more fluids will help ensure toxins are flushed from the system and will reduce this appearance. D. This change is temporary and will subside once the steroid medication has been discontinued.
D. This change is temporary and will subside once the steroid medication has been discontinued.
The nurse collects data on a client shortly after kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? A. Serum potassium level of 4.9 mEq/L B. Serum sodium level of 135 mEq/L C. Temperature of 99.2° F (37.3° C) D. Urine output of 20 ml/hour
D. Urine output of 20 ml/hour
A nurse is caring for several client's with human immunodeficiency virus (HIV) infection. Which client does the nurse suspect has acquired immunodeficiency syndrome (AIDS) wasting syndrome? A. a client with oral pain, dysphagia, and yellow-white plaques in his mouth and throat B. a client with recurrent vaginitis causing intense itching and white, thick vaginal discharge C. a client with impaired memory, hallucinations, loss of balance, and personality changes D. a client who has lost 12% of her body weight, with weakness, fever, and chronic diarrhea for the past 35 days
D. a client who has lost 12% of her body weight, with weakness, fever, and chronic diarrhea for the past 35 days
A client with rheumatoid arthritis is about to begin aspirin therapy to reduce inflammation. When teaching the client about aspirin, the nurse discusses adverse reactions to prolonged aspirin therapy. These include: A. weight gain. B. fine motor tremors. C. respiratory acidosis. D. bilateral hearing loss.
D. bilateral hearing loss.
The nurse is caring for a client who is receiving antibiotics to treat a gram-negative bacterial infection. Because antibiotics destroy the body's normal flora, the nurse must monitor the client for: A. platelet dysfunction. B. oliguria and dysuria. C. stomatitis. D. diarrhea.
D. diarrhea.
A nurse is caring for a client who had cardiac revascularization surgery 3 days ago. Upon analysis of lab reports, the nurse notes the client's platelet count decreased from 230,000 to 5,000 μL? Which condition is suspected? A. pancytopenia B. idiopathic thrombocytopenic purpura (ITP) C. disseminated intravascular coagulation (DIC) D. heparin-associated thrombosis and thrombocytopenia (HATT)
D. heparin-associated thrombosis and thrombocytopenia (HATT)
A nurse is caring for a client with multiple myeloma. When assisting with the plan of care, which nursing intervention is most appropriate? A. monitoring respiratory status B. balancing rest and activity C. restricting fluid intake D. preventing bone injury
D. preventing bone injury
A nurse is caring for a client newly diagnosed with Human Immunodeficiency Virus (HIV). Which action by the nurse violates the client's confidentiality? A. sharing the client's information with some of the nurses on the unit B. sharing the client's information with family members involved in the care of the client C. sharing the client's information with the nursing assistant providing care to the client D. sharing the client's information with the clergy who is visiting with the client
D. sharing the client's information with the clergy who is visiting with the client
A child is admitted to the hospital for an asthma exacerbation. The nursing history reveals this client was exposed to chickenpox 1 week ago. When would this client require isolation if he or she were to remain hospitalized? A. isolation isn't required B. immediate isolation is required C. 10 days after exposure D. 12 days after exposure
B. immediate isolation is required
The nurse is caring for a client with pneumonia. The health care provider orders 600 mg of ceftriaxone oral suspension to be given once per day. The medication label indicates that the strength is 125 mg/5 mL. How many milliliters of medication should the nurse administer? Record your answer using a whole number.
24 mL
The nurse is caring for a client with Kaposi sarcoma with slight serous drainage. What should the nurse wear during the care of this client? Select all that apply. A. gloves B. gown C. surgical mask D. particulate mask E. shoe cover
A. gloves B. gown
A female client with human immunodeficiency virus (HIV) receives family-planning counseling. Which statement made by the client about safer sex practices for persons with HIV is accurate? A. "If both sexual partners are HIV-positive, unprotected sex is permitted." B. "A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse." C. "Contraceptive methods, such as hormonal contraceptives, implants, and injections, are recommended for me to prevent HIV transmission." D. "The only safe sex my partner and I can practice is hugging, petting, and mutual masturbation."
B. "A latex condom with spermicide provides the best protection against HIV transmission during sexual intercourse."
A client suspects an allergy to latex. When gathering data from the client, which questions would be appropriate for the nurse to ask? Select all that apply. A. "Are you allergic to dairy products?" B. "Are you allergic to bananas?" C. "Are you allergic to kiwi?" D. "Are you allergic to chestnuts?" E. "Are you allergic to avocados?"
B. "Are you allergic to bananas?" C. "Are you allergic to kiwi?" D. "Are you allergic to chestnuts?" E. "Are you allergic to avocados?"
The nurse is reinforcing education for a female client, who is HIV positive, about transmission of the virus. Which statement made by the client demonstrates that further education is required? A. "If I become pregnant, I must continue to take my antiretroviral medication." B. "I should not kiss anyone while I have an open sore in my mouth." C. "I will be able to breastfeed if my baby and I are taking antiretroviral drugs." D. "I may be able to transmit HIV if someone uses a glass after I drink from it."
D. "I may be able to transmit HIV if someone uses a glass after I drink from it."
A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy? A. "I will receive parenteral vitamin B12 therapy until my signs and symptoms disappear." B. "I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal." C. "I will receive parenteral vitamin B12 therapy monthly for 6 months to a year." D. "I will receive parenteral vitamin B12 therapy for the rest of my life."
D. "I will receive parenteral vitamin B12 therapy for the rest of my life."
Which nursing intervention takes priority for a client infected with Pneumocystis carinii pneumonia? A. Encouraging the client to be actively involved in his care B. Keeping the client's skin clean and dry C. Turning the client every 2 hours D. Auscultating breath sounds
D. Auscultating breath sounds
A client is receiving a blood transfusion. If this client experiences an acute hemolytic reaction, which nursing intervention is the most important? A. Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician. B. Slow the transfusion and monitor the client closely. C. Stop the transfusion, notify the blood bank, and administer antihistamines. D. Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician.
D. Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician.
Which symptom is the most common manifestation of severe combined immunodeficiency disease (SCID)? A. increased bruising B. failure to thrive C. prolonged bleeding D. susceptibility to infection
D. susceptibility to infection
When discussing activities that are safe for the school-age child with hemophilia, which activities should the nurse encourage? Select all that apply. A. baseball B. cross-country running C. football D. swimming E. leisure walking
D. swimming E. leisure walking
How many lobes does the right lung have?
has three lobes the upper, middle, and lower lobes
What are the two types of respiration?
internal respiration and external respiration
What is the larynx, and what is it's function?
is also known as the voice box; air passes through it from the pharynx, and it is made of cartilage
What is the trachea, and what is it's function?
is also known as the windpipe; air passes to the trachea from the larynx; has cartilaginous rings that provide rigidity and help keep it open; divides into two bronchi
What is internal respiration?
is the exchange of oxygen for carbon dioxide within the cells
What is external respiration?
is the exchange of oxygen within the alveoli of the lungs